Recent data shows that Oklahoma is in the top three out of 50 states with the highest percentage of uninsured residents. If you are one of the people who represent this statistic, then it’s more important than ever for you to be searching for an affordable and comprehensive insurance solution. Believe it or not, you have more options than you think. Below, we will go through all of the different options that are available near you and discuss why some are better than others depending on your personal circumstances. After that, you may be able to find the coverage you need to keep you and your loved ones as healthy as you deserve to be.
Major Medical Insurance in Oklahoma
Most working adults get their health insurance through their employer – but if you don’t, then you’re going to have to find a way to get the medical coverage you need outside of your job. The most popular alternative to employer-sponsored health coverage is to get a major medical health insurance policy through the Marketplace. The federal Health Insurance Marketplace, also commonly referred to as the exchange, is where these policies are sold.
If you want major medical coverage, the best way to get it is to stop by HealthCare.gov on November 1st, which is the day that open enrollment starts each year. For most states, Open Enrollment continues through December 15th – but some states will make exceptions and extend the deadline if there is a high enough demand. You might also qualify for a Special Enrollment Period if, for example, you move far enough away to change zip codes or welcome the birth of a child. There are many different situations which might qualify you for a Special Enrollment Period – but you’ll never know unless you go to HealthCare.gov to check and see.
Why is health insurance through the Marketplace so popular? The short answer is that these health insurance policies give consumers what they want and need, starting with guaranteed issue coverage. With guaranteed issue coverage, you can never be rejected, even if you have pre-existing conditions or ailments when you apply. You also cannot be charged more for your coverage despite your health status. In fact, these four factors are the only things which can allow an insurance company to charge you extra on your monthly premiums:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Another good thing that Marketplace insurance offers which you usually can’t get anywhere else are the 10 Essential Health and Wellness Benefits. These benefits are guaranteed with every single Marketplace health insurance policy. Their comprehensive nature helps you get the best possible medical care in order to lower your total healthcare costs over the long term:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
You may think that offering all of these comprehensive benefits without raising costs on or denying coverage to people with pre-existing conditions might make this insurance more expensive – and you’re not entirely wrong. But the government makes an effort to offer federal subsidies to qualifying working families in order to make these insurance policies affordable. If you make at least 138% of the federal poverty limit according to the data in the chart below, you can qualify for one of these subsidies. This can save you hundreds of dollars a month on your insurance costs and make the difference between being able to afford major medical insurance or not.
So what happens if you make less than 138% of the federal poverty limit, but can’t get health insurance through your employer? Well, things are a little bit more complicated in Oklahoma when it comes to needy families and households qualifying for low-cost health insurance. Unlike most other states, lawmakers are still refusing to accept free federal money which would make Medicaid available to needy families that are below the 138% threshold. This is called the Medicaid expansion gap – and tens of thousands of Oklahomans are falling into it every year. People who make too much money to apply for Medicaid but not enough money to qualify for a subsidy are finding themselves stranded with fewer options. Below, we will discuss some options you might want to look into if you fall into this gap. And if you do happen to make 100% or less of the federal poverty limit, you can apply for SoonerCare at the Oklahoma Health Care Authority website.
|Household Size||Annual Income (138% of FPL)||Annual Income (100% of FPL)|
Short Term Health Insurance in Oklahoma
Anyone unfortunate enough to fall into the Medicaid expansion gap and who can’t qualify for a subsidy might want to look at short-term health insurance first. Short of major medical coverage, short-term health insurance is the next most comprehensive and affordable option compared to all the others. Unfortunately, these plans usually aren’t as comprehensive as major medical coverage through the ACA. But if you missed the most recent Open Enrollment period, can’t qualify for a Special Enrollment Period, or you’re between jobs right now, these plans can help you out.
These insurance policies are comparatively affordable compared to major medical through the ACA without a subsidy; sometimes as much as one-third less expensive. Short-term health insurance also comes with the greatest amount of consumer protections compared to what your other options are – which means that if your short-term health insurance company tries to shirk their responsibilities on you and refuses to pay out claims, you might be able to take them to court. You also might be able to customize your coverage and add things to your plan if your short-term health insurance provider decides to sell you the extra coverage you want – but it’s unlikely you will be offered all of the same benefits you would get through the ACA. And keep in mind that short-term health insurance in Oklahoma is limited to 6 month plans, so you might end up doing a lot of hopping from plan to plan just to stay continuously covered.
