Can I use One Medical without Insurance?
One Medical is a membership-based primary care organization that works with your health insurance plan to give you access to different healthcare services. However, it is essential to consider whether or not this service can be used by individuals who might be uninsured.
Unfortunately, OneMedical is only compatible with individuals with an existing health insurance plan. Individuals without insurance will have to pay for their services in full. This is because One Medical bills healthcare services through your current insurance plan. By doing so, One Medical can help streamline your healthcare and give you access to more affordable care.
Insurance Plan Compatibility
One Medical has a list of insurance plans compatible with its services. One Medical is compatible with various private plans, including but not limited to Aetna, Cigna, BlueCross, BlueShield, etc. They are also compatible with select Medicare and some Medicare Advantage plans. This link lists all compatible Medicare plans for your reference. It is important to note that this list is not comprehensive and changes frequently. If you do not see your plan on this list, contact One Medical directly.
Off-Exchange Affordable Care Act (ACA) Plans
One Medical is not in network with plans off the ACA exchange. As such, if you have a plan that is not available on the Healthcare Marketplace, you will be responsible for all medical charges in full to use One Medical Services.
Get Mira - Health Benefits You Can Afford.
Get doctor visits, lab tests, prescription, and more. Affordable copays. Available in 45+ states. Only $45/month on average.
List of Accepted Insurance Plans In New York
The following chart lists the carriers that One Medical accepts as of March 10th. 2023. Even though they might accept your plan, not all procedures will be covered.
| Carrier | Covered Plan |
|---|---|
| Aetna | Aetna Whole Health ACO |
| Commercial Plans - HMO / PPO / POS | |
| Managed Choice POS | |
| Medicare Advantage Plans - HMO / PPO | |
| Open Access Plans - EPO / Select / POS II | |
| Open Choice PPO | |
| Cigna | Choice Fund PPO |
| Cigna Medicare Advantage HMO | |
| Commercial Plans - HMO - CIGNA HealthCare of New York, Inc. | |
| Commercial Plans - Open Access / POS | |
| Commercial Plans - PPO | |
| OA plus, Choice Fund OA Plus | |
| Open Access Plus | |
| Empire BlueCross BlueShield in New York | Access Plans - Commercial |
| BlueCard PPO | |
| Commercial Plans - HMO, POS, PPO | |
| MediBlue Access PPO | |
| Medicare Advantage Plans - HMO (excludes MediBlue HealthPlus plans) | |
| Medicare Advantage Plans - PPO (excludes MediBlue HealthPlus plans) | |
| Select EPO plans (limited participation - please call to verify) | |
| Medicare | AARP Medicare Advantage Choice PPO |
| AARP Medicare Advantage HMO | |
| AARP Medicare Advantage Premier Choice PPO | |
| AARP Medicare Advantage Value Care PPO | |
| AARP MedicareComplete Essential - HMO | |
| AARP MedicareComplete Mosaic - HMO | |
| Aetna Medicare Advantage PPO / HMO | |
| Cigna Medicare Advantage HMO | |
| Empire BlueCross BlueShield Medicare Advantage Plans - HMO & PPO (excludes MediBlue HealthPlus plans) | |
| Humana Medicare Advantage Choice PPO (please call to verify) | |
| Humana Medicare Advantage Gold Choice (please call to verify) | |
| Humana Medicare Advantage Gold Plus Medicare HMO (please call to verify) | |
| Medigap plans | |
| Original Medicare FFS Part B | |
| United Healthcare Medicare Advantage PPO / POS / HMO | |
| Oscar in New York | Circle, Circle Plus |
| Commercial & Individual PPO, EPO, POS (NY Plans Only, excluded from NJ plans) | |
| Oxford in New York | Freedom HMO/POS/PPO |
| Freedom with Choice Plus | |
