Oscar Health
Silver Simple Breathe Easy with Enhanced COPD Benefits
Plan ID91908OK0020006
Plan year2027Sold on HealthCare.gov
Plan typeHMONo referral needed
Metal levelSilverNot HSA-eligible
Sold in12 countiesof 77 in Oklahoma
Deductible$6,200$12,400 family
Out-of-pocket max$10,300$20,600 family
Primary care visitFreein network
Generic drugs$4per prescription
7,603 Oklahoma doctors and facilities in this plan's network · Directory updated Nov 5, 2026 · Monthly premiums are not shown: they depend on age, county and income. NPI Profile does not sell insurance; HealthCare.gov lists premiums and handles enrollment.
Find a doctor in this plan
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Listed in Oscar Health's provider directory. Directories can be out of date, so call the office to confirm they take this plan.
What you pay with this plan
In-network costs for one person, from the CMS plan files for 2027. "After deductible" means you pay the full cost until you reach the $6,200 deductible.
Doctor visits
- Primary care visit
- Free
- Specialist visit
- $40
- Nurse practitioner or PA visit
- Free
- Preventive care and vaccines
- Free
- Urgent care
- $35
Prescription drugs
- Generic drugs
- $4
- Preferred brand drugs
- $75 after deductible
- Non-preferred brand drugs
- 50% after deductible
- Specialty drugs
- 50% after deductible
Tests and imaging
- Lab work
- $65
- X-rays
- 45% after deductible
- MRI, CT and PET scans
- 45% after deductible
Emergencies and hospital
- Emergency room
- 45% after deductible
- Ambulance
- 45% after deductible
- Hospital stay
- 45% after deductible
- Outpatient surgery (facility)
- 45% after deductible
Mental health
- Therapy and counseling visits
- Free
- Inpatient mental health care
- 45% after deductible
Pregnancy
- Prenatal and postnatal care
- Free
- Delivery and hospital stay
- 45% after deductible
Other care
- Physical and occupational therapyLimit: 25 visits a benefit period
- 45% after deductible
- Chiropractic care
- $40
- Eye exam for childrenLimit: 1 exam a year
- Free
- Glasses for childrenLimit: 1 item a year
- Free
- Adult dental
- Not covered
$8,200Having a baby (CMS example)
$4,500Managing type 2 diabetes for a year
$2,680A simple fracture
Every service in the plan file (67)
| Service | You pay | Limits and notes |
|---|---|---|
| Abortion for Which Public Funding is Prohibited | Not covered | |
| Accidental Dental | 45% after deductible | |
| Acupuncture | Not covered | |
| Allergy Testing | $40 | |
| Bariatric Surgery | Not covered | |
| Basic Dental Care - Adult | Not covered | |
| Basic Dental Care - Child | Not covered | |
| Chemotherapy | 45% after deductible | |
| Chiropractic Care | $40 | |
| Cosmetic Surgery | Not covered | |
| Delivery and All Inpatient Services for Maternity Care | 45% after deductible | |
| Dental Check-Up for Children | Not covered | |
| Diabetes Education | Free | |
| Dialysis | 45% after deductible | |
| Durable Medical Equipment | 45% after deductible | |
| Emergency Room Services | 45% after deductible | |
| Emergency Transportation/Ambulance | 45% after deductible | |
| Eye Glasses for Children | Free | 1 item a year |
| Generic Drugs | $4 | |
| Habilitation Services | 45% after deductible | 25 visits a benefit period |
| Hearing Aids | 45% after deductible | |
| Home Health Care Services | 45% after deductible | 30 visits a benefit period We do not pay Home Health Care Benefits for Dietician services, except as specified for diabetes self- management training; Homemaker services; Maintenance therapy; Speech Therapy; Durable Medical Equipment; Food or home--delivered |
| Hospice Services | 45% after deductible | |
| Imaging (CT/PET Scans, MRIs) | 45% after deductible | |
| Infertility Treatment | Not covered | |
| Infusion Therapy | 45% after deductible | |
| Inpatient Hospital Services (e.g., Hospital Stay) | 45% after deductible | |
| Inpatient Physician and Surgical Services | 45% after deductible | |
| Laboratory Outpatient and Professional Services | $65 | |
| Long-Term/Custodial Nursing Home Care | Not covered | |
| Major Dental Care - Adult | Not covered | |
| Major Dental Care - Child | Not covered | |
| Mental/Behavioral Health Inpatient Services | 45% after deductible | |
| Mental/Behavioral Health Outpatient Services | Free | |
| Non-Preferred Brand Drugs | 50% after deductible | |
| Nutritional Counseling | Free | |
| Orthodontia - Adult | Not covered | |
| Orthodontia - Child | Not covered | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | Free | |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 45% after deductible | |
| Outpatient Rehabilitation Services | 45% after deductible | 30 days a benefit period |
| Outpatient Surgery Physician/Surgical Services | 45% after deductible | |
| Preferred Brand Drugs | $75 after deductible | |
| Prenatal and Postnatal Care | Free | |
| Preventive Care/Screening/Immunization | Free | |
| Primary Care Visit to Treat an Injury or Illness | Free | |
| Private-Duty Nursing | 45% after deductible | 85 visits a benefit period |
| Prosthetic Devices | 45% after deductible | |
| Radiation | 45% after deductible | |
| Reconstructive Surgery | 45% after deductible | |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | 45% after deductible | 25 visits a benefit period |
| Rehabilitative Speech Therapy | 45% after deductible | 25 visits a benefit period |
| Routine Dental Services (Adult) | Not covered | |
| Routine Eye Exam (Adult) | Not covered | |
| Routine Eye Exam for Children | Free | 1 exam a year |
| Routine Foot Care | Not covered | |
| Skilled Nursing Facility | 45% after deductible | 30 days a benefit period No Benefits are available: Once you can no longer improve from treatment; or for Custodial Care, or care for someone’s convenience. |
| Specialist Visit | $40 | |
| Specialty Drugs | 50% after deductible | |
| Substance Abuse Disorder Inpatient Services | 45% after deductible | |
| Substance Abuse Disorder Outpatient Services | Free | |
| Transplant | 45% after deductible | Exclusions and Limitations Applicable to Organ/Tissue/Bone Marrow Transplants: - The transplant must meet the criteria established by the Plan for assessing and performing organ or tissue transplants, or Bone Marrow Transplant procedures, as set forth in the |
| Treatment for Temporomandibular Joint Disorders | Not covered | |
| Urgent Care Centers or Facilities | $35 | |
| Weight Loss Programs | Not covered | |
| Well Baby Visits and Care | Free | |
| X-rays and Diagnostic Imaging | 45% after deductible |
How this plan works
HMO: You pick a primary care doctor in the network, and most specialists need a referral from them. Care outside the network is not covered, except emergencies.
