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Oklahoma Health Insurance

Oklahoma Medical Insurance Overview

The State of Oklahoma offers a variety of health insurance programs to the state’s residents ranging from state assistance, employer group coverage, and individual plans. Despite the availability of these programs, many Oklahoma residents remain uninsured, and the state performs poorly, on the whole, in terms overall health.

Fortunately, new state and federal laws triggered by the Affordable Care Act are making it easier for individuals in Oklahoma to get and keep their health insurance. This summary explores the major health care issues in the state, along with the various health insurance coverage options that are available to Oklahoma residents.

In 2012, the Governor announced that the state would not create a state-managed benefits marketplace.
Oklahoma’s Health Care Issues
In terms of the overall health of its residents, the state of Oklahoma is ranked in 45th place when compared to the other states in the country.  According to the United Health Foundation, this means that Oklahoma has a great deal of room for improvement in its healthcare and health status.

Among the state’s strengths are its high rates of immunization coverage among its population of children, its low prevalence of people who drink in excess and its low disparity in health status by level of education.  Among its weaknesses are its high rate of obese people, its prevalence for its population to suffer from cardiovascular related deaths and its limited availability of primary care physicians.
Understanding Oklahoma’s Uninsured Population
As of 2014, the Henry J. Kaiser Family Foundation points out that there was 16 percent of the state’s population who were without health insurance coverage.  In terms of the population, this meant that 583,400 people in the state had no kind of health insurance benefits.

According to the Foundation’s website:

  • 27% of non-elderly uninsured people in the state of Oklahoma for 2014 were earned 100% or less than the FPL
  • 27% earned between 100-199% of the FPL
  • 17% earned between 200-399% of the FPL
  • 9% earned over 400% of the FPL

Group Health Plans
For the working population of the state of Oklahoma, 45% have group health insurance coverage.  Employers who issue this type of health benefits plans are negotiators of the plan’s benefits with the insurance providers.  The employer is able to change or reduce the amount of benefits offered to the employees, increase the premiums that the employees have to pay, change insurance providers or stop insurance coverage altogether.

If you are working in Oklahoma, you should check with the Human Resources department within your company to determine whether or not group coverage is available.  If it is, you should sit down and discuss all of the benefits options to ensure that you and your dependents are covered with comprehensive benefits that are designed to fit your situation.

Individual Health Plans
For those unable to secure insurance coverage through a group policy or those who earn too much to qualify for a state-funded insurance program can seek coverage through an individual insurance plan.  Of the population of Oklahoma, 5% of the residents are covered under individual policies.

Under this plan type, there are minimums with regard to the benefits offered.  Also, insurance providers of this plan type cannot cancel your policy because of any claims made against the policy or because of the health status of the policyholder.  In the event that you have falsified claims during the application process or if you didn’t pay your monthly premiums, these would be the only ways that the provider could cancel your insurance benefits.

COBRA and Group Coverage Continuation
COBRA exists to fill in the gaps of insurance coverage for those who have lost their insurance benefits because of a change in job or marital status.  The Consolidated Omnibus Budget Reconciliation Act offers insurance coverage that is temporary and lasts for up to 18 months.  Because of the separation between the employer and the employee, the premiums under COBRA are higher.

In order to be eligible for COBRA benefits in the state of Oklahoma, the original insurance policy must have been offered by a company that had 20 or more employees.  For those with fewer than 20 employees, COBRA coverage is extended for four months.

Oklahoma Health Benefits Exchange
In 2012, it was decided by Governor Mary Fallin that the state would not pursue a state-managed health benefits marketplace.  Because of that, the task fell to the federal government to offer health insurance benefits to residents of the state of Oklahoma.  Prior to that decision, she signed legislation prohibiting any health benefits marketplace from covering abortions with the exceptions of rape, incest or situations that put the life of the mother at risk.

As of 2014, the federal government has taken on the responsibility of offering health insurance choices and benefits to the population of Oklahoma residents.

