Gold Simple Diabetes Guided Care
Starting at
$574
/month before subsidy
Gold Simple Diabetes Guided Care is a 2026 Gold HMO health insurance plan from Oscar Insurance Company, sold on the ACA Marketplace in Texas under plan ID 20069TX0510044. The monthly premium starts at $574 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $2,000 ($4,000 for a family), and the individual out-of-pocket maximum is $9,800 ($19,600 for a family). After the deductible, coinsurance is 20% for covered in-network care. The plan is not HSA-eligible.
- Plan ID
- 20069TX0510044
- Plan year
- 2026
- State
- Texas
- Metal level
- Gold
- Plan type
- HMO
- HSA-eligible
- No
Individual Deductible
$2,000
Family: $4,000
Out-of-Pocket Max
$9,800
Family: $19,600
Coinsurance
20%
You pay after deductible
Network Type
HMO
TXN002
Medical Services
Prescription Drugs
Having a baby
Normal delivery
$3,800
your estimated cost
- Deductible
- $2,000
- Copays
- $100
- Coinsurance
- $1,700
Managing type 2 diabetes
A year of routine care
$1,800
your estimated cost
- Deductible
- $0
- Copays
- $1,800
- Coinsurance
- $0
A simple fracture
ER visit + follow-up
$2,180
your estimated cost
- Deductible
- $2,000
- Copays
- $80
- Coinsurance
- $100
Enter your ZIP code first to search nearby doctors.
This Gold HMO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.
Consider this plan if you:
- Have ongoing health conditions requiring regular care
- Take multiple prescription medications
- Prefer lower costs at the time of service
- Want peace of mind with comprehensive coverage
This summary is generated based on plan attributes for educational purposes only.
If you max out this year
$1,391/month
Annual Premium
$6,888
OOP Maximum
$9,800
💡 What this means:
With a $2,000 deductible, you pay 100% of costs until you've spent that much. After that, you pay 20% (coinsurance) until you hit $9,800 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 Gold Simple Diabetes Guided Care
How much does Gold Simple Diabetes Guided Care cost per month?
Gold Simple Diabetes Guided Care from Oscar Insurance Company starts at $574 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 Gold Simple Diabetes Guided Care?
The individual medical deductible is $2,000, and the family deductible is $4,000. 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 Gold Simple Diabetes Guided Care?
The most you would pay in a year for covered in-network care is $9,800 for an individual and $19,600 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.
Is Gold Simple Diabetes Guided Care HSA-eligible?
No. Gold Simple Diabetes 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 Gold Simple Diabetes Guided Care use?
Gold Simple Diabetes 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.