Oklahoma Health Insurance

 Health insurance in Oklahoma

● Oklahoma uses the federally subsidized health insurance exchange.

● Open enrollment in Oklahoma for 2021 health plans is November 1 to December 15, 2020. Outside of that window, residents need qualifying events to sign up.

● Six insurance companies offering health plans in exchange for 2021, up from three in 2020.

● Short-term health insurance plans can be sold in Oklahoma with initial plan terms of up to 364 days.

● Nearly 159,000 Oklahomans have purchased health insurance plans for 2020 coverage.

● Oklahoma lawmakers have mostly opposed the Affordable Care Act, but have also sought to create state health care reform.

● Oklahoma voters approved Medicaid expansion in June 2020; coverage is expected to take effect by mid-2021.

● Oklahoma's high-risk pool ceased operations in 2014, after the ACA secured individual market coverage.

● More than 746,000 Oklahomans are enrolled in Medicare, including private Medicare plans.

This page provides information and guidance for consumers looking for health insurance resources in Oklahoma. We've included an overview of the Oklahoma health insurance market (exchange) and the upcoming open enrollment period for individual market health insurance; details of the election initiative that will lead to Medicaid expansion in Oklahoma by mid-2021; a quick look at short-term health insurance rules and availability in the state; information about state-specific Medicare rules and Medicare enrollment; as well as various other health insurance resources for Oklahoma residents.

Oklahoma's health insurance marketplace

Oklahoma has a federally facilitated trade (market), which means individuals and families use web HealthCare.gov to buy health insurance.

By 2021, six health insurance companies will offer health plans through the Oklahoma exchange, including three newcomers: Oscar, UnitedHealthcare, and CommunityCare Oklahoma. They will come the three existing exchange insurers (Bright Health, Blue Cross Blue Shield of Oklahoma and Medica).

BCBSOK and Medica have service areas that include the entire state, while the other four have more limited service areas. So the availability of the plan varies from one part of the state to another.

The market is used by individuals and families who need to buy their own health insurance. This includes people who have retired before the age of 65 (and therefore are not yet eligible for Medicare), people who are self-employed, and people who are employed in a small business that does not provide health benefits to employees (under the ACA, only companies that have 50 or more workers are required to offer employer-sponsored health coverage).

The market is also the only place where individual market participants can obtain financial assistance with their health insurance, depending on their family income. This includes premium subsidies that reduce the monthly premiums that people pay for their coverage, and cost-sharing reductions that make out-of-pocket medical expenses (deductible, copays, coinsurance) cheaper.

Open enrollment period and dates in Oklahoma

Open enrollment for 2021 health plans in Oklahoma runs from November 1, 2020 to December 15, 2020. The open enrollment period gives individuals and families the ability to sign up for coverage, regardless of their previous coverage history or pre-existing conditions. It's also an opportunity for existing individual market participants - both on and off the stock exchange - to compare the options available for 2021 and renew their current insurance coverage or switch to a different plan. The entry of three new insurers into the Oklahoma market for 2021 makes it especially important for people to shop and actively compare the various plans, as there may be a new option available in their area that provides better value than the plan they currently have.

Outside of the open enrollment period, requesting an individual market plan (on-exchange or off-exchange) requires proof of a qualifying event.

During the open enrollment period for 2020 health coverage, 158,642 people purchased private individual market plans through the Oklahoma health insurance market. Only a handful of states using HealthCare.gov recorded enrollment growth in 2020. Oklahoma is among them; only four states recorded a higher percentage increase in enrollment from 2019 to 2020.

Short-term health insurance in Oklahoma

Before November 2019, Oklahoma had strict enough regulations for short-term health insurance plans: Policies could not last more than six months and could not be renewed. But the state enacted a law in 2019 that changed those rules.

As of November 2019, short-term health insurance coverage in Oklahoma can follow federal rules that allow initial terms of up to 364 days and total duration, including renewals, up to three years.

Medicaid expansion in Oklahoma

As of May 2020, there were 773,600 Oklahoma residents enrolled in Medicaid (Sooner Care) and CHIP in Oklahoma. This is a 2% decrease since 2013, although it is an increase of about 50,000 people since the beginning of 2020. The coronavirus pandemic has brought Medicaid enrollment higher across the country, even in states where Medicaid has not yet been expanded under ACA rules.