Oklahoma State Insurance Programs
In the state of Oklahoma, various state-funded insurance programs are available to those who qualify.  Typically, in order to qualify, you must earn a low annual salary.

See the descriptions of the various plans below:

State Children’s Health Insurance Program (SCHIP)
The SCHIP program offers benefits for infants, kids and adolescents who don’t have insurance coverage in Oklahoma.  If the child is part of a family unit whose income levels meet certain requirements, coverage is offered if the income is higher than what would qualify for Medicaid coverage.  For benefits under this plan, the child needs to be under the age of 19 and ineligible to receive Medicaid coverage.

Medicaid / SoonerCare
SoonerCare is the state’s version of the Medicaid program.  This program offers medical benefits to people who earn lower than average incomes in the state of Oklahoma.  This program guarantees basic medical services to those who qualify and eligibility is based on income.
To qualify, you must not have insurance, earn a lower than average income, have a disabled family member, be pregnant or a parent of a dependent under the age of 19.

The WIC program is federally funded and offers a wide range of benefits to pregnant women and mothers of young children.  Under WIC, benefits offered include breastfeeding information, supplemental food items and infant safety education.

SoonerCare Supplemental/Medicare
Medicare is available to residents who are over the age of 65, suffering from a disability or and the end-stage of Renal Disease.  SoonerCare Supplemental helps pay for the costs associated with Medicare coverage if you have limited financial resources.  The coverage under this plan supplements the benefits offered under the Medicare program.

The SoonerPlan is the state’s program to help residents with their family planning needs.  In order to qualify for participation, you must not be members of SoonerCare.  To qualify, your income must be at or under 185% of the Federal Poverty Level.  Under this program, you can receive birth control education and supplies, exams related to family planning, STD screenings, tubal ligations and vasectomies for those who are 21 and older.

SoonerCare Choice
SoonerCare Choice offers home medical services to those who qualify.  If you are eligible for SoonerCare, but not Medicare, you may be able to get assistance under this program.

Oklahoma Cares
This program aids the female residents of Oklahoma by providing breast and cervical cancer treatments.  If you are under 65 and uninsured, you can qualify to receive screenings and diagnoses for cancer along with treatment options.

To qualify for coverage, you must have participated in the state’s program for early detection of cancers, receive an abnormal screening and require treatment.  If you have a lower than average income, are uninsured and under the age of 65, you can get coverage under this plan.

Child Health
This program provides free hearing, vision and dental services to children who are participants in the SoonerCare program.  Income requirements must be met in order to qualify and the participant must be under the age of 20.

Other State Programs

Health Management Program
For participants of SoonerCare Choice who have received a diagnosis of a chronic disease, this program aims to provide nursing care management, pharmacy services and behavioral health screenings.

SoonerRide is a transportation program that offers rides to SoonerCare members to get them to and from their doctor’s appointments.

Tax Equity and Fiscal Responsibility Act of 1985 (TEFRA)
This legislation was enacted in 1982 to offer Medicaid benefits to kids suffering from mental or physical disabilities.  If the participant is ineligible for SSI benefits due to their family’s resources, they can qualify for coverage.

Insure Oklahoma
Insure Oklahoma is an employer-sponsored benefits package for employers to offer to their workers that is affordable.  For those eligible, they can also participate in the Insure Oklahoma Individual Plan.  The Individual plan can range from zero to $192 per month for premiums and coverage under this plan is not immediate.

Insure Oklahoma Employer Sponsored Insurance (ESI)
The ESI plan was created to help employees with low incomes afford the rising costs of health insurance coverage.  Under this program, the state shares 60 percent of the premiums, while 25 percent falls on the employer’s responsibility and 15 percent is left to the employee.

Health Insurance Portability and Accountability Act (HIPAA)
HIPAA was enacted to create standards of treatment by healthcare professionals and insurance companies.  Through this legislation, certain practices are mandated and prohibited based on the type of insurance coverage that a person has.