Alyssa Lane
Insure Oklahoma is a health premium assistance program created by the state to bridge the gap in health coverage for low-income working adults. The program is not Medicaid but rather a form of Employer-Sponsored Insurance (ESI) where the state, employer, and employee share the cost of commercial health insurance premiums. Insure Oklahoma is open to Oklahomans aged 19-64 who meet certain income requirements and are not enrolled in Medicare or Medicaid. The program allows eligible employees to access affordable health care and dental plans.
| Characteristics | Values |
|---|---|
| Purpose | To bridge the gap in health coverage for low-income working adults |
| Age limit | 19-64 |
| Cost sharing | State (60%), employer (25%), employee (15%) |
| Contact | Insure Oklahoma, PO Box 54200, Oklahoma City, OK 73154, (888) 365-3742, Fax: (405) 949-9563 |
| Enrollment period | SoonerSelect enrollment is open through June 13 |
| Exclusion criteria | Enrolled in Medicare or Medicaid |
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What You'll Learn
- Insure Oklahoma is a health premium assistance program for low-income working adults
- The program is for those aged 19-64 who meet annual gross household income limits
- Insure Oklahoma is not for those enrolled in Medicare or Medicaid
- The state, employer and employee share commercial health insurance premium costs
- SoonerSelect allows members to pick or change their health and dental plans
Insure Oklahoma is a health premium assistance program for low-income working adults
Insure Oklahoma is a health premium assistance program designed to bridge the gap in health coverage for low-income working adults. Under the Employer-Sponsored Insurance (ESI) option, the state, employer, and employee share the cost of commercial health insurance premiums. Specifically, the state pays 60% of the premium costs, the employer contributes 25%, and the employee pays the remaining 15%. This program aims to provide affordable health care for eligible employees by helping small business owners offer health insurance to their staff and their families.
To qualify for Insure Oklahoma, an individual must be between the ages of 19 and 64, meet annual gross household income limits, and not be enrolled in Medicare or Medicaid. Additionally, they must work for an Oklahoma business with 250 or fewer employees but not qualify for Insure Oklahoma Employer-Sponsored Insurance. Small business owners can apply for Insure Oklahoma premium subsidies if they have 250 or fewer employees, offer a qualified health plan, and contribute at least 25% of the premiums for their qualifying employees.
It is important to note that Insure Oklahoma is not Medicaid. Instead, it is a separate program designed to assist low-income working adults who do not qualify for Medicaid or Medicare. Medicaid, on the other hand, is a state/federal program that provides medical services for specific low-income groups, such as pregnant women, children, elderly individuals, people with disabilities, parents, and women with breast or cervical cancer. Each state has its own Medicaid program, and individuals must meet income and other eligibility requirements to qualify for this program.
The Insure Oklahoma program has been successful in insuring more people and helping residents maintain their health insurance. This success aligns with the program's mission to increase access to health insurance for those who need it. As of the latest update, there are 4,752 businesses enrolled in the program.
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The program is for those aged 19-64 who meet annual gross household income limits
The INSURE (Improving health and Creating Opportunities) Oklahoma waiver program is designed for adults aged 19 to 64 who meet certain annual gross household income limits. This program provides healthcare coverage to low-income adults who would otherwise not be eligible for traditional Medicaid.
To be eligible for INSURE Oklahoma, an individual's income must not exceed a certain threshold. Specifically, the program is targeted towards those with an annual gross household income at or below 133% of the federal poverty level. This income limit is subject to change annually, so it is important to refer to the latest guidelines to determine eligibility.
For the year 2023, the income limits for the INSURE Oklahoma program are as follows: for a household size of one person, the annual gross income limit is $17,774; for a household size of two people, the limit is $24,088; and for a household of three people, the limit is $30,402. These limits increase by $6,314 for each additional household member.
These income limits are used to determine eligibility for the program, and individuals or families must provide documentation to verify their income during the application process. This may include providing pay stubs, tax returns, or other financial documents. Additionally, applicants must be residents of Oklahoma and meet other general eligibility requirements for Medicaid, such as citizenship or immigration status.
By focusing on this specific income bracket, the INSURE Oklahoma program aims to provide healthcare coverage to low-income adults who may have difficulty accessing affordable healthcare. This includes individuals who do not have employer-provided insurance and those who are not eligible for other government-sponsored programs. The program offers a range of benefits, including coverage for preventive care, hospital services, prescription drugs, and more.
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Insure Oklahoma is not for those enrolled in Medicare or Medicaid
Insure Oklahoma is a health premium assistance program designed to bridge the gap in health coverage for low-income working adults in the state. The program is not available to those enrolled in Medicare or Medicaid. This is an important distinction, as there are often misconceptions or confusion around this topic.
Insure Oklahoma's Employer-Sponsored Insurance (ESI) plan helps employers provide their eligible employees with affordable healthcare options. Under this plan, the costs of commercial health insurance premiums are shared by the state, the employer, and the employee. Specifically, the state covers 60% of the costs, the employer contributes 25%, and the remaining 15% is paid by the employee. This plan is designed to make health coverage more accessible and affordable for low-income individuals who may otherwise struggle to obtain adequate healthcare.
