Oklahoma is officially nicknamed as “The Sooner State” because the non-Native settlers staked their claims on the place before the Indian Appropriations Act. The state is known for their great plains, hills, lakes, and forests. The state defaults to a federally run exchange, though Oklahoma has worked to try to create state-based health care reform solutions within the framework of the ACA. However, amid delays in the federal approval process, Oklahoma withdrew the waiver proposal and enacted another bill in 2018 authorizing the state to seek federal funding for a reinsurance program. The state did not submit a waiver proposal in 2018 so still no reinsurance program is in the state. It is a fact that Oklahoma has been among the states, which have highest rate of uninsured residents. The state has however seen improvement in the health insurance since the start of the Affordable Care Act’s health insurance exchanges coverage in 2014. Though the state still has the highest uninsured percentage. The Oklahoma health insurance landscape majorly includes public health insurance programs for individuals of all ages and family of all sizes, employer-based healthcare benefits and subsidized coverage through the state’s Obamacare exchange along with ACA-compliant health plans available in the private marketplace through HealthCare.org.
Highlights and Updates of Oklahoma Health Insurance
- Open enrollment period in Oklahoma like any other states starts from November 1, and ends on December 15. Residents having qualifying events can enroll even outside the open enrollment period.
- The state uses the federally facilitated exchange.
- In Oklahoma short-term health plans from November 1, 2019 are available with initial plan terms of up to 364 days and total duration including renewals of up to 36 months.
- Lawmakers in Oklahoma is mostly against the ACA and have tried to implement state-based health care reform.
- About 140,000 residents of Oklahoma purchased health plans for 2018 coverage.
- With Affordable Care Act making health coverage a guaranteed-issue, Oklahoma’s high-risk pool operations has stopped since 2014.
Individuals & Family Health Plans in Oklahoma
Individual health insurance before 2014 was underwritten in nearly every state along with Oklahoma, this meant that pre-existing conditions prevented individuals from getting health coverage or it significantly resulted in higher premiums or policy exclusions. Therefore, the state created the Oklahoma Health Insurance High Risk Pool to provide its residents an alternative of purchasing individual health insurance if they were ineligible to purchase health plans because of their medical history. With the ACA implementation and a guaranteed issue of health plans, individual heath plans market have eliminated the need for high-risk pools in Oklahoma.
To easily compare costs and benefits of individual and family health plans, all the qualifying health plans have been categorized in one of four metals plans, namely Gold, Silver, Bronze and Platinum. Each plan is categorized in one of the metal plan based on the average amount of healthcare costs the plan will cover is shown as a percentage that is covered by the company and the percentage paid by the insured. Insurance companies participating in the federal or Oklahoma state healthcare exchange need to offer at least Gold and Silver plans. The Individuals and Family Health Insurance plans in Oklahoma may be purchased through private insurance companies or healthcare providers participating in Oklahoma through the federal exchange, HealthCare.gov. Most of the Individual and Family health plans are some form of Managed Care and these include HMO, PPO and POS. The following types of individuals and families health insurance plans are available in Oklahoma.
PPO – PPO or Preferred Provider Organization is a more popular and highly flexible Individual and Family health plan in which insured have the flexibility to visit any health care professional of their choice. Although, while receiving healthcare from in in-network healthcare provider, the insured will have lower out-of-pocket costs. Besides, the members of the plan do not need a primary care physician to manage their health and to provide referral for visiting a healthcare provider. The members of the PPO plans probably have to pay an annual deductible before insurers start covering their medical bills and they may also have a co-insurance for certain services or they need to cover a specific percentage of their total medical bills.
HMO – Individuals enrolled in HMO plans receive a wide range of healthcare services through a network of healthcare providers, who agree to render healthcare services at pre-negotiated rates to the members of the plan. HMO plans provide coverage for a broader range of preventive healthcare services than any other type of plans. The members of this plan need to choose a primary care physician, who would take care of most of their healthcare needs and to provide a referral to members for visiting specialist. The HMO plans allow members to have lower out-of-pocket healthcare expenses, as they do not require to pay a deductible before the start of the coverage and their co-payments amount are also likely to be minimal.
POS – POS plans come with the mixed qualities of PPO and HMO plans, and the benefit levels of the plan vary depending whether the insured are receiving healthcare in or out of their insurance company’s network of providers. In this plan also, members are required to appoint a primary care physician to receive healthcare services and who will also provide referral to network specialists when required. Healthcare services rendered by the primary care physician usually do not have deductible and these services come with preventive care benefits. However, members of the plan can obtain services from the out-of-network provider but with greater out-of-pocket costs and they may also be responsible for coinsurance, co-payments and deductibles.
