Gold Simple Diabetes Guided Care
Gold · HMO · Oscar Insurance Company · Texas
At age 40 it costs $649.46 a month before any subsidy.
What CMS publishes about it
| Plan ID | 20069TX0510037 |
|---|---|
| Insurer | Oscar Insurance Company |
| Metal level | Gold |
| Plan type | HMO |
| Deductible (individual) | $2,000 |
| Deductible (family) | $4,000 |
| Drug deductible | Included in the medical deductible |
| Most you could pay in a year | $9,800 |
| Family maximum | $19,600 |
| Primary care visit | No Charge |
| Specialist visit | $40 |
| Emergency room | 20% Coinsurance after deductible |
| Inpatient stay | 20% Coinsurance after deductible |
| Generic drugs | $3 |
| Preferred brand drugs | $75 |
| Specialty drugs | 50% Coinsurance after deductible |
| Adult dental included | No |
| Child dental included | No |
| Share of premium buying essential health benefits | 100.00% |
| Network directory | Who is in network |
| Summary of benefits | Summary of benefits and coverage |
| Drug list | Formulary |
| Customer service | 1-855-672-2755 |
Where it is sold, and what it costs there
3 counties. The premium is the price before any tax credit; what you pay depends on your income.
| County | At 21 | At 30 | At 40 | At 50 | At 60 |
|---|---|---|---|---|---|
| Hays County | $508.20 | $576.79 | $649.46 | $907.62 | $1,379.22 |
| Travis County | $508.20 | $576.79 | $649.46 | $907.62 | $1,379.22 |
| Williamson County | $508.20 | $576.79 | $649.46 | $907.62 | $1,379.22 |
Open enrollment for 2026 coverage runs 1 November 2025 to 15 January 2026 in most states. Outside that window you need a qualifying life event — losing other coverage, moving, marrying, having a child — to enrol.
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When this plan’s price or benefits change.
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Premiums, deductibles, out-of-pocket maximums and cost sharing are reproduced from the HealthCare.gov Qualified Health Plan landscape file published by the Centers for Medicare & Medicaid Services for plan year 2026. Nothing on this page is calculated by us. This is not a complete list of your options and it is not advice: to see every plan and to enrol, use HealthCare.gov or call 1-800-318-2596.