Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

Oklahoma residents have plenty of health care options to consider when looking for coverage. You can receive insurance benefits from an employer, purchase private insurance, or enroll in Medicare or Medicaid.

This guide reviews these options in greater detail.

What to know about health insurance in Oklahoma

  • Marketplace plans: Oklahoma lets residents purchase private insurance to meet their needs, even if they have insurance through their employer.
  • Open Enrollment: Each year, residents enroll in insurance plans through the Health Insurance Marketplace during the open enrollment period from November 7 through December 15.
  • Special Enrollment: If you miss open enrollment, you might still qualify to enroll during a special enrollment period. Qualifying life events include getting married, having children, changing jobs, or moving into a new home.
  • Health Insurance Marketplace: Because Oklahoma doesn’t have a state health care exchange, the only way to receive the Advanced Premium Tax Credit is to enroll through the federal Health Insurance Marketplace.
  • Premium tax credit: You don’t need to enroll through the Health Insurance Marketplace if you’d prefer to purchase insurance elsewhere. However, you can only get the Advanced Premium Tax Credit when you enroll through the marketplace.
  • Coverage types: Around 5% of Oklahoma’s residents are insured by employers, while 5.5% have private insurance. In addition, 17% of the state residents have Medicaid, and an additional 15% have coverage through Medicare. Conversely, nearly 15% of Oklahoma’s residents are uninsured.

How do I enroll in Oklahoma’s health insurance marketplace?

Because Oklahoma doesn’t have an exchange, you can enroll for coverage on the federal exchange by visiting and creating an account. Follow the instructions, provide your contact information, and set your security questions. After you’ve created your account, you’re able to apply for insurance.

Ensure that you have all of the required information available for each person you’re going to place on your coverage. This information includes:

  • Each person’s full name
  • Each person’s birth date
  • Each person’s Social Security number
  • Household income
  • The number of dependents you claim on your taxes
  • Marital status
  • Whether you’d like to apply for financial assistance will automatically determine if you qualify for the Advanced Premium Tax Credit, Medicaid, or additional financial assistance programs. You can use the comparison tool to evaluate up to three plans at once. The tool allows you to see key differences such as the monthly premium, deductible, and coinsurance requirements for each policy so that you can make an informed decision. After you’ve chosen your plan, you can complete your enrollment.

The following insurance companies offer health insurance coverage in Oklahoma:

  • Blue Cross Blue Shield of Oklahoma
  • Bright Health
  • CommunityCare Oklahoma
  • Medica
  • Oscar Insurance Company
  • UnitedHealthcare

How do I enroll in Oklahoma individual and family insurance?

Whether you need individual or family coverage, the enrollment process is the same. Still, if you’re buying insurance for your entire household, there’s far more to consider. You need to find a balance between your ability to afford monthly premiums, the type of plan you want, your family deductible, and how much you need to use your insurance.

Insurance for Individuals in Oklahoma

As an individual, you can customize your coverage to your needs with greater ease without considering how coverage impacts other people. For example, you can save money by accepting a greater deductible and copayment requirement. If you need more coverage from your insurance, you’re going to pay more out-of-pocket.

On the federal exchange, there are three types of plans. Each offers different benefits for you to consider while also coming with drawbacks.

  • Health Maintenance Organization plans (HMOs) can save you money with lower premiums. However, HMOs restrict doctor choice because you must choose one from a predetermined network of doctors. Furthermore, HMOs require you to get a referral from your primary care provider to see a specialist.
  • Preferred Provider Organization plans (PPOs) let you choose where you receive treatment and won’t force you to get referrals to specialists. Be cautioned. PPO plans cost more each month.
  • Point-of-Service plans (POS plans) combine HMO and PPO benefits. POS plans give you a network of available physicians and let you see doctors outside of your network, provided you agree to higher copayments.

Insurance for families in Oklahoma

Shopping for family coverage is a little more complicated than finding a plan just for yourself. Consider the total cost of care for everyone in your family instead of focusing on monthly premiums when considering a plan. Even if you’re young and healthy, your spouse or children might require greater access to care than you do.

Paying lower monthly premiums may require you to meet higher deductibles and pay higher coinsurance requirements. First, choose a deductible you believe you can afford and calculate your copayment cost should your family need medical treatments. Then, decide if paying more per month for insurance saves you money by reducing your out-of-pocket expenses.

  • While you might prefer one type of plan, investigate the network of doctors you’d be allowed to see if you enrolled in an HMO or POS plan. The available specialists in-network might suit your needs, potentially saving you money.

