Health Insurance

Can I use One Medical without Insurance?

Sophie Wei
Sophie Wei10 Mar 2023

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. 

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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. 

CarrierCovered Plan
AetnaAetna 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
CignaChoice 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 YorkAccess 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 YorkCircle, Circle Plus
Commercial & Individual PPO, EPO, POS (NY Plans Only, excluded from NJ plans)
Oxford in New YorkFreedom HMO/POS/PPO
Freedom with Choice Plus
Liberty HMO/POS/PPO
Liberty with Choice Plus
Metro
United Healthcare in New YorkAARP 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 YorkCommercial 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

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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 Wei

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.