What you need to know about Oklahoma’s new Health Insurance Marketplace

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Beginning October 1 and lasting until March 31, 2014, Oklahomans without access to affordable health insurance through their employer or a government sponsored plan will be able to purchase a plan through the new Health Insurance Marketplace at www.healthcare.gov or calling (800) 318-2596.

Also starting October 1^st, Oklahomans will be able to dial 2-1-1 to get general information about the Affordable Care Act, the Health Insurance Marketplace, or to find help locating in-person assistance. Oklahoma Health Insurance Marketplace resources will also be available on-line at www.211Oklahoma.org.

Important Facts to Know

1. Coverage for the health plans begin January 1, 2014
2. All insurance plans will have to cover essential health benefits including – doctor visits, hospitalizations, maternity care, emergency room, and prescriptions.
3. You might be able to get financial help to pay for a health insurance plan
4. If you have a pre-existing condition insurance plans cannot deny you coverage
5. All insurance plans will have to show the costs and what is covered in simple language with no fine print.

How will consumers compare plans?

The marketplace will feature four different types of health plans, known as medal plans. Plans will be available at bronze, silver, gold, and platinum levels. Insurance companies will be required to at least offer the silver and gold plans in the marketplace. These plans will NOT vary in coverage but they will vary in cost, so choosing the right plan depends on how much premium and out-of-pocket costs a consumer is willing to pay.

Consumers selecting a bronze or silver plan will pay lower premiums but will experience higher out-of-pocket costs in the form of deductibles, co-pays, and coinsurance when they go get care. Consumers selecting gold and platinum plans will pay higher premiums but lower out-of-pocket expenses.  

The chart to the right shows the average division of costs between insurance companies and consumers by plan level.

Individuals under the age of 30 will also have the option to purchase a catastrophic plan, which will include three free office visits and preventive services but will otherwise require enrollees to meet a high deductible.

How will Oklahomans get financial assistance to purchase health insurance?

Financial assistance will be available for income eligible consumers. The types of assistance available include:

1. Advance Premium Assistance Tax Credits that subsidize premium costs for individuals and families with incomes between 100 – 400 percent of the federal poverty level (FPL) when purchasing insurance in the marketplace.
2. Cost-Sharing Reductions which lower out-of-pocket costs for deductibles, co-pays, and co-insurance for individual and families who purchase a silver health plan and earn up to 250 percent of the FPL.

Since Oklahoma lawmakers have opted not to accept federal funds for extending Medicaid eligibility, Oklahomans with incomes below the federal poverty level will be left without assistance for purchasing health insurance. Those who do not qualify for traditional Medicaid in Oklahoma and have incomes below 100 percent of the FPL will not be required to have health insurance coverage for 2014.

How will Oklahomans get help finding insurance on the marketplace?

Oklahomans can get help finding insurance on the marketplace from:

• Navigators are comprehensively trained entities that will assist consumers with identifying what subsidies they qualify for and enrolling in a health plan. In Oklahoma, navigators will be Oklahoma Community Health Centers, Inc. and Little Dixie Community Action Agency, Inc.
• Certified Application Counselors are organizations, typically community based non-profits, who will educate consumers about the marketplace and assist with completing an application for coverage.
• Agents and Brokers are paid by insurance companies to sell coverage and will be available to enroll consumers in health plans through the marketplace.