- Referral for specialists
- Not required
- Coinsurance
- 45% after the deductible
- Works with an HSA
- No
- Network
- Individual Oklahoma HMO (OKN002)
- Sold in
- 12 Oklahoma counties
Summary of Benefits and Coverage (PDF) Plan brochure Covered drugs (formulary)
Other Oscar Health plans on the same network
The same doctors and hospitals, with different costs.
| Plan | Metal | Deductible | Out-of-pocket max |
|---|---|---|---|
| Bronze Elite + PCP Saver Plus HMO | Expanded Bronze | $0 | $12,000 |
| Gold Classic Standard HMO | Gold | $2,500 | $8,600 |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits HMO | Expanded Bronze | $5,500 | $12,000 |
| Bronze Simple Chronic Care CKM HMO | Expanded Bronze | $5,500 | $12,000 |
| Bronze Simple Diabetes HMO | Expanded Bronze | $5,500 | $12,000 |
| Silver Simple PCP Saver HMO | Silver | $5,750 | $10,000 |
| Silver Simple Women's Health with Menopause Benefits HMO | Silver | $6,000 | $10,600 |
| Silver Classic Standard HMO | Silver | $6,400 | $10,300 |
| Silver Simple Chronic Care CKM HMO | Silver | $6,500 | $10,500 |
| Silver Simple Diabetes HMO | Silver | $6,500 | $10,600 |
| Bronze Classic Standard HMO | Expanded Bronze | $7,500 | $12,000 |
| Silver Core Plan HMO | Silver | $9,000 | $10,300 |
| Bronze Simple HMO | Expanded Bronze | $9,150 | $12,000 |
Questions about Silver Simple Breathe Easy with Enhanced COPD Benefits
Does Silver Simple Breathe Easy with Enhanced COPD Benefits cover my doctor?
Use "Find a doctor in this plan" on this page: choose the city, then the kind of doctor. The list shows providers Oscar Health lists in this plan's network for 2027. Directories can be out of date, so call the office to confirm before your visit.
What kind of plan is Silver Simple Breathe Easy with Enhanced COPD Benefits?
It is an HMO plan: you pick a primary care doctor in the network, and most specialists need a referral from them. Care outside the network is not covered, except emergencies. It is a Silver plan.
How much is a doctor visit with Silver Simple Breathe Easy with Enhanced COPD Benefits?
A primary care visit costs Free. A specialist visit costs $40. These are in-network costs for one person. "After deductible" means you pay the full cost until you reach the $6,200 deductible.
Where is Silver Simple Breathe Easy with Enhanced COPD Benefits sold?
It is sold to people who live in 12 Oklahoma counties, through HealthCare.gov. Oscar Health's directory can also list providers outside these counties, such as pharmacies and specialists, but the plan itself is only for people who live in its area.
Why is there no monthly premium on this page?
Premiums depend on your age, county, household size and income, and most people get a subsidy, so a single price would mislead. HealthCare.gov shows the price for your household.
About this data
NPI Profile is not an insurance company, agent or broker, and it does not sell insurance or enroll anyone in a plan. It is a free reference tool built on public files that CMS and insurers publish, to help you compare Marketplace plans and check whether your current or future doctor is in a plan's network. It is not affiliated with CMS, HealthCare.gov, any state exchange or any insurer. Confirm costs and networks with the insurer and the doctor's office, and enroll on HealthCare.gov.
| Source | What it provides here | Source date |
|---|---|---|
| CMS Marketplace public use files (Plan Attributes, Benefits and Cost Sharing, Service Area) | This plan's costs, covered services, coverage examples and the counties where it is sold | Plan year 2027 |
| Oscar Health's provider directory | The doctors and facilities listed in this plan's network. Only providers with an address in Oklahoma are counted. | Updated November 5, 2026 |
| NPPES NPI registry | Provider names, practice addresses and primary specialties | Matched November 8, 2026 |
- Costs are for the standard version of the plan, for one person, in network. People who qualify for cost-sharing reductions pay less.
- Monthly premiums are not shown: they depend on age, county, household and income. HealthCare.gov lists them for your household.
- Confirm costs in the plan documents and with the insurer, and confirm with the doctor's office that they take this plan.
