Alyssa Lane
If you're looking to get medical insurance in Oklahoma, there are a variety of options to choose from. Oklahoma's Medicaid program is called SoonerCare, and it is administered by the Oklahoma Health Care Authority. SoonerCare is available to state residents who qualify based on their income level. Aside from SoonerCare, Oklahoma works with several providers to offer Affordable Care Act (ACA)-compliant health plans, including Ambetter, Blue Cross Blue Shield of Oklahoma, Medica, Oscar, and UnitedHealthcare. These providers offer a range of individual and family health insurance plans with different price points and coverage options. Open enrollment for Oklahoma health insurance typically starts on November 1 and extends until January 15, but special enrollment periods may be available for qualifying events such as having a baby or getting married.
| Characteristics | Values |
|---|---|
| Open enrollment period | November 1 to January 15 |
| Eligibility | US citizens or qualified immigrants who are Oklahoma residents |
| Providers | Ambetter, Blue Cross Blue Shield of Oklahoma, Medica, Oscar, and United Healthcare |
| Types of plans | Individual, family, ACA Marketplace, short-term, Medicare, and Medicaid |
| Average monthly premium | $69 |
| Monthly premium after financial assistance | $50-$100 |
| Application process | Online, by phone, or by mailing a form |
| Application channels | Healthcare.gov, Marketplace, DHS website, or by calling a local My OK Plan navigator |
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What You'll Learn
Understanding Medicaid and eligibility
Medicaid is a state-federal programme that covers medical expenses for specific low-income and limited-resource groups. Oklahoma's Medicaid programme is called SoonerCare, and it is administered by the Oklahoma Health Care Authority.
SoonerCare is a government programme that provides no-cost or low-cost healthcare for millions of Americans. Eligibility is based on total family income and household size, and citizenship. Adults under the age of 65 with a household income of up to 138% of the poverty level, pregnant women with a household income of up to 210% of the poverty level, and children in households with income up to 210% of the poverty level are all eligible for SoonerCare Medicaid in Oklahoma. Coverage for the mother continues for 12 months after the baby is born. Adults over the age of 65 and people with disabilities have eligibility based on income and assets.
Additionally, American Indian and Alaska Native (AI/AN) members can opt in to join a SoonerSelect plan. If they choose not to opt in, they will continue to receive the same SoonerCare coverage they already have. SoonerCare also covers disabled children who do not qualify for Social Security Income due to their parents' income and/or resources (TEFRA), individuals residing in nursing homes who qualify for SoonerCare, and individuals with Medicare coverage who need assistance with premiums, coinsurance, and/or deductibles.
To apply for SoonerCare, you can apply online or at your local county DHS office. You can also download the application form from the DHS website or call the SoonerCare Helpline for assistance.
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Open enrollment and special enrollment periods
Open enrollment is a period during which anyone can apply for health insurance coverage. It is a time when individuals who are not currently enrolled in a health plan can explore their options and enroll in a plan that suits their needs. Open enrollment periods are typically annual and set by the health insurance provider or the state.
During the rest of the year, outside of the open enrollment period, you may still be able to enroll in a health plan under certain circumstances. This is known as a special enrollment period. Special enrollment periods are triggered by specific life events, allowing individuals to make changes to their health insurance coverage when these events occur.
For example, if you lose your existing health coverage due to a job loss, a strike, a lockout, or a labour dispute, you may qualify for a special enrollment period. Similarly, if you move out of your current plan's service area, you will have a special enrollment period during which you can join a new plan or switch to Original Medicare if you were previously enrolled in a Medicare Advantage Plan.
Special enrollment periods can also apply to individuals with Medicaid or Extra Help, allowing them to make changes to their coverage once a calendar month. Additionally, certain groups, such as AI/AN individuals, may have the flexibility to sign up for a health plan at any time of the year and change their plan as frequently as once a month.
It is important to note that the availability of special enrollment periods and the specific guidelines surrounding them can vary depending on your location and the health insurance provider. Therefore, it is always advisable to contact the relevant health insurance provider or refer to their official website for detailed information regarding open enrollment and special enrollment periods.
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Finding the right health insurance plan
Evaluate your needs:
Consider the medical services you or your family use most frequently. Do you require regular doctor visits, specialist care, prescription medications, or any specific services like maternity care or mental health services? Understanding your needs will help you prioritize the coverage options that are most relevant to you.
Compare premiums and out-of-pocket costs:
Health insurance plans typically require you to pay a premium, which can be paid monthly or annually. Compare the premium costs across different plans, but also consider the out-of-pocket expenses, such as deductibles and copays. Sometimes, a plan with a higher premium may offer more comprehensive coverage, saving you money overall if you frequently use healthcare services.
Check the provider network:
Ensure that your preferred doctors and hospitals are included in the plan's network. Choosing in-network providers will help you avoid higher out-of-network costs. Additionally, look for plans that offer a wide range of options within their network, including a diverse selection of doctors, clinics, and healthcare professionals.
Explore extra benefits:
Some health insurance plans offer additional perks and benefits beyond basic coverage. These may include wellness programs, telemedicine services, mental health services, or discounts on specific treatments. Consider whether these extra benefits align with your health goals and could enhance your overall well-being.
