Silver Simple PCP Saver Guided Care
Starting at
$689
/month before subsidy
Silver Simple PCP Saver Guided Care is a 2026 Silver HMO health insurance plan from Oscar Insurance Company, sold on the ACA Marketplace in Texas under plan ID 20069TX0510019. The monthly premium starts at $689 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $5,750 ($11,500 for a family), and the individual out-of-pocket maximum is $10,150 ($20,300 for a family). After the deductible, coinsurance is 40% for covered in-network care. The plan is not HSA-eligible.
- Plan ID
- 20069TX0510019
- Plan year
- 2026
- State
- Texas
- Metal level
- Silver
- Plan type
- HMO
- HSA-eligible
- No
Individual Deductible
$5,750
Family: $11,500
Out-of-Pocket Max
$10,150
Family: $20,300
Coinsurance
40%
You pay after deductible
Network Type
HMO
TXN002
Medical Services
Prescription Drugs
Having a baby
Normal delivery
$7,950
your estimated cost
- Deductible
- $5,750
- Copays
- $0
- Coinsurance
- $2,200
Managing type 2 diabetes
A year of routine care
$2,300
your estimated cost
- Deductible
- $100
- Copays
- $2,200
- Coinsurance
- $0
A simple fracture
ER visit + follow-up
$2,700
your estimated cost
- Deductible
- $2,600
- Copays
- $100
- Coinsurance
- $0
Enter your ZIP code first to search nearby doctors.
This Silver HMO plan offers a balanced approach between monthly premiums and out-of-pocket costs, making it a popular choice for many families.
Consider this plan if you:
- Visit the doctor a few times per year
- Take regular prescription medications
- Want moderate protection against high medical bills
- May qualify for Cost-Sharing Reductions (CSR) to lower deductibles
This summary is generated based on plan attributes for educational purposes only.
If you max out this year
$1,535/month
Annual Premium
$8,268
OOP Maximum
$10,150
💡 What this means:
With a $5,750 deductible, you pay 100% of costs until you've spent that much. After that, you pay 40% (coinsurance) until you hit $10,150 total. Then insurance covers everything else for the year.
More plans from Oscar Insurance Company in Texas
- Bronze Classic 4700from $433/mo
- Bronze Classic Standardfrom $428/mo
- Bronze Elite + PCP Saver Plusfrom $452/mo
- Bronze Simple Breathe Easy with Enhanced COPD Benefitsfrom $414/mo
- Bronze Simple Chronic Care CKMfrom $442/mo
- Bronze Simple Diabetesfrom $434/mo
- Silver Classicfrom $674/mo
- Silver Classic Standardfrom $665/mo
Frequently asked questions about Silver Simple PCP Saver Guided Care
How much does Silver Simple PCP Saver Guided Care cost per month?
Silver Simple PCP Saver Guided Care from Oscar Insurance Company starts at $689 per month before any subsidy in Texas. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.
What is the deductible for Silver Simple PCP Saver Guided Care?
The individual medical deductible is $5,750, and the family deductible is $11,500. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.
What is the out-of-pocket maximum for Silver Simple PCP Saver Guided Care?
The most you would pay in a year for covered in-network care is $10,150 for an individual and $20,300 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.
Is Silver Simple PCP Saver Guided Care HSA-eligible?
No. Silver Simple PCP Saver Guided Care is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.
What type of network does Silver Simple PCP Saver Guided Care use?
Silver Simple PCP Saver Guided Care is a HMO plan. HMO plans generally require you to use in-network providers and to get a referral to see a specialist, in exchange for lower costs.
Understand what you'd actually pay
- 2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
- How ACA subsidies work
Premium tax credits and who qualifies
- The 2026 subsidy cliff
Why income near 400% FPL matters again this year
Important Notice
Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.