What Insurance Does Oak Street Health Accept? A Clear Guide for Patients and Caregivers

If you or a family member is considering Oak Street Health and wondering what insurance is accepted, you’re not alone. Insurance rules can feel confusing, especially when you’re trying to choose a primary care provider that fits your health and budget.

This guide breaks down, in plain language, the types of health insurance Oak Street Health commonly accepts, how coverage usually works, and what to check before you schedule an appointment.

Big Picture: What Types of Insurance Does Oak Street Health Generally Accept?

While the exact list of plans varies by state, clinic, and insurance contract, Oak Street Health locations commonly work with:

• Medicare Advantage plans
• Traditional Medicare (Original Medicare), often with a Medicare Supplement (Medigap) plan
• Medicaid, in some states and for certain plans
• Dual-eligible plans (for people who qualify for both Medicare and Medicaid)
• Some commercial/employer health insurance plans, depending on the market

Here’s a simplified overview:

*This table reflects common patterns, not a guarantee. Always verify with the clinic and your insurer.

Oak Street Health and Medicare: Where Coverage Often Starts

Many Oak Street Health patients are older adults or people who qualify for Medicare. That’s why understanding Medicare coverage is especially important.

1. Medicare Advantage Plans (MA)

Oak Street Health often partners with a range of Medicare Advantage plans. These are private insurance plans that replace Original Medicare and usually include extra benefits.

Common features to understand:

• Network-based:
  Medicare Advantage plans usually have a network of doctors and clinics. Oak Street Health may be:

  • In-network for some plans in a given area
  • Out-of-network or not covered at all for others

• Plan type matters:

  • HMO: Typically requires you to use in-network providers like Oak Street Health to get full coverage, and may require referrals for specialists.
  • PPO: More flexibility out of network, but you’ll usually pay less when you stay in-network.

• Costs to clarify:

  • Primary care visit copays
  • Deductible status
  • Any referral or prior authorization requirements

📌 Action step:
Call the number on your Medicare Advantage card and ask:

2. Original Medicare (Parts A and B)

Many Oak Street Health clinics also accept Original Medicare. With Original Medicare:

• Medicare Part B helps cover doctor visits and outpatient services.
• You usually pay:
  • A standard Part B deductible (once per year)
  • A portion of the cost as coinsurance, unless another policy covers it

If the clinic accepts assignment for Medicare (a common pattern at many primary care practices), your costs are typically limited to what Medicare allows.

📌 Action step:
Ask the clinic:

3. Medigap (Medicare Supplement) Plans

If you have Original Medicare + a Medigap policy, your supplement may help pay some or all of:

• Part B coinsurance
• Some deductibles
• Certain out-of-pocket costs not covered by Medicare

Whether you can use Medigap at Oak Street Health usually depends on:

• Whether the clinic accepts Original Medicare
• The specific benefits and cost-sharing rules in your Medigap plan

📌 Action step:
Call your Medigap insurer and ask:

Oak Street Health and Medicaid: Coverage Varies Widely

Medicaid is run at the state level, so what’s covered in one area may not be covered in another. Oak Street Health’s participation in Medicaid programs varies by state and clinic.

1. Traditional/State Medicaid

Some locations may accept state-run Medicaid programs for eligible patients. Important points:

• Not all clinics accept Medicaid.
• Some states use managed care Medicaid plans, which require you to pick a primary care provider within a specific network.

You’ll want to confirm:

• Whether Oak Street Health is enrolled with your state’s Medicaid program
• If your specific plan (such as a managed Medicaid plan) lists Oak Street Health as in-network

2. Managed Care Medicaid Plans

Many states use Medicaid managed care organizations (MCOs). These are private plans that contract with the state to run Medicaid benefits.

With an MCO:

• You must usually choose a primary care provider within the plan’s network.
• Oak Street Health may be in-network for some Medicaid MCOs but not others.

📌 Action step:
Call your Medicaid plan and ask:

Dual-Eligible Patients: Medicare and Medicaid Together

If you have both Medicare and Medicaid (often called dual-eligible), you may be enrolled in:

• A Medicare Advantage Special Needs Plan (SNP) for dual-eligible members
• Original Medicare plus Medicaid as a secondary payer
• Another coordinated program depending on your state

Oak Street Health often works with dual-eligible plans, but again, this depends on contracts in your area.

