Injured shoulder but worried of out of pocket costs/coverage (oscar health). Seeking any advice
Hello all,
My workplace insurance lapsed because I missed the open enrollment emails during a period when I had to lay off a large number of people. Mind wasn't there. Signed up with Oscar at nearly 600 mo.
A few months ago, I injured my shoulder, and all signs seem to point to a rotator cuff issue. I’ve honestly been afraid to get it checked because I’m worried it could cost thousands of dollars. I’m considering waiting until next year when I can get back onto my employer insurance plan.
Do you guys have any advice? I’m pretty worried and feel stuck.
Current Plan Details:
Oscar Bronze Classic (EPO)
Coverage Period: 1/1/2026 to 12/31/2026
Plan Details:
- In-network only, except emergencies and limited urgent care
- Individual deductible: $3,300
- Individual out-of-pocket maximum: $9,300
- Specialist visits: $75 copay after deductible
- MRI / CT scans: 50% coinsurance after deductible
- Outpatient surgery center: 50% coinsurance after deductible
- Surgeon fees: 50% coinsurance after deductible
- Physical therapy: $50 copay after deductible
My concern is that if this ends up requiring imaging, injections, PT, or surgery, I could get hit pretty hard financially under this plan.
At the same time, I’m worried waiting could make the shoulder worse if it actually is a rotator cuff tear.
- Get evaluated now?
- Wait until January for better coverage?
- Go to urgent care?
-Maybe theres a place I can just pay out of pocket for it?
Any advice from people who have dealt with shoulder injuries or these insurance situations is appreciated!