How much does health insurance cost in Oklahoma?

The Health Insurance Marketplace offers four tiers of health insurance coverage: bronze, silver, gold, and platinum. These tiers divide plans into groups based on deductibles, premiums, and coinsurance requirements. Consider whether the coverage provided by a more expensive plan can reduce your total cost of care.

Average premiums in Oklahoma 2018 2019 2020 2021
Most affordable bronze Plan $395 $361 $365 $367
Most affordable silver Plan $535 $529 $527 $504
Most affordable gold Plan $664 $522 $521 $502

  • Bronze plans have the lowest monthly premiums, but a lower cost is in exchange for higher deductibles and copayments. With a bronze plan, you’d be responsible for 40% of the after-deductible cost of your medical expenses whenever you see a doctor, visit a hospital, or require a procedure. This may be a good choice if you’re young and healthy and want coverage if an emergency strikes. In 2021, the cheapest bronze plan in Oklahoma costs $367 per month.
  • Silver plans cost more each month but also offer lower deductibles and copayments. You qualify for a silver plan for less than a bronze plan would cost if your income fits under the threshold for assistance. You’d be required to pay a 30% copay after your deductible on all medical services you receive. A silver plan will offer a lower deductible than a bronze plan. The cheapest 2021 silver plan in Oklahoma costs $504 per month.
  • Gold and platinum plans are traditionally the most expensive policies. They also provide the most comprehensive coverage with low deductibles and copays. A gold plan offers a copay of 20%, while a platinum plan only requires 10% coinsurance. The cheapest plan in 2021 costs $502 per month.

What kind of low-income health insurance is available in Oklahoma?

Oklahoma residents have access to two different low-income health insurance programs as long as your income is under the recommended threshold. SoonerCare is Oklahoma’s Medicaid program. The CHIP program provides insurance coverage to children living in households that can’t afford to insure them. Your eligibility depends on your total household income and the number of people in your household.

SoonerCare in Oklahoma

To qualify for SoonerCare, you must be:

  • Pregnant
  • Disabled
  • Over the age of 65
  • The parent or legal guardian for minor children

If a member of your household is disabled, you may qualify for SoonerCare as well. SoonerCare covers routine medical care, hospital stays, approved outpatient care, diagnostic testing, and rehabilitative therapy.

SoonerCare is only available if your income is considered low or very low, which means your total household income can’t exceed the maximum threshold for your household size. For example, an individual making less than $17,131 qualifies for SoonerCare. Conversely, a household of two qualifies as long as its total income remains under $23,169. A household of five would qualify so long as the total income remained under $41,284.

SoonerCare may assist Oklahoma residents over the age of 18 who require long-term nursing home care. A qualified assisted living center or nursing home must provide these services.

To apply for SoonerCare, you can enroll through the Member Portal on the state website. After you’ve created your account, you can see whether you’re eligible and enroll online.

Oklahoma CHIP Program

Residents who don’t qualify for SoonerCare may still receive assistance for their children through the Children’s Health Insurance Program (CHIP). This program provides coverage for preventative care, immunizations, emergency care, mental health services, hearing or speech therapy, dental care, and approved outpatient procedures. If you’re pregnant, you may also qualify for coverage for prenatal care during pregnancy. Check eligibility by visiting the SoonerCare website and entering your income information, household size, age of all your household members, and any special coverage needs.

What are Oklahoma’s Medicare Options for Seniors and People with Disabilities?

Oklahoma has multiple options that provide older residents and the disabled with insurance coverage.

  • Original Medicare includes Medicare Part A and B. Medicare Part A covers hospital visits, skilled nursing care, home health care, and hospice care. Medicare Part B covers routine doctor visits, testings, exams, emergency room visits, outpatient procedures, and more. Original Medicare doesn’t provide prescription drug coverage but does cover some outpatient drugs. You’re able to enroll in Part D if you need prescription coverage.
  • Medicare Advantage is an alternative to Medicare that allows residents to choose a private insurance company rather than the government for its coverage. An Advantage plan must cover everything provided by Medicare Parts A and B. But, you can customize your coverage by adding dental, vision, prescription drug coverage, and additional perks. If your Advantage plan doesn’t cover prescription medications, you’re still allowed to enroll in Medicare Part D.

Medicare Supplement Insurance plans are sold by insurers and cover the out-of-pocket expenses you’re responsible for that aren’t covered by your Medicare plan. Enrolling in one of these plans is advised if you’re concerned about your ability to cover a significant medical expense. A Medicare supplement plan can cover your deductibles, coinsurance, and additional out-of-pocket expenses.