Fee-For-Service (FFS) – With the growing popularity of PPO plans, Fee-for-Service plans are becoming less common and therefore this plan is not available in all of the U.S. states. However, with the availability of this plan in Oklahoma, people can compare its features with other plans before considering for this plan. Fee-for-Service plans provide flexibility of choosing doctor and hospital of one’s choice. The insured have to pay upfront the healthcare cost and need to later on file for the reimbursement from their insurance company. This is considered as the highly expensive individual and family healthcare plan, which also include deductibles and co payments for the received medical services.
HDHP with HSA – HDHP along with an HSA is a way to manage health care expenses. Members of this plan can pay the deductible along with qualified medical expenses utilizing the money set aside in their tax free Health Saving Account. The balance in the HSA gets rolls over year to year that allow members to build up reserve to pay for healthcare expenses and services at the later stages. HDHP usually comes with a higher annual deductible than a typical health plan, and its deductible amount varies every year. For 2020 it is $1,400 for individuals and $2,800 for families. A high-deductible health plan has lower insurance premiums and allow individuals to qualify for a tax-advantaged HSA. This option is best for wealthy individuals and families who are capable of paying high deductible out-of-pocket and wish to have benefits of HSA.
Dental Insurance Plans in Oklahoma
Dental care services are quite expensive in and even the routine preventive care can add up to several hundred dollars. Thus, to help cut down out-of-pocket costs of several dental treatments and procedures, individuals and families can opt for dental insurance plans in Oklahoma. Some of the dental services covered under dental plans in Oklahoma include, preventive care like regular cleanings and x-rays, fillings, sealants, tooth extraction, bridges, crowns, dentures, oral surgery and root canals. The basic difference between dental and health insurance is that most dental plans can the yearly amount spending on benefits. Some of the popular dental insurance plans in Oklahoma are:
Managed Care Dental Plans – Managed care dental plans have a network of participating dentists who agree to render dental care services at pre-negotiated rates. Insured need to visit any of the in-network dentist to receive the dental care at discounted rates. The dental care provider then submit the claim to the insurance carrier on behalf of the patient or insured. People opting for this plan has power out-of-pocket costs.
Indemnity or Fee-for-Service Plans – In Indemnity dental plans, the insurance carrier pay for the covered dental care services only after receiving a bill, which means that the insured first have to pay upfront and then they can obtain reimbursement from their insurance carrier later. However the best part of indemnity dental plan is that it offers a broader choice of dentists compared to other dental plans.
Dental Savings Plan – With this dental plans, insured can save considerably on a wide range of dental care services like root canals, cleanings, dentures and Orthodontics for children and adults. There is no waiting period in this plan and there is no limit on use and age. Beside this plan has extensive nationwide network of dentists.
Vision Insurance in Oklahoma
Preventive eye care is essential to ensure the health of vision in the years to come and hence individuals should take the vital step to receive routine examinations from a qualified eye care professionals. To receive eye examinations and corrective eye-wear services, residents in Oklahoma should opt for vision insurance plans, the benefits and features of which vary depending on the provider.
Short-term Health Plans in Oklahoma
Earlier Oklahoma defer the federal government health care reform issues and has own fairly strict regulations for short-term plans. The short-term plans were not available for a period of more than six months and the plans were also non renewable. However, as of November 1, 2019, short-term insurance plans follow federal maximum duration rules and so now these plans are allowed to have initial terms of up to 364 days and total duration including renewals of up to 36 months. Short-term health plans are great solution for individuals who are between jobs, waiting for group coverage to start, need affordable solution to traditional health insurance for limited time. Such plans are often termed as temporary coverage and is different from ACA-compliant coverage. The benefits offered by short-term plans are such that these plans usually work for individuals who don’t require regular medical care like frequent visit to the doctor or expensive prescriptions. Individuals opting for short-term plans must keep in mind that these plans typically do not cover pre-existing medical conditions or several benefits that are covered by more comprehensive health plans. Short terms plans generally do not guarantee renewal and hence if the insured develop any conditions while being on a short-term plan then they may be prevented from renewing their plan.
Insurance Carriers in Oklahoma
People shopping for health plans through Oklahoma’s federally facilitated exchange have a choice of three insurers in 2020:
- Bright Health
- Blue Cross Blue Shield of Oklahoma
CommunityCare is also offering individual market plans but only outside the exchange.