Oklahoma Health Insurance Consumer Guide

To be able to enroll in a health plan through the Oklahoma Marketplace, you must: ⁴

• Live in Oklahoma
• Be lawfully present in the United States
• Not be incarcerated
• Not be enrolled in Medicare

Eligibility for financial assistance (premium subsidies and cost-sharing reductions) depends on your income. In addition, to qualify for financial assistance with your Marketplace plan you must:

• Not have access to affordable health coverage offered by an employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP.
• Not be eligible for premium-free Medicare Part A.⁵
• If married, file a joint tax return.⁶
• Not be able to be claimed by someone else as a tax dependent.⁶

In Oklahoma, open enrollment for individual and family health coverage runs from November 1 to January 15.⁷ 

Your coverage will start on January 1 if you enroll before December 15. But if you apply between December 16 and January 15, your coverage will begin on February 1.⁷ 

Outside of open enrollment, a special enrollment period (typically linked to a specific qualifying life event) is necessary to enroll or make changes to your coverage.

If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment. We also have a comprehensive guide to special enrollment periods.

To enroll in an ACA Marketplace plan in Oklahoma, you can: 

• Visit Healthcare.gov to access Oklahoma’s Health Insurance Marketplace. Here you will find an online platform to shop, compare, and choose the best health plans. 
• Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.⁸

You can reach HealthCare.gov’s call center by dialing 1-800-318-2596 (TTY: 1-855-889-4325). The call center is available 24 hours a day, seven days a week, except holidays.

Oklahoma uses the federally run exchange/Marketplace for individual market plans, so residents who buy their own health insurance enroll through HealthCare.gov.

Ninety-seven percent of Oklahoma Marketplace enrollees save money on their 2024 premium payments, because they qualify for advance premium tax credits (premium subsidies). The average subsidy in Oklahoma amounts to $574/month, bringing the average net premium down to just $79/month.⁹

In addition to premium tax credits (subsidies), the Affordable Care Act provides cost-sharing reductions (CSR) that will reduce out-of-pocket costs on Silver-level plans if your household income isn’t more than 250% of the poverty level.¹⁰ In 2024, half of Oklahoma Marketplace enrollees were receiving CSR benefits.⁹

(Note that the numbers above are based on effectuated enrollment in early 2024, while the numbers in the graphic below are based on everyone who enrolled during the open enrollment period for 2024 coverage. So there’s some variation in the numbers and the metrics reported.)

Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan in the Oklahoma Health Insurance Marketplace provides the best value for your health insurance needs.

Source: CMS.gov¹¹

Oklahoma implemented the ACA’s expansion of Medicaid starting in mid-2021, under the terms of a voter-approved ballot measure. So Medicaid is available to Oklahoma adults under age 65 with household income up to 138% of the poverty level — currently a little under $21,000 in annual income for a single person.¹² (Medicaid was already available to children with even higher household income,¹³ and is available to older adults but with both income and asset limits.)

For 2025, seven insurers will offer health plans through the Oklahoma exchange, all of which also offered coverage in 2024.³ 

In 2024, insurer participation varies significantly from one area to another. Some counties have just one insurer offering Marketplace plans, while others have at least five.²

For 2025, Taro Health is expanding its individual market coverage area in Oklahoma from three counties to 27 counties.¹⁴

Oklahoma’s Marketplace insