Oak Street Health Care Model and Medicare Plan Acceptance

If you are on Medicare and considering a new primary care provider, you have likely encountered Oak Street Health. The company operates a network of primary care centers designed exclusively for adults on Medicare, and its value-based care model has attracted significant attention. But before you switch your care, you need to understand exactly how the Oak Street Health care model works and which Medicare plans they accept. This guide breaks down the essentials so you can make an informed decision about your health care and your coverage.

What Is Oak Street Health and How Does Its Care Model Work?

Oak Street Health is a network of primary care centers focused on Medicare-eligible adults. Unlike traditional fee-for-service clinics where providers are paid for each test or visit, Oak Street operates on a value-based care model. In this model, the goal is to keep patients healthy and out of the hospital, and the center is rewarded for better health outcomes rather than for the volume of services provided. This fundamental difference shapes nearly every aspect of the patient experience.

The care model emphasizes a team-based approach. At an Oak Street center, you are not just seeing a single doctor and then leaving. You have a care team that may include a primary care physician, a nurse practitioner, a registered nurse, a social worker, and a community health worker. This team coordinates your care, helps you manage chronic conditions, and addresses social factors that can affect your health, such as access to nutritious food or transportation to appointments. The centers also offer on-site services like lab work, vaccinations, and behavioral health support, which makes it easier to get comprehensive care in one place.

Another key feature is the focus on prevention and chronic disease management. Oak Street uses data and risk stratification to identify patients who may need extra support and then provides proactive outreach. For example, if you have diabetes, your care team might call you to schedule a check-up or help you manage your medications. The model also includes 24/7 access to a provider, often through telehealth, so you can get help when you need it without going to the emergency room. This approach is designed to reduce hospitalizations and improve quality of life for older adults with complex health needs.

Which Medicare Plans Does Oak Street Health Accept?

Oak Street Health does not accept Original Medicare (Part A and Part B) on its own. Instead, the centers contract with specific Medicare Advantage plans. Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your Medicare benefits through private insurance companies. These plans often include extra benefits like dental, vision, and hearing, and they may have different cost-sharing structures than Original Medicare.

The exact list of accepted plans varies by location. Oak Street Health contracts with a range of Medicare Advantage carriers across its service areas. Commonly accepted plans include those from major national insurers such as Humana, Cigna, Aetna, Anthem, and UnitedHealthcare, as well as some regional plans. However, it is critical to verify the specific plans accepted at the center nearest you, because the network of contracted plans can change from year to year and from one center to another. You can check the Oak Street Health website or call the center directly to confirm which plans they accept.

If you have a Medicare Advantage plan that is not in Oak Street's network, you may still be able to see an Oak Street provider, but you would likely pay out-of-network costs, which can be significantly higher. In some cases, your plan may not cover non-emergency services at all outside its network. Therefore, before scheduling an appointment, it is essential to confirm that your specific plan is accepted. If you are considering switching to a plan that Oak Street accepts, you will need to do so during a valid enrollment period, such as the annual Open Enrollment Period or a Special Enrollment Period if you have a qualifying life event.

How to Switch Your Primary Care Provider and Keep Your Specialists in Network

Switching your primary care provider to Oak Street Health is a straightforward process, but it requires some planning to ensure continuity of care. The first step is to verify that your Medicare Advantage plan is accepted at the Oak Street center you want to use. Once you confirm that, you can contact the center to schedule a new patient appointment. They will typically ask for your insurance information and may help you transfer your medical records from your previous provider.

However, one of the most important considerations is how the switch will affect your access to specialists. Many Medicare Advantage plans use a gatekeeper model, meaning you need a referral from your primary care provider to see a specialist. If you switch to an Oak Street provider, that provider will become your gatekeeper. You should ask whether Oak Street will honor existing referrals and whether your specialists are in the same network as your Medicare Advantage plan. In some cases, your specialists may be in a different network, and you may need to find new ones. It is also important to confirm that any ongoing treatments or prescriptions will be covered without interruption.

To make the transition smooth, gather a list of your current specialists, medications, and any upcoming appointments. Share this with your new Oak Street care team and ask them to coordinate with your specialists. If you need help understanding your plan's network or comparing Medicare Advantage options that include Oak Street, you can use resources like our guide on having two health insurance plans to navigate coordination rules, or consult a licensed insurance agent. Additionally, if you are thinking about life insurance as part of your overall financial planning, FindTermLife connects you with licensed agents who can help you compare term life insurance quotes that suit your goals.

Questions to Ask Before Moving Your Care to an Oak Street Center

Before you commit to switching your primary care to Oak Street Health, it is wise to ask a few key questions. These questions will help you understand whether the care model aligns with your needs and whether the transition will be seamless. Start by asking about insurance acceptance and costs. Even if Oak Street accepts your plan, you should confirm what your copays and coinsurance will be for common services like office visits, labs, and specialist referrals.

Next, ask about the care team and how they coordinate with specialists. You will want to know if your current specialists are in the Oak Street network or if you will need to find new ones. Also, ask about access to care: what are the hours, how do you reach a provider after hours, and what telehealth options are available? Since Oak Street emphasizes preventive care, ask how they help manage chronic conditions and whether they offer programs for specific conditions like diabetes or heart disease.

Finally, ask about the process for transferring your medical records and how they will ensure continuity of care. A good care team will be proactive in coordinating your transition. It is also helpful to ask about patient satisfaction and outcomes data, if available. By asking these questions, you can make a more informed decision about whether Oak Street Health is the right fit for your health care needs.

The Bottom Line on Oak Street Health and Medicare Plan Acceptance

Oak Street Health offers a unique value-based care model that emphasizes team-based, preventive care for Medicare-eligible adults. However, it is not a fit for everyone, particularly if you have Original Medicare or a Medicare Advantage plan that is not in their network. The key is to verify plan acceptance at your local center and to plan your transition carefully to avoid disruptions in care. With the right information and a little preparation, you can decide whether switching to Oak Street Health aligns with your health and coverage goals.