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SilverHMO

Silver Classic Standard 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 data

Deductible (Individual)

$6,000

Max Out-of-Pocket

$8,900

Actuarial Value

70%

Service Areas

8

About This Plan

Silver Classic Standard Guided Care is a Silver HMO plan offered by Oscar Insurance Company in Texas for the 2026 plan year with an actuarial value of 70%. The in-network deductible for an individual is $6,000, and the maximum out-of-pocket cost is $8,900. A referral is required to see a specialist.

Compared to the median across 80 other Silver plans in Texas, this plan's estimated out-of-pocket costs are: having a baby ($8,120 — 3% above the median); managing diabetes ($1,500 — 18% below the median); treating a fracture ($2,500 — right at 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

$8,120
Total Out-of-Pocket
+3% vs median
Deductible$6,000
Copayment$20
Coinsurance$2,100
Limit$0

Type 2, routine care

Managing Diabetes

$1,500
Total Out-of-Pocket
-18% vs median
Deductible$100
Copayment$1,400
Coinsurance$0
Limit$0

ER treatment

Simple Fracture

$2,500
Total Out-of-Pocket
0% vs median
Deductible$2,200
Copayment$300
Coinsurance$0
Limit$0

Deductibles & Out-of-Pocket Maximums

In-NetworkOut-of-Network
IndividualPer PersonPer GroupIndividualPer PersonPer Group
Deductible$6,000$6000 per person$12000 per groupNot Applicableper person not applicableper group not applicable
MOOP$8,900$8900 per person$17800 per groupNot Applicableper person not applicableper group not applicable

Coinsurance after deductible: 40.00%

Medical & Drug Deductibles IntegratedMedical & Drug MOOP Integrated

Plan Features

Plan TypeHMO
HSA EligibleNo
Referral Required for SpecialistYes
National NetworkNo
Pregnancy Notice RequiredNo
Out-of-Country CoverageYes
Out-of-Service-Area CoverageYes
Child-Only OfferingAllows Adult and Child-Only
Wellness ProgramNo
Inpatient Copayment Max Days0
Plan Effective Date2026-01-01
Plan Expiration Date2026-12-31

Disease Management Programs

AsthmaDepressionDiabetesHeart DiseaseHigh Blood Pressure & High Cholesterol

Official Documents

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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.