Oklahoma Health Insurance

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Facts and Figures

Place in State
Health Report Card 48^th
Insured 3,004,008
Uninsured 578,500
Insurance
Carriers 6
Number of
Primary Care Physicians 6450
Number of
Hospitals 116
Average Cost of
Health Insurance* $787

Breakdown of Insureds

Employer-sponsored health insurance 57%
Private plans 5%
Medicaid 18%
Medicare 18%
Others 2%

Insurance Carriers

State Health Report Card

The rate of preventable hospitalizations decreased from 88.7 to 81.8 percent in the past year.The percentage of children under age 18 who are living in poverty has increased from 20.3 percent to 25.0 percent in the past year. The number of adults with diabetes has increased from 8.9 percent to 10.4 in five years. There are currently 293,000 adults with diabetes. The rate of obesity has increased from 19.7 percent to 31.3 percent in ten years. There are 669,000 adults in Oklahoma who smoke. This number is a drop from 25.1 percent to 23.7 percent in the past five years.

Oklahoma Health Insurance Laws and Regulations

State laws require Oklahoma health insurance providers to guarantee that policyholders can renew their coverage when they choose to. Insurers are also prohibited from terminating coverage due to a health condition. Oklahoma health insurance providers are allowed to implement an exception to coverage for conditions diagnosed or treated prior to the effectivity of your plan. This exception may last for months or permanently.HMOs in Oklahoma are exempt from this exclusion. Oklahoma health insurance providers can deny application based on risk factors. They also have the authority to set premium rates.Small businesses are allowed to purchase any group plans being offered in the state. However, small businesses must adhere to the requirements for group plans for them to be able to keep their coverage. Oklahoma health insurance providers are prohibited from cancelling a group policy because a member has become sick. Premium rates for group plans vary depending on the group’s risk factors.Self employed individuals are not allowed to purchase small business group plans.But they can earn tax credits for the Oklahoma health insurance plans they purchased.

Insurers are allowed to implement an exception to coverage for conditions diagnosed or treated prior to the effectivity of your plan. This exception may last for months or permanently.HMOs in Oklahoma are exempt from this exclusion.

Oklahoma health insurance providers can deny application based on risk factors. They also have the authority to set premium rates.

Small businesses are allowed to purchase any group plans being offered in the state. However, small businesses must adhere to the requirements for group plans for them to be able to keep their coverage. Insurers are prohibited from cancelling a group policy because a member has become sick.

Premium rates for group plans vary depending on the group’s risk factors.

Self employed individuals are not allowed to purchase small business group plans.But they can earn tax credits for the Oklahoma health insurance they purchased.

Heath Care Reform

Young adults in Oklahoma can now stay under their parent’s
policy. The new health law mandates health insurance companies to allow parents
to keep their children in their Oklahoma health insurance plans until age 26. 37,262 young adults in have benefited from this plan (as of June 2011).

Because of the new law, Medicare members no longer need to
worry about their extra prescription cost. Once they reach the donut hole in
2010, they are sent a check for a $250 rebate. 54,173 seniors in Oklahoma have
received the rebate to offset the cost of their prescription drugs. A 50
percent discount was also given for brand name drugs once they’ve hit the donut
hole. This resulted to an average savings of $28,461,930 for Oklahoma Medicare
members. The Affordable Care Act aims to close the donut hole by 2020.

One of the provisions of the health care reform is to
provide preventive care services free of charge for Medicare members and free
from cost-sharing for those enrolled under private plans. In 2011, 420,097
Medicare members and 616,000 private plan members in Oklahoma have
received free preventive care services like colonoscopies and mammograms.

The new health law protects consumers’ money through the
medical loss ratio which mandates insurers to spend 80 percent of their premium
dollars on medical care and only 20 percent on administrative costs. 855,000
Oklahoma residents are now able to maximize their Oklahoma health insurance quotes.

Insurers are no longer allowed to impose a lifetime limit on
their members’ benefits. 1,197,000 Oklahoma residents are now free from having
lifetime limits on their coverage. Patients with chronic diseases don’t have to
worry about maximizing their limit because of their accumulating medical costs.

Through the Pre-Existing Condition Insurance Plan, Oklahoma
residents who have pre-existing condition can now have affordable coverage. As
of 2011, 576 residents now have an Oklahoma insurance. Without this provision,
they would still remain uninsured. Oklahoma health insurance quotes for this plan is available from private insurers.

Oklahoma has received a $13.2 million grant to develop more health programs and
policies. They have also received $19.7 million to create more health centers
and to improve existing centers and the quality of health care delivered.

State Government Insurance Programs Offered

Medicaid SoonerCare www.okdhs.org (Search: SoonerCare)

800-987-7767

SoonerCare: Family planning, Home health inpatient, Laboratory and x-ray, Nurse-midwife, Nursing facility outpatient, Physician, Ambulatory surgical center, Hearing, Durable medical equipment, Prescription drugs, Prosthetics, Mental health, Rehabilitative services, Transportation services, Dental and vision for some people, and more. SoonerPlan: Office visits and physical exams related to family planning. Pregnancy tests, birth control education and supplies, Pap smears, STD screening. For patients age 21 and older, tubal ligations for women and vasectomies for men are offered. Fertility services are not covered. Eligibility: Both: Must be an Oklahoma resident and a U.S. citizen or legal alien who has been in the U.S. at least five years. SoonerCare: Aged, blind and disabled: Singles earning $715/ month with asset limit of $2,000. Couples earning $1,052/month for an eligible individual with an ineligible spouse; couples with both individuals eligible earning $1,093/month. Asset limit of $3,000 for both kinds of couples. Parents/caretakers living with children ages 0–18: 32% FPL. Pregnant women and children ages 0–18: 185% FPL SoonerPlan: Must be over 18 years old, uninsured, not enrolled in SoonerCare, and did not already have surgery that prevents pregnancy. Income limit of 185% FPL.

Insure Oklahoma (IO) www.insureoklahoma.org

888-365-3742

Insure Oklahoma: Limited health services subject to medical necessity, such as inpatient hospital services (acute care only), outpatient hospital services, prescription drugs, physician services, etc.

Child and Adolescent Health Clinical Services (CAHCS) cah.health.ok.gov (Search: Clinical Services)

405-271-4471

Eligibility: CAHCS: Must be age 0–21 years old, uninsured or underinsured for health care services. Income limit of 185% FPL. Services will not be refused based on patient’s inability to pay.

Medicare www.medicare.gov

800-633-4227

Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs. SHIP is a Medicare counseling service. Eligibility: Both: Must be U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age

Women-Infant-Children (WIC) www.ok.gov (Search: WIC)

405-271-4676 888-655-2942

WIC: Must reside in Oklahoma. Must be a pregnant or recently pregnant woman, or child up to age 5, and determined to be at nutritional risk. Income limit of 185% FPL.

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