Oklahoma health insurance

For 2020 coverage, Oklahoma individual-market buyers have a choice of three insurers. Short-term plans are now allowed to follow federal rules

Health insurance in Oklahoma

2020 health plan carriers, rates

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Oklahoma is among the states that have done the least to preserve the Affordable Care Act’s gains.

Those who shop Oklahoma’s federally facilitated exchange (marketplace) have a choice of three insurers for 2020, as Bright Health joined the exchange in the Oklahoma City area.

Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.

During the open enrollment period for 2020 health coverage, 158,642 people purchased private individual market plans through the Oklahoma exchange. Only a handful of states that use HealthCare.gov saw enrollment growth in 2020. Oklahoma is among them; only four states had a larger percentage increase in enrollment from 2019 to 2020.

Read our guide to the Oklahoma health insurance marketplace.

Oklahoma rules for short-term plans were relaxed in late 2019 to align with federal rules

Prior to November 2019, Oklahoma had fairly strict regulations for short=term health insurance plans — they couldn’t last more than six months, and couldn’t be renewed. But the state enacted legislation in 2019 that changed those rules. As of November 2019, short-term health plans in Oklahoma can follow the federal rules that allow for initial terms of up to 364 days, and total duration, including renewals, of up to three years.

Read more about short-term health insurance in Oklahoma.

Oklahoma Medicaid/CHIP enrollment

As of January 2020, there were 721,273 Oklahoma residents enrolled in Medicaid (SoonerCare) and CHIP in Oklahoma. That’s a decrease of 7 percent since 2013, although most of the decrease has occurred since late 2018, when the decrease stood at just 1 percent. Nationwide, enrollment in Medicaid/CHIP has increased by 26 percent since 2013.

Oklahoma has not expanded Medicaid under the ACA, so only about an eighth of the state’s Medicaid population is non-elderly adults. But nevertheless, Oklahoma is pursuing a waiver that would allow for a Medicaid work requirement. Governor Stitt has proposed a Medicaid expansion program that would take effect in mid-2020 but would phase in a work requirement, premiums, and a per-capita spending cap in 2021.

Although Oklahoma’s lawmakers and governors have steadfastly refused to expand Medicaid, consumer advocates took it upon themselves to gather enough signatures in 2019 to get a Medicaid expansion initiative on the ballot in Oklahoma in 2020. Gov. Stitt determined that it will be on the primary ballot on June 30, 2020.

Oklahoma and the Affordable Care Act

Oklahoma is one of five states considered “diehard hold outs” against Obamacare, according to a 2014 study from Georgetown University. In 2010, both of Oklahoma’s U.S. Senators, Republicans Thomas Coburn and James Inhofe, voted no on the ACA. In the U.S. House, one Democrat, the second district’s Dan Boren, voted yes, while four Republican Representatives from Oklahoma voted no. As of 2018, the entire US congressional delegation from Oklahoma was Republican, but Kendra Horn, a Democrat, has been representing the 5th District in the House since January 2019.

At the state level, there’s a strong Republican majority in both the House and Senate, and Gov. Kevin Stitt is also a Republican. Stitt opposes Medicaid expansion  (although he has proposed SoonerCare 2.0, which calls for expansion with subsequent restrictions added to the program) and believes that selling health insurance across state lines is a key to reducing premiums (Oklahoma enacted legislation in 2017 to allow this, but like the handful of other states that have done the same thing, they’ve had no interest from insurers wanting to participate).

But Oklahoma has also worked to try to create state-based health care reform solutions within the framework of the ACA. In 2017, Oklahoma submitted a 1332 waiver proposal to CMS, seeking federal pass-through funding for a reinsurance program (and the state was planning extensive additional reform via additional 1332 waivers that were to be submitted subsequently). But Oklahoma ultimately withdrew the waiver proposal amid delays in the federal approval process, when it was clear that the approval wouldn’t happen in time for rates to decrease for 2018.

Oklahoma enacted another bill, in 2018, authorizing the state to seek federal funding for a reinsurance program, but the state did not submit a waiver proposal to the federal government, so there is still no reinsurance program in Oklahoma as of 2020.

Does Oklahoma have a high-risk pool?

Prior to 2014, individual health insurance was underwritten in nearly every state, including Oklahoma. This meant that pre-existing conditions could prevent an applicant from getting coverage, or could result in significantly higher premiums or policy exclusions.

The Oklahoma Health Insurance High Risk Pool (administered by Blue Cross Blue Shield of Oklahoma) was created in 1995 to provide an alternative for people who were ineligible to purchase individual health insurance because of their medical history.

Implementation of the ACA and a guaranteed issue individual market have eliminated the need for high-risk pools, and the Oklahoma Health Insurance High Risk Pool ended operations as of December 31, 2014.

Medicare in Oklahoma

As of April 2020, there were 746,520 Oklahoma residents enrolled in Medicare. You can read more about Medicare in Oklahoma, including details about Medicare Advantage, Medicare Part D, and Oklahoma’s rules for Medigap (Medicare Supplement) plans.

State-based health reform legislation

Scroll to the bottom of this page for a summary of recent Oklahoma bills related to public health and healthcare reform.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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