With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Oklahoma, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Oklahoma
Oklahoma placed 46th in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include a low prevalence of binge drinking, a low incidence of pertussis infections, and moderate per capital public health funding. According to the rankings, Oklahoma’s biggest health challenges include a high rate of drug deaths, low immunization coverage among children, and limited availability of primary care physicians. In Oklahoma, 32.2 percent of adults are obese and 28.3 percent are physically inactive. In the past 10 years, the rate of cardiovascular deaths in the state decreased from 402.2 to 330.5 deaths per 100,000 population.
Oklahoma individual and family health insurance
Because Oklahoma decided against creating a state-based health insurance exchange, it defaulted to a federally facilitated exchange. Oklahomans may shop and apply for qualified individual and family health plans on the Federal Health Insurance Marketplace website. When doing so, they may be eligible for income-based premium tax credits and cost-sharing subsidies. Those who go without health insurance may face a tax penalty known as the shared responsibility payment.
ACA-compliant and supplemental health insurance plans are also available in the private marketplace through websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Oklahoma’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 69,221 individuals in Oklahoma selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Oklahoma enrolled in a marketplace plan increased to 126,115 during the open enrollment period.3
|Oklahoma’s health insurance exchange:||healthcare.gov|
|Oklahoma’s health insurance exchange:||ok.gov/oid|
Oklahoma small group health insurance plans
The federal marketplace’s Small Business Health Options Program (SHOP) allows Oklahoma small business owners with 50 or fewer employees to provide workers with access to health insurance. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Small businesses may also enroll in ACA-compliant small group health insurance plans sold through the private marketplace. Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the federally facilitated exchange.
Oklahoma state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Oklahoma’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||2–19|
|Maximum continuation period – standard||4 months|
|Maximum premium Increase||100 percent|
|State legislation reference||OK Stat. Tit. 36 Sec. 4509|
|More information||405-521-2828 or 800-522-0071 — Oklahoma Insurance Department|
|Additional notes5||Upon receiving notification of employee termination, a carrier must offer employee continuation coverage within 30 days, and upon receiving the notice the employee must accept the offer and pay the premium within 31 days|
Oklahoma high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.6
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).7
Oklahoma opted not to expand Medicaid in 2014.8 Because Medicaid was not expanded, there is currently a coverage gap that includes those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange. Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to SoonerCare, the Oklahoma Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Oklahoma Department of Human Services|
|Where to apply||apply.okhca.org/Site/Rights.aspxAdditional options—okhca.org/individuals.aspx?id=92&menu=40&parts=11601|
|Open-enrollment period||Year-round in all states|
|Eligibility9||U.S. citizens and qualified non-citizens living in Oklahoma who meet financial and resources standards in certain categories|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Oklahoma’s health insurance program for low-income children:
|Where to apply||apply.okhca.org/Site/Rights.aspx / Additional options—okhca.org/individuals.aspx?id=92&menu=40&parts=11601|
|Eligibility10||U.S. citizens and qualified non-citizens living in Oklahoma who meet financial and resources standards in certain categories|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 State of Oklahoma. “Important Information Regarding the President’s Economic Stimulus Package and COBRA.” http://www.ok.gov/oid/Consumers/Insurance_Basics/COBRA_Information.html.
5 Oklahoma Insurance Department. “Legislation, Administrative Code, and OID Changes 2012.” https://www.ok.gov/oid/documents/2012%20Legislative%20Update.pdf/.
6 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
7 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
8 Centers for Medicare & Medicaid Services. “Oklahoma.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/oklahoma.html.
9 Oklahoma Department of Human Services. “What is SoonerCare?” http://www.okhca.org/individuals.aspx?id=52&menu=114&parts=11601_7453.
10 Oklahoma Department of Human Services. “What is SoonerCare?” http://www.okhca.org/individuals.aspx?id=52&menu=114&parts=11601_7453.