Understand Medicaid and SoonerCare:
If you have a low income or qualify for other eligibility requirements, you may be eligible for Medicaid, a state/federal program that covers medical expenses for certain groups. In Oklahoma, the Medicaid program is called SoonerCare and is administered by the Oklahoma Health Care Authority. SoonerCare also includes the state's Children's Health Insurance Program (CHIP).
Consider a licensed broker or navigator:
If you're unsure where to start or feel overwhelmed by the options, consider seeking assistance from a licensed broker or a My OK Plan navigator. These professionals can help you navigate the different plans, understand your options, and find affordable health insurance that meets your specific needs and budget.
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Applying for SoonerCare
To apply for SoonerCare, Oklahoma residents can either apply online or at their local county DHS office. The application process involves filling out a form and providing supporting documents.
Online Application
The first step in the online application process is to prepare for the application. This includes gathering detailed personal information, including:
- Taxable income for you and your spouse
- Social Security numbers and birth dates of people in your home
- Current or recent health insurance information
- Citizenship information or alien registration information
- Income information, including the employer name, address, and phone number of all household members who are employed
- Amount of money received from other types of income
- Expected date of delivery and number of babies for any pregnant household members
- Current health insurance information for all household members with health insurance, including company name, policy or group number, type of coverage, effective date, policyholder's name, and ID
Once you have gathered all the required information, you can proceed to the online application. You will need to create a user account to save and return to your application, check its status, and make any necessary changes.
Local County DHS Office Application
If you prefer, you can apply for SoonerCare at your local county DHS office. The DHS workers will assist you in gathering the necessary information, including your income, assets, family size, and recent medical information. They will also help you fill out the PS-1 - Request for Services application form, which you can also download from the DHS website.
Eligibility
To be eligible for SoonerCare, individuals must meet certain income and citizenship guidelines. Additionally, SoonerCare is available for specific groups, including:
- Disabled children who do not qualify for Social Security Income due to their parents' income and/or resources (TEFRA)
- Individuals who reside in nursing homes but qualify for SoonerCare
- Individuals with Medicare coverage who need assistance with premiums, coinsurance, and/or deductibles
- Individuals who were enrolled in Medicaid and aged out of foster care (at 18 years old) in another state on or after January 1, 2023
- Women with breast and/or cervical cancer
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Supplemental plans and extra coverage
Medicare Supplement Insurance, also known as Medigap, is one such option. Medigap is extra insurance that you can purchase from a private health insurance company to help cover the out-of-pocket costs associated with Original Medicare (Part A and Part B). In Oklahoma, you'll find ten Medicare Supplement plans offered by private insurers. Keep in mind that you cannot purchase both a Medigap and a Medicare Advantage plan in Oklahoma, as the latter replaces your complete Medicare plan. When considering a Medigap policy, it's important to review the specific benefits and costs associated with each plan. MoneyGeek, for instance, provides valuable insights into the pricing practices of different providers, helping you understand potential age-related charges.
Plan F and Plan G are the most popular choices among those eligible for Medicare. Plan F, offered by Aetna, costs around $144.78 per month and includes a high-deductible option that can lower your monthly costs to approximately $52.91. Plan G, also offered by Aetna, averages $120.80 per month and covers 80% of foreign exchange within plan limits. It's important to note that Plan G does not include Part B deductibles. Aetna also excels in its supplemental Plan N, which offers Foreign Travel Emergency coverage at a monthly rate of $89.78.
In addition to Medigap, Oklahoma offers SoonerCare, a health insurance program through the Oklahoma Health Care Authority. SoonerCare is designed for individuals and families who meet specific citizenship and income guidelines. It assists those with Medicare coverage in paying their premiums, coinsurance, and deductibles. SoonerCare also supports disabled children who don't qualify for Social Security Income due to their parents' income and resources. Moreover, it caters to individuals residing in nursing homes who meet the eligibility criteria.
When considering supplemental plans and extra coverage in Oklahoma, it's beneficial to explore options like Medigap and SoonerCare to ensure you have the right protection for your health needs.
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Frequently asked questions
You can find health insurance plans in Oklahoma at many price points. You can apply for Medicaid, also known as SoonerCare, which is a state/federal program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents, and women with breast or cervical cancer. You can also apply for private insurance plans, such as those offered by Blue Cross Blue Shield of Oklahoma, UnitedHealthcare, Ambetter, Medica, and Oscar.
It's important to consider factors such as the types of medical services you or your family use most frequently, whether you need regular doctor visits, specialist care, or prescription medications, and whether your preferred doctors and hospitals are included in the plan's network. You should also evaluate both premiums and out-of-pocket costs, as sometimes a plan with a higher premium may save you money overall if you frequently use healthcare services.
You can apply for SoonerCare online, or by downloading the English or Spanish application and mailing it in. You may also apply at your local county DHS office. If you need help filling out the form, you can call the SoonerCare Helpline at 1-800-987-7767.
Open enrollment for Oklahoma health insurance starts on November 1 and extends until January 15. If you need health insurance outside of this period, you may qualify for a special enrollment period if you've experienced a qualifying life event, such as having a baby or getting married.
Four out of five Oklahomans with coverage through the Marketplace receive financial help, and many individuals and families are now eligible for lower, or even $0, monthly premiums for ACA Marketplace health coverage. You can also look into short-term health plans if you are between jobs or waiting for the open enrollment period.