To be eligible for Insure Oklahoma, individuals must meet certain criteria. Firstly, they must be between the ages of 19 and 64 and meet the annual gross household income limits set by the program. Additionally, they should not be enrolled in Medicare or Medicaid, as these programs have different eligibility requirements and benefit structures. It's important to note that Insure Oklahoma is specifically targeted at working adults who may not qualify for traditional assistance programs like Medicare or Medicaid.
The distinction between Insure Oklahoma and Medicare or Medicaid lies in their target populations and funding structures. Insure Oklahoma is designed for low-income working adults who may not qualify for other assistance programs. It provides a way for individuals to obtain affordable healthcare through their employers, with shared costs between the state, employer, and employee. On the other hand, Medicare and Medicaid are federal and state-funded programs, respectively, with different eligibility criteria and benefit packages.
While Insure Oklahoma is not for those enrolled in Medicare or Medicaid, it serves as a valuable option for low-income working adults in the state who need assistance in obtaining affordable healthcare. By bridging the gap in health coverage, Insure Oklahoma helps ensure that more individuals have access to the healthcare services they need. For those who are enrolled in Medicare or Medicaid, it is important to understand the benefits and limitations of those programs and explore other available options if needed.
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The state, employer and employee share commercial health insurance premium costs
Insure Oklahoma is a health premium assistance program that aims to bridge the gap in health coverage for low-income working adults. The program offers two options: Employer-Sponsored Insurance (ESI) and a state-sponsored individual plan (IP).
Under the ESI option, commercial health insurance premium costs are shared by the state, the employer, and the employee. Specifically, the state covers 60% of the costs, the employer contributes 25%, and the employee pays the remaining 15%. To qualify for premium assistance under this option, employers must have an operating location in Oklahoma and have a Federal Employer Identification Number (FEIN) issued by the Oklahoma Employment Securities Commission. Employees must be between the ages of 19 and 64, meet annual gross household income limits, and not be enrolled in Medicare or Medicaid. They must also work for an Oklahoma business with 250 or fewer employees but not qualify for Insure Oklahoma Employer-Sponsored Insurance.
The O-EPIC ESI, or Oklahoma Employer and Employee Partnership for Insurance Coverage, is a qualified health plan approved by the Oklahoma Health Care Authority. It offers benefits including hospital, physician, clinical laboratory and radiology, pharmacy, and office visits. The plan may require copayments and deductibles, with restrictions to ensure affordability for members. For example, an annual out-of-pocket maximum cannot exceed $3,000 per person covered, and an office visit copayment cannot be more than $50 per visit.
The IP option, or O-EPIC IP, is available for individuals who are self-employed, work for small employers but are ineligible for employer-sponsored insurance, or are unemployed and seeking work. Spouses of eligible employees can enroll in either the ESI or IP, while dependent children in the family would qualify for the state's SCHIP program. The benefit package for the Individual Plan is limited compared to the ESI option.
The Insure Oklahoma program helps employers provide their eligible employees with affordable healthcare. It is a way for employers to retain good employees and ensure their workforce has access to the healthcare they need.
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SoonerSelect allows members to pick or change their health and dental plans
SoonerSelect is a healthcare delivery system that allows members to pick or change their health and dental plans. It is a program that coordinates health and dental care to improve the overall quality of care. SoonerSelect provides Medicaid health benefits through contracted arrangements between state Medicaid agencies, health plans, and dental plans.
SoonerSelect enrollment is open to all residents of Oklahoma's 77 counties. Members can choose between three health plans: Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma, and Oklahoma Complete Health. Each health plan has its own network of providers, including doctors, dentists, pharmacists, and mental health professionals. Members can compare the benefits of each plan and choose the one that best suits their needs.
The SoonerSelect Dental Program enables members to enroll in a dental plan that covers essential preventive and restorative dental care, as well as medically necessary orthodontic services for children under 21. Similar to the health plans, members can compare the benefits offered by different dental plans and select the one that meets their requirements.
It is important to note that American Indian and Alaska Native members have the option to opt in to a SoonerSelect plan but are not required to enroll. Additionally, members involved in the juvenile justice system and those served by Oklahoma Human Services, including children in foster care and receiving adoption assistance, will enroll in a children's specialty plan instead of the regular health plan.
SoonerSelect does not incur any additional costs for enrollment. However, members may be responsible for copays for certain services.
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Frequently asked questions
Insure Oklahoma is a health premium assistance program created to bridge the gap in health coverage for low-income working adults.
Under the Employer-Sponsored Insurance (ESI) option, commercial health insurance premium costs are shared by the state (60%), the employer (25%), and the employee (15%).
To qualify for Insure Oklahoma, an individual must be between the ages of 19-64, meet annual gross household income limits, not be enrolled in Medicare or Medicaid, and work for an Oklahoma business with 250 or fewer employees.
You can enroll in Insure Oklahoma by visiting the Insure Oklahoma website or contacting their office at (888) 365-3742.
SoonerCare is a health coverage program for Oklahomans who meet certain income guidelines and other eligibility requirements. Insure Oklahoma is a premium assistance program for low-income working adults who do not qualify for SoonerCare or Medicaid.