Oklahoma voters have approved an election initiative to expand Medicaid that will allow eligibility to expand in July 2021. Meanwhile, Oklahoma is still pursuing a waiver that would allow a Medicaid work requirement. Labor requirements are not currently in place anywhere in the country, although federal approval has been granted for many other states. Some have been overthrown by judges, while others have been suspended or suspended amid legal battles and the COVID pandemic.

Oklahoma and the Affordable Care Act

Oklahoma is one of five states initially considered "diehard hold outs" against Obamacare, according to a 2014 study by Georgetown University. In 2010, both Oklahoma U.S. senators, Republicans Thomas Coburn and James Inhofe, voted no to the ACA. In the United States House, a Democrat, the Dan Boren of the second district voted yes, while four Oklahoma Republican representatives voted no. As of 2018, the entire U.S. Congressional delegation from Oklahoma was Republican, but Kendra Horn, a Democrat, represents the 5th district in the House since January 2019.

At the state level, there is a strong Republican majority in both the House and Senate, and Governor Kevin Stitt is also a Republican. Stitt opposes Medicaid expansion (though he proposed SoonerCare 2.0, which called for expansion with subsequent restrictions added to the program, but withdrew his support for it amid the coronavirus pandemic and the resulting increase in the number of people who would need expanded Medicaid) and believes that selling health insurance across state lines is a key to reducing premiums (legislation enacted in Oklahoma in 2017 to allow this , but like the handful of other states that have done the same thing, they have had no interest from insurers who want to participate).

But Oklahoma has also worked to try to create state-based health reform solutions under the ACA. In 2017, Oklahoma submitted a 1332 waiver proposal to the CMS, seeking federal funding for a reinsurance program (and the state was planning extensive additional reform through an additional 1332 waivers that were to be filed later). But Oklahoma eventually withdrew its waiver proposal amid delays in the federal approval process, when it was clear that approval would not happen in time for rates to fall for 2018.

Oklahoma enacted another bill, in 2018, authorizing the state to seek federal funding for a reinsurance program, but the state has not submitted a waiver proposal to the federal government, so there is still no reinsurance program in Oklahoma.

Does Oklahoma have a high-risk pool?

Prior to 2014, individual medical insurance was taken out in nearly every state, including Oklahoma. This meant that pre-existing conditions could prevent an applicant from getting coverage or result in significantly higher monthly premiums or policy exclusions.

The Oklahoma Health Insurance High Risk Pool (administered by Blue Cross Blue Shield of Oklahoma) was created in 1995 to provide an alternative to people who were unfit to purchase individual medical insurance because of their medical history.

The implementation of the ACA and a guaranteed-emission individual market eliminated the need for high-risk pools, and the Oklahoma Health Insurance High Risk Pool ended operations as of December 31, 2014.

Medicare coverage and enrollment in Oklahoma

Medicare is a health coverage program provided by the federal government for elderly and disabled Americans. As of August 2020, there were 751,324 Oklahoma residents enrolled in Medicare. About a quarter of Oklahoma's beneficiaries are enrolled in Medicare Advantage plans, while the others have Original Medicare.

In most cases, receiving a Medicare card goes back to 65. But 18% of people with Medicare in Oklahoma are under the age of 65 and are entitled to Medicare due to a long-term disability, SRIA or end-stage kidney disease.

Oklahoma Health Insurance Resources

● Oklahoma Insurance Department - Regulates and licenses health insurance companies, brokers, and agents and can answer consumer questions and complaints. But Oklahoma is one of only three states where the insurance department does not conduct the premium rate review process (the federal government manages it instead).

● Legal Aid Services of Oklahoma — The federally funded Navigator organization in Oklahoma; it can help residents understand their health insurance options and sign up for coverage through HealthCare.gov.

● Oklahoma Medicare Assistance Program — Help for Medicare beneficiaries and their caregivers; includes the Senior Health Insurance Counseling Program and senior Medicare Patrol.

● Medicare Rights Center — A national service that provides information and answers questions about Medicare