| Liberty HMO/POS/PPO | |
| Liberty with Choice Plus | |
| Metro | |
| United Healthcare in New York | AARP Medicare Advantage Choice PPO |
| AARP Medicare Advantage HMO | |
| AARP Medicare Advantage Premier Choice PPO | |
| AARP Medicare Advantage Value Care PPO | |
| AARP MedicareComplete Essential - HMO | |
| AARP MedicareComplete Mosaic - HMO | |
| Charter / Charter Balanced | |
| Choice Plus - POS / PPO | |
| Core / Core Plus (excluded from Compass) | |
| EPO plans - please call to verify | |
| Medicare Advantage PPO/POS/HMO | |
| Navigate / Navigate Balanced | |
| Nexus ACO Open Access | |
| Options PPO (excludes The Empire Plan) | |
| Select / Select Plus | |
| UMR - POS | |
| UMR - PPO | |
| Emblem Health HIP in New York | Commercial SelectCare Network Select Care Bronze Value (On Exchange) |
| Commercial SelectCare Network Select Care Silver Value (On Exchange) | |
| Commercial SelectCare Network Select Care Silver Value D (Off Exchange) | |
| Connecticare Network HMO / POS / PPO | |
| Millenium Network EmblemHealth EPO Value (Large Group) | |
| Millenium Network EmblemHealth EPO Value HDHP (Large Group) | |
| Millennium Network EmblemHealth Gold EPO | |
| Millennium Network Virtual-M (Small Group) | |
| Prime Network Access I / II | |
| Prime Network Connecticare HMO / POS / PPO | |
| Prime Network EmblemHealth Bronze HAS | |
| Prime Network EmblemHealth Bronze Value S | |
| Prime Network EmblemHealth EPO Value | |
| Prime Network EmblemHealth Gold 40/60 | |
| Prime Network EmblemHealth Gold Open Access | |
| Prime Network EmblemHealth Healthy NY Gold | |
| Prime Network EmblemHealth HMO Plus | |
| Prime Network EmblemHealth HMO Preferred Plus | |
| Prime Network EmblemHealth Platinum 15/35 | |
| Prime Network EmblemHealth Platinum D / Gold D / Silver D / Bronze D / Basic D | |
| Prime Network EmblemHealth Silver Value S | |
| Prime Network Enhanced Care Prime Network | |
| Prime Network EPO | |
| Prime Network Platinum / Gold / Silver / Bronze / Basic | |
| Prime Network Prime HMO/POS/PPO | |
| Prime Network Select PPO | |
| Prime Network Vytra | |
| Select Care Network EmblemHealth EPO Value (Large Group) | |
| Select Care Network EmblemHealth EPO Value HDHP (Large Group) | |
| Select Care Network EmblemHealth PPO Value (Large Group) | |
| Select Care Network Select Care Bronze Value D (Off Exchange) |
Source: OneMedical
OneMedical Insurance Billing
Even if One Medical accepts your insurance plan, it is important to note that not all OneMedical providers will be covered. Your coverage from One Medical is based on the quality of your current insurance plan, and there is a possibility that One Medical services are only partially covered. This can lead to the potential for surprise bills or higher costs.
The following are examples of OneMedical members who incurred higher surprise costs because their insurance plan did not cover their One Medical provider.
Source: Twitter
Source: Twitter
Source: Twitter
Virtual care for only $25 per visit
Virtual primary care, urgent care, and behavioral health visits are only $25 with a Mira membership.
Bottom Line
Although One Medical can be a beneficial service for those who are insured, it is not compatible with uninsured individuals or individuals that do not belong to an ACA plan. It’s important to contact One Medical and your insurance provider to help decrease the potential of surprise bills.
Sophie is a 2024 Pharm D. candidate studying pharmacy at Rutgers University, New Brunswick. She has a passion for healthcare and writing and hopes to make meaningful contributions to healthcare transparency and accessibility. In her free time, she likes to take care of her houseplants, cook, and hang out with her cat.