Key questions:

• Is Oak Street Health in-network with your Medicare plan?
• How does your Medicaid coverage help with:
  • Copays
  • Deductibles
  • Coinsurance

For dual-eligible patients, Medicaid may help reduce or eliminate out-of-pocket costs for many covered services, depending on the plan rules.

Private, Employer, and Marketplace Insurance

Oak Street Health’s focus tends to be on Medicare and related coverage, but some locations may also accept:

• Employer-sponsored health insurance
• Individual or family plans (including those purchased through the Health Insurance Marketplace)
• Commercial PPO or HMO plans

This is especially common in markets where the clinic serves a mix of age groups or works with local insurers.

When checking private insurance:

1. Look at your insurance card for the plan name and network (HMO, PPO, EPO, etc.).
2. Call customer service and ask if Oak Street Health is:
   • In-network
   • Considered primary care or specialty care for billing
3. Ask about expected costs:
   • Copay for a primary care visit
   • Deductible and whether you’ve met it
   • Coinsurance percentages

How to Confirm Your Insurance at a Specific Oak Street Health Location

Because coverage can differ block by block, the most reliable answer always comes from two sources:

1. The Oak Street Health clinic
2. Your health insurance plan

Here’s a simple process you can follow.

Step 1: Gather Your Information

Before you call, have:

• Your insurance card(s):
  • Medicare card (red, white, and blue), if applicable
  • Medicare Advantage or Medigap card
  • Medicaid card
  • Employer or Marketplace plan card
• Your date of birth and member ID
• The address or phone number of the Oak Street Health location you’re considering

Step 2: Call Oak Street Health

Ask questions like:

• “Do you accept my insurance? I have [plan name] from [insurance company].”
• “Are you in-network for my plan, or considered out-of-network?”
• “Are there any limitations for new patients with my type of insurance?”

If they say yes, write down:

• The name of the person you spoke with
• The date and time of the call
• Any specific instructions they give you (for example, needing to assign them as your primary care provider)

Step 3: Call Your Insurance Plan

Next, call the number on the back of your insurance card and ask:

1. “Is Oak Street Health [location or doctor’s name]in-network for my plan?”
2. “What are my copays or coinsurance for primary care visits there?”
3. “Do I need a referral or prior authorization to see them?”
4. “Do I have an annual deductible, and how much of it have I already met?”

This double-check protects you from surprise bills and clarifies how costs will be shared between you and your plan.

Common Terms You’ll Hear When Asking About Insurance

Understanding a few key insurance terms can make these conversations much easier:

• In-network:
  The clinic has a contract with your plan. You usually pay less for care.

• Out-of-network:
  No contract with your plan, or limited participation. You may:

  • Pay more, or
  • Have no coverage at all, depending on your plan type.

• Copay:
  A fixed dollar amount you pay at each visit (for example, $0, $10, or $40).

• Deductible:
  The amount you must pay first each year before your plan starts covering certain services.

• Coinsurance:
  A percentage of the cost you pay after meeting your deductible (for example, 20% of Medicare-approved charges).

• Primary Care Provider (PCP):
  The main doctor or clinic you see regularly for general health needs. Many plans require you to designate a PCP.

Practical Tips for Getting the Most from Your Insurance at Oak Street Health

To help avoid confusion and unexpected expenses:

• Confirm coverage before your first visit
  Call both the clinic and your insurance plan.

• Ask about new-patient policies
  Some clinics may have specific intake rules depending on plan type or local capacity.

• Keep your insurance information current
  If your plan changes (for example, you switch Medicare Advantage plans), update the clinic immediately.

• Bring all insurance cards to your first appointment
  This helps the office bill correctly and check your benefits.

• Review your Explanation of Benefits (EOB)
  After a visit, your insurer will send an EOB explaining what was billed, what was allowed, and what you may owe.

Key Takeaways: Which Insurance Does Oak Street Health Accept?

• Oak Street Health commonly accepts:

  • Medicare Advantage
  • Original Medicare, often with Medigap
  • Medicaid (varies by state and plan)
  • Dual-eligible plans (Medicare + Medicaid)
  • Some employer and individual/commercial plans

• Coverage is highly location- and plan-specific.
  One Oak Street Health clinic may accept a plan that another clinic in a different city does not.

• The safest way to know exactly what your insurance covers at Oak Street Health is to:

  1. Call the clinic with your insurance details.
  2. Call your insurance company and verify network status and costs.

By confirming both sides, you can walk into your first appointment with a clear understanding of what your insurance covers at Oak Street Health, what you may pay out of pocket, and how to make the most of your benefits.