OKPOLICY.ORG
Ah, fall: crunchy leaves on sidewalks, a hint of frost in the air, pumpkin spice everything… In other words, it’s time for open enrollment, the span between Nov. 1, 2015, and Jan. 31, 2016, when people can enroll in or change their private health insurance plans. This is a particularly good time for people who are currently uninsured but who are eligible for health insurance to get covered.
How do I enroll?
Oklahomans can shop around for and enroll in health insurance via Healthcare.gov. Some other states built their own health insurance marketplaces, which is why your aunt in Kentucky got hers via kynect. In states like Oklahoma that declined to build their own marketplace, residents should enroll at Healthcare.gov. There you’ll be asked to provide some basic information about the people you’re looking for coverage for, as well as your projected income for the next year.
I have coverage through my employer. Does this apply to me?
Probably not, although you should probably ask about any upcoming changes.
I bought coverage last year. I’m good, right?
Possibly, but the plan you purchased last year may not be the best deal this year. Last year, people who switched plans within the same coverage tier saved an average of $400 per year more than those who kept the same plan. In addition, some insurers have left the Oklahoma market. It’s best to get on Healthcare.gov and shop around, if only to see what your options are.
I’m pretty sure I’m not eligible, and it’s probably not affordable anyway.
You might be surprised! Nearly half of Oklahoma’s 581,000 uninsured are eligible for subsidized coverage, either through Soonercare or a tax credit to purchase health insurance on Healthcare.gov. Many people don’t realize that tax credits can help offset the cost of monthly premiums – four in five Oklahomans who purchased health insurance last year received premium tax credits. On average, those tax credits knocked the monthly cost from nearly $300 per month to less than $100 per month. A cost-sharing subsidy can further reduce what you pay for copayments, deductibles, and other out-of-pocket expenses.
Did premiums go up a bunch this year?
Yes and no. Average premiums for a very specific type of plan went up an average of 7.5 percent nationwide this year, with enormous variation either way. In Oklahoma City, the average premium increase before the average tax credit was 35.7 percent. However, with the tax credit, the cost actually dropped slightly. The only way to know what you’d be paying is to look.
This is all really complicated.
Shopping for health insurance can be overwhelming and complicated! Fortunately, help is available. You can contact a navigator to help you figure out what you’re looking at (you can also find help by dialing 211). The Kaiser Family Foundation has an updated list of nearly 300 frequently-asked questions on health reform. Sarah Kliff, a leading health care journalist, recently wrote about how she shops for coverage. If the enrollment process seems intimidating, remember that you can preview your options.
I’m young and healthy. I don’t need health insurance.
In Oklahoma, people ages 25 – 34 are more likely to be uninsured than any other group. Because they’re young and typically healthy, this group – sometimes referred to as “young invincibles” – may resist purchasing health insurance. However, health insurance improves financial health, and is a great step towards improved mental and physical health. So-called “young invincibles” may be underestimating both their risk of needing health care and the cost of obtaining that care without insurance. As the Washington Post explained:
One Centers for Disease Control and Prevention study found that 17 percent of women ages 18 to 29, and 13 percent of men, have a chronic condition such as cancer or diabetes. Federal data show that young adults have higher rates of car accidents, which could lead to pricey medical bills. The high cost of maternity care can be another concern for young adults, with the average charges ranging upward of $32,000.
What if I don’t get health insurance?
Not carrying coverage will incur a financial penalty. The cost will either be $695 per person in your household ($347.50 for children under 18), up to $2,085, or up to 2.5 percent of your annual taxable income – whichever is greater. If you really want to play with the math, the Tax Policy Center has a calculator here, but it’s worth noting that the penalty is approximately the cost of six months of health insurance, and you don’t even get any health insurance out of it.
However, there’s a caveat. When the ACA was drafted, it was with the intention that all states would accept an impressive infusion of federal funds to expand their Medicaid programs to low-income adults. In 2012, the Supreme Court made expansion optional, and it’s an option Oklahoma hasn’t taken. So for an estimated 100,000 Oklahomans who are affected by the state’s refusal to expand Medicaid, not carrying insurance won’t incur a penalty. You can find an explanation of that exemption, as well as others, here. If you think you might fall into this group, or have any questions about this, you should contact a navigator.
What’s the bottom line?
For thousands of Oklahomans, the next few months present an opportunity to improve both their physical and financial health. In a notably unhealthy state where half of all households are one misstep away from financial emergency, health insurance offers access to everything from preventive care to mental health and substance abuse screenings to lifesaving treatments. Take a look: you might find that it works for you.