Now let’s talk about the downsides of short-term health insurance. These insurance policies require medical underwriting, which makes them the opposite of guaranteed issue. You could be rejected for coverage, or charged substantially more for your monthly premiums if you have a pre-existing condition that your insurance provider doesn’t like. Some of the health benefits that people need the most – like preventive care, or mental health counseling – are too expensive and most short-term health insurance companies don’t want to sell them to you. These plans also come with deductibles that are sometimes in the thousands of dollars, and you must pay them out of pocket before your insurance provider pays out on your claims. But if you need something that won’t take too big of a chunk out of your monthly budget to protect yourself from an unexpected medical emergency, then short-term health insurance isn’t a bad idea.
Christian Health Plans/Health Share Plans in Oklahoma
Most people might not know this, but as of the beginning of 2019, the individual mandate was no longer in effect. Taxpaying Americans used to be required to pay a financial penalty every year when they filed their taxes if they did not purchase qualifying medical coverage. One thing that gave people an exception to this rule was the religious exemption available for a Christian health plan, also known as a health share plan. Like short-term health insurance, though, purchasing a membership in a Christian health plan can be a good way to protect yourself from unforeseen medical expenses if facing a sudden amount of medical debt would bankrupt you (even though there is no longer a legal requirement to purchase any health insurance whatsoever).
There are a few other factors which Christian health plans have in common with short-term health insurance. Here are the most important highlights:
- No guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
But you should also familiarize yourself with the differences between these plans before you choose one or the other. They aren’t as closely regulated by the government as short-term health insurance, so that means you don’t have any consumer protections. Your healthcare plan provider could decide not to pay out some or most of your claims and you wouldn’t be able to take them to court for it. You also have to follow participation guidelines that may be religious in nature, including the declaration of a specific faith or attending a specific church. You might also have to immediately stop all tobacco use or adhere to other biblical teachings in order to remain in good standing. Christian health plans don’t charge a monthly premium, they charge a monthly share amount; likewise, they charge “unshared amounts” and “personal responsibility amounts” as opposed to coinsurance, deductibles, or co-pays. But like short-term health insurance, they could cost up to 1/3 less than an unsubsidized ACA plan, and could provide you with the health benefits you need to keep you and your family healthy while you try to find better coverage.
Fixed Indemnity Plans in Oklahoma
Fixed indemnity plans can fill several different roles, although they aren’t intended to be a replacement for major medical coverage. In fact, most people purchase fixed indemnity insurance right alongside major medical coverage, short-term health insurance, or a Christian health plan. They don’t pay out a fixed percentage of your total medical costs the way ACA insurance does; rather, they pay out a fixed amount of money based on a per day, per week, per month, per visit, or per-incident basis.
Fixed indemnity plans have a few things in common with short-term health insurance such as lifetime and annual benefit caps, no limits your out-of-pocket costs, and medical underwriting. You can just as easily get rejected for coverage or charged more if you have a pre-existing condition. When it comes to fixed indemnity coverage, some plans offer hospital benefits, some will give you the chance to visit a doctor, and some may even give you basic dental coverage. Unlike major medical coverage, fixed indemnity plans don’t usually limit themselves to networks like PPO or HMOs. So you will have the flexibility to go anywhere that will accept your coverage – while not everyone may accept your fixed indemnity plan, it’ll give you better flexibility shopping around for the right type of healthcare provider that can give you the care you need.
Discount Cards in Oklahoma
Are you thinking about a medical discount card? Medical discount cards can definitely help you save money off your medical expenses – but they are the furthest thing you can get from an adequate replacement major medical coverage. The problem with some medical discount cards is that the company selling these memberships claim they are just like regular health insurance, but that couldn’t be further from the truth. Medical discount cards work very differently than regular insurance; they are more akin to a discount club like the AAA or the AARP than they are major medical coverage.
With a medical discount card, you usually pay a fee either on a monthly or an annual basis in exchange for your membership. Then you get a discount card in the mail that you have to present at the register when you buy prescription drugs, visit certain doctors, or go to a participating eye doctor or dentist (among other places). You should also double-check and make sure that the discounts that are advertised and the participating providers advertised actually work with the company who offers the card. In some cases, the amount of money you save with discounts might be more than your membership fee, making the card worth the price. But this isn’t always the case. So you need to do your homework and do a little bit of research into the company before you rush out to purchase a medical discount card.