Eligibility and Enrollment
Eligibility Before enrolling in Medicare, you need to meet eligibility requirements. Medicare is available if you’re a U.S. citizen or permanent resident 65 or older or have a disability that causes you to receive SSDI benefits for at least 24 months. You may also qualify for Medicare at a younger age if you have ALS or end-stage renal disease. To be eligible for automatic enrollment when you turn 65, you must have contributed to Social Security for at least ten years.
Enrollment Periods Three months before you turn 65, you’ll become eligible for an initial enrollment period. During the IEP, you’ll have an opportunity to sign up for Medicare. If you started receiving Medicare before the age of 65, you could make changes to your coverage at this time.

You’re also able to enroll during the General Enrollment Period from January 1 to March 31 or change your plan during Open Enrollment each year. Open Enrollment begins on October 15 and ends on December 7, when you can switch between Medicare and an Advantage plan or change your Medicare Part D coverage.

Medicare Resources

For further assistance, you can contact the Oklahoma Insurance Department by calling 800-763-2828. The OID can help you find an insurance plan and assist with enrollment.

Are there short-term health insurance plan options in Oklahoma?

Oklahoma recently removed state restrictions on short-term insurance plans to make it easier to access a temporary insurance plan if you need one. Temporary health insurance bridges a gap in health coverage resulting from changing jobs, moving, missing your enrollment deadline for coverage, or waiting for Medicare enrollment.

Oklahoma residents can purchase short-term policies with a maximum duration of one year. You’re also able to apply to renew a short-term policy up to two times for up to three years of total coverage with one insurance company. These policies don’t have the same restrictions that the ACA places on other insurance policies. Thus, an insurance company may increase your rates due to a medical condition, refuse to cover a preexisting condition or deny coverage outright.

If you lose your job or have missed an enrollment period for a different type of coverage, shop for a plan immediately. If you’re injured or are diagnosed with an illness during a coverage gap, you’re responsible for the entire cost of your medical treatment. This is why short-term coverage exists – so that you’re able to protect yourself until you find something more permanent.

Oklahoma insurance FAQs

Does Oklahoma require health insurance?

You’re not required to purchase health insurance in Oklahoma, but it’s still a good idea to do so. The Affordable Care Act mandates that every United States citizen have health insurance, but the federal government removed the penalty for not having insurance in 2019.

Do I have to use the Health Insurance Marketplace in Oklahoma?

You’re free to purchase insurance from wherever you choose. However, there are benefits to using the federal exchange to buy coverage. The primary benefit is the Advanced Premium Tax Credit. Unless you enroll using the Health Insurance Marketplace, you’ll miss out on this benefit. Some people don’t want or qualify for the credit and obtain coverage elsewhere.

What types of alternative health insurance plans (like cost-sharing plans) are available in Oklahoma?

In addition to ACA-compliant health insurance and short-term policies, residents can find cost-sharing plans offered by Health Care Sharing Ministries (HCSMs), which may pay for health care costs at a lower cost than insurance.

Do I need health insurance if I have HSA/FSA?

Flexible savings accounts and health savings accounts are good ideas if you’re concerned about protecting yourself from a sudden medical expense that you couldn’t afford. Of course, you’d need to save lots of money to be able to afford health care without insurance. Most people open one of these accounts to save for out-of-pocket expenses such as paying your deductible and copay. Still, it’s not a replacement for health coverage.

Do I need short-term disability coverage in Oklahoma if I have health insurance?

Short-term disability coverage is a supplemental type of insurance that helps you pay your bills if you’re disabled due to illness or injury. While you’re unable to work, it provides you with the money you need to pay for your ordinary bills. It’s essential to know the difference between short-term disability insurance and health coverage. Your health insurance pays for your doctor’s visits and medical treatment, while the added coverage helps you pay other costs.

Do I need long-term disability coverage in Oklahoma if I have health insurance?

Long-term disability coverage functions in the same manner as short-term disability insurance because it protects you when your injury or illness keeps you from being able to work for a long time. Therefore, it covers the same things that short-term disability coverage does and is an excellent supplement to health insurance.

What does CHIP cover?

Oklahoma’s Children’s Health Insurance Program covers routine care, immunizations, diagnostic testing, mental health, dental, vision, emergency care, and medically necessary procedures. It also helps pregnant mothers with the cost of their prenatal care.