Gold Simple Diabetes Guided Care
by Oscar Insurance Company in Texas
How we get our data
Our insurance data is sourced directly from the CMS ACA Marketplace (HIOS), the federal database that insurers are required to report to. We process that data to surface standardized out-of-pocket cost estimates based on three SBC scenarios defined by CMS: having a baby, managing diabetes, and treating a fracture. We update our data annually with each new plan year and link to the original SBC documents so you can verify costs directly with the insurer.
Learn more about our dataDeductible (Individual)
$2,000
Max Out-of-Pocket
$9,800
Actuarial Value
78%
Service Areas
8
About This Plan
Gold Simple Diabetes Guided Care is a Gold HMO plan offered by Oscar Insurance Company in Texas for the 2026 plan year with an actuarial value of 78%. The in-network deductible for an individual is $2,000, and the maximum out-of-pocket cost is $9,800. A referral is required to see a specialist.
Compared to the median across 79 other Gold plans in Texas, this plan's estimated out-of-pocket costs are: having a baby ($3,800 — 15% below the median); managing diabetes ($1,800 — 11% above the median); treating a fracture ($2,180 — 7% above the median).
This plan includes disease management programs for Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol.
Cost Scenarios
What you'd pay out-of-pocket for three common medical situations with this plan.
Normal delivery
Having a Baby
Type 2, routine care
Managing Diabetes
ER treatment
Simple Fracture
Deductibles & Out-of-Pocket Maximums
| In-Network | Out-of-Network | |||||
|---|---|---|---|---|---|---|
| Individual | Per Person | Per Group | Individual | Per Person | Per Group | |
| Deductible | $2,000 | $2000 per person | $4000 per group | Not Applicable | per person not applicable | per group not applicable |
| MOOP | $9,800 | $9800 per person | $19600 per group | Not Applicable | per person not applicable | per group not applicable |
Coinsurance after deductible: 20.00%
Plan Features
Disease Management Programs
Official Documents
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Need Help Choosing?
Our AI navigator can help you compare this plan against others based on your specific health needs and budget.
Disclaimer: Our AI navigator provides information collected from trusted sources only and does not constitute licensed insurance advice.
Written by Jayant Panwar | Last reviewed: Q1 2026 | Last updated: January 2026
Insurance Disclaimer: This information is for educational purposes only and does not constitute insurance advice or a recommendation to enroll in this plan. SBC scenarios show standardized cost estimates for normal delivery, routine diabetes care, and emergency fracture treatment — your actual costs will vary based on providers, services, and your specific plan benefits. This is a CMS marketplace plan; other insurance options may be available in Texas. Consult your insurance company for accurate cost estimates and with your healthcare provider for medical decisions.
Data source: CMS ACA Marketplace (HIOS), 2026 plan year. See our data methodology and editorial policy. Found an error? Report an inaccuracy.