What You Need to Know
Oklahoma residents sign up for individual on the federal health insurance marketplace or directly with insurers off the exchange.
Your application for an ACA plan also reveals if you qualify for Medicaid instead of federal subsidies to pay for health insurance.
Some Obamacare plans could cost $0 in monthly premiums after federal help is applied.
More Oklahomans enrolled in Marketplace coverage for 2020 than the year before. You can find plans from four insurers in the Marketplace.
Oklahoma and the Affordable Care Act
Although the number of people without coverage dropped to 14% as of 2018, the Sooner State still has the second-highest uninsured rate in the country. More than 521,000 residents are without health insurance.2
Oklahoma’s decision not to expand Medicaid to childless adults has contributed to its high uninsured rate. The ACA gave states the option to expand Medicaid to this group. If childless adults could qualify, about 111,000 more residents would have health insurance.3
Buying Oklahoma Health Insurance for Individuals, Families, and Self-Employed Entrepreneurs
Obamacare offers affordable health insurance for individuals, families, and self-employed entrepreneurs. You’re self-employed if you have no employees.
Obamacare plans are categorized by metal tier: bronze, silver, gold, and platinum. Each tier covers a certain percentage of your health insurance costs with bronze covering the least. All plans include essential health benefits, such as maternity and pediatric care, prescription drug coverage, and free preventive services. Plus, policies must offer vision and dental benefits to children.
Obamacare health insurance in Oklahoma is available through the federal Marketplace via Healthcare.gov. Plans are also sold through insurance brokers and directly from private insurance companies.4 Keep in mind that you only qualify for financial help when you enroll through the Marketplace (called the exchange).
Oklahoma Health Insurance Marketplace Enrollment
Open enrollment usually takes place each year from November 1 to December 15. If you missed signing up, you can get coverage if you have a qualifying life event, such as having a child or moving to a new area. Otherwise, you’ll have to wait until the following November for next year’s enrollment period.
Special Enrollment Period
Oklahoma residents who missed open enrollment can still sign up. Due to the coronavirus, the federal government reopened enrollment on the federal Marketplace from February 15, 2021 through August 15, 2021.
Oklahoma Health Insurance Companies
- Blue Cross Blue Shield of Oklahoma
- Bright Health Insurance Company
- CommunityCare HMO
- Medica Insurance Company
- Oscar Insurance Company
Health Insurance Costs in Oklahoma
Oklahoma health insurance premiums have declined slightly over the past few years. Here’s a look at the average Marketplace monthly premiums from 2018 to 2020:
|Oklahoma Marketplace Average Monthly Premiums||2018||2019||2020|
|Average lowest-cost bronze premium||$395||$361||$365|
|Average lowest-cost silver premium||$535||$529||$527|
|Average lowest-cost gold premium||$664||$522||$521|
For 2021 plans, the state approved a 2.7% increase for the average unsubsidized premium although other private analysis shows a decrease of 0.36%.8
How to Qualify for Obamacare Subsidies in Oklahoma
Applying for health insurance through the federal Marketplace will reveal if you qualify for Obamacare subsidies. Subsidies, known as premium tax credits, are based on your income and household size. You must earn between 100% and 400% of the federal poverty level (FPL) to qualify. In 2020, this means your income must be within $12,760 and $51,040.
Subsidies reduce your monthly insurance premium. You may even qualify for a bronze plan with a $0 monthly premium after federal help is applied. The average premium tax credit received among Oklahoma Marketplace enrollees in 2019 was $647 per month; that same year, 94% of enrollees received subsidies. 10
Another 64% received cost-sharing reductions (CSRs), which only apply to silver plans. CSRs lower your out-of-pocket costs (such as copayments) when you use your coverage. You typically qualify if you earn up to 250% of the FPL, which is $31,900 for an individual in 2020. It’s possible to receive premium tax credits and CSRs.
Before enrolling, check your out-of-pocket costs, such as premiums and deductibles, to decide which plan works best for your needs and budget.
Oklahoma’s Medicaid Program for Low-Income Residents
Your Marketplace application also reveals if you qualify for Medicaid instead of federal subsidies. Medicaid is a public health insurance program funded by the state and federal government.
In Oklahoma, Medicaid is called SoonerCare. It includes a children’s health insurance program called Soon-to-be Sooners.11 SoonerCare covers about 684,000 adults and children, or 18% of the state’s 3.8 million residents.12
SoonerCare may cover up to 100% of medical expenses. It’s available to some low-income citizens and legal immigrants who reside in Oklahoma. These are:
- Children under 19
- Parents and caretakers with children under 19
- Pregnant women
- People who are blind or have disabilities
- Individuals 65 and older
- Women under 65 who need breast or cervical cancer treatment
- Men and women 19 and older who have family planning needs
Income limits to qualify for SoonerCare vary. Parents and caretakers of minor children can earn up to $5,508 a year for an individual in 2019. Meanwhile, pregnant women can make an individual income of up to $16,620.
Medicare in Oklahoma for Seniors and People With Disabilities
You can get Medicare if you’re 65 or older or under 65 and have a disability. Nearly 743,000 Oklahomans have health insurance through Medicare.13
About eight in 10 adults get benefits through the federal government’s Original Medicare program. It includes inpatient hospital (Part A) and outpatient medicare care (Part B). Another 1 in 5 gets Part A and B through private Medicare Advantage plans. Most of these plans also offer Medicare Part D prescription drug benefits.
Original Medicare does not offer comprehensive drug coverage. So many residents buy a separate Part D drug plan from a private insurer. Nearly 363,000 Oklahoma Medicare beneficiaries have an individual Part D plan.14
Private companies also offer Medicare Supplement plans, commonly called Medigap. These plans only work with Original Medicare. They help pay for out-of-pocket costs, including coinsurance, copays, and deductibles.
Oklahoma Short-Term Health Insurance If You’re In Between Jobs or in a Coverage Gap
Short-term health insurance can help fill a gap in coverage, such as when you’re in between jobs or waiting for benefits to start at a new job. You can get short-term coverage in Oklahoma for up to six months, but plans aren’t renewable.
Buying short-term health insurance usually requires you to answer medical questions. Short-term health plans don’t qualify as major medical insurance under the Affordable Care Act (ACA). So plans can deny you a policy based on your health and exclude coverage for preexisting conditions.
Before you choose to sign up for health coverage, carefully review the policy to understand its limitations. You also want to compare costs, such as premiums and deductibles, to decide which works best for your needs and budget.