The Oklahoma Health Insurance Marketplace
Oklahoma residents have access to a federally-run health insurance exchange, which provides affordable, guaranteed issue coverage to uninsured individuals, families and small business owners. While Oklahoma has always sold more affordable individual coverage than other states, the state allowed insurers to decline and rate up numerous applicants, forcing them into a high-risk pool, debt or simply being uninsured. Under the Affordable Care Act, people who couldn’t obtain coverage in the past due to cost or underwriting can enroll in subsidized individual health plans. The health reform law enabled every state to create a marketplace in which insurers can sell reasonable coverage with a variety of benefits. This law also requires every Oklahoman to get covered through any insurance plan for which you may qualify, and for many, that’s the marketplace. You can also find out if you qualify for SoonerCare Medicaid if you can’t afford coverage on the exchange.
Insurers selling plans on the exchange factor in subsidies to lower premiums and cost sharing for eligible applicants. Many individuals applying for health plans on the Oklahoma exchange qualify for reduced rates and medical expenses, including residents who earn between 100-400 percent FPL. In addition to cost reductions, the marketplace guarantees certain types of services will be covered, known as essential health benefits. This includes services related to maternity care, doctor’s office visits, prescriptions, and hospitalization. Plans are sold by a selection of private Oklahoma insurers.
The exchange provides beneficial and reasonably priced coverage options for individuals, families and small local businesses. For help and guidance with costs and coverage options, contact a licensed agent at 888 803 5917.
The comprehensive plans sold on the Oklahoma marketplace are categorized in four “metallic” coverage levels: bronze, silver, gold or platinum. These levels indicate how much your plan pays for qualified medical services and how much you are expected to pay. Bronze and silver plans are also more reasonable in terms of monthly premiums, while gold and platinum plans tend to be higher as they offer more coverage.
Young and healthy Oklahomans under age 30 have the option of catastrophic plans apart from the more inclusive policies. They don’t cover the majority of health care services, but only a few necessities. Preventive care and four office visits are covered at 100 percent, and emergency room visits are subject to your deductible. Typically, these plans cost slightly less than the bronze level policies, but they cannot be used with tax credits.. Use the cost comparison tool below to view estimates of your rates in Oklahoma or call us for an accurate quote.
Premium Tax Credit
The health insurance exchange offers financial assistance to residents with family income between 100 and 400 percent of poverty. Lower income enrollees will receive the greatest amount of assistance, including help paying for monthly premiums and covered medical expenses. While it doesn’t offer the best coverage, some applicants can even qualify for a zero-premium bronze plan after their subsidy is factored in. Marketplace applicants in Virginia earning between 100 and 250 percent of federal poverty qualify for a cost sharing subsidy to help pay for coinsurance, copays and deductibles. If you earn up to 400 percent of FPL, the government will provide you with a premium tax credit.
Subsidies are calculated by income and household size, and the price of the second lowest-cost silver plan in your zip code as a percentage of annual income. According to your family income, you can determine about how much your premium share will be in the table below. The tax credit covers the remainder of premium costs.
Six insurers throughout Oklahoma participate in the marketplace, offering individual and small group policies that can be used with . Different companies are available in different areas, with about 1-3 carriers per region. You may find that the insurers’ provider networks are smaller than usual, which is usual for exchange plans. Slimmer provider networks allow insurers to afford to offer these plans. Please check that your doctors are included in your plan’s network prior to applying. If not, you may check which plans outside the marketplace can connect you with your providers of choice. The following carriers sell plans on the marketplace in Oklahoma. Call us to find out which plans are in your area at 888 803 5917.
- Blue Cross Blue Shield of Oklahoma
- CommunityCare HMO
- Coventry Health and Life Insurance
- Coventry Health Care of Kansas
To simplify shopping for health plans on the marketplace, each insurer is required to cover ten types of benefits, providing a general idea of what you can expect. Copays, coinsurance and other costs vary between plans and companies, as do the specifics of covering the ten essential health benefits. Certain services, such as preventive immunizations or exams, are covered in full, and others, like ER visits and hospital care, require some amount of cost sharing. Always read the fine print of your plan, notably the outline of benefits, to be sure a service is covered.
Essential Health Benefits include:
- Emergency care
- Preventive, wellness, and chronic disease management services
- Office visits
- Laboratory tests
- Prescription medications
- Maternity and newborn care
- Pediatric care, including dental and vision
- Rehabilitative and habilitative services and devices
- Mental health and substance abuse services, including behavioral health care
Small Business Health Options Program
The exchange is beneficial not only for applies to individual and family coverage, the Small Business Health Options Program (SHOP) provides small group plans at a reduced rate for qualifying businesses. Small business owners throughout Oklahoma can offer to cover their workers for a reduced rate if they have fewer than 25 full-time equivalent employees who earn up to $50,000 per year each. The Small Business Health Care Tax Credit is offered to employers who meet these criteria, and those who employ up to 49 workers may qualify for a plan through the SHOP without financial assistance. The highest subsidy an business can receive pays 50 percent of their premium contribution, which is given to companies with up to 10 employees who make $25,000 or less annually.
How to Apply
You can apply for Oklahoma exchange plans by a licensed insurance agent at 888.803.5917. In addition, you can visit a facility where navigators are staffed, including community health clinics and apply in person. Oklahomans can use HealthCare.gov, the federal portal, to sign up for insurance on their own. It’s often helpful to discuss your options with a professional prior to finding the cheapest health plan and clicking “Add to Cart”. Our agents are licensed to sell non-marketplace individual health plans throughout the state, and are also certified to enroll Oklahomans in subsidized marketplace coverage. With any application method, it is important to know your options for affordable coverage and select the plan that ultimately meets your health needs and budget.
Compare Oklahoma Marketplace Plans
Below is a cost comparison tool providing a closer look at the marketplace health plans. These rates are calculated by premium rate averages on the marketplace and subsidy eligibility. You can also view which plans serve your area. For specific details on your Oklahoma marketplace options including a precise quote of your premiums on the exchange and subsidy eligibility, call an agent at 888 803 5917.
*The above disclaimer pertains to the creator of this comparison tool, not East Coast Health Insurance, a licensed broker of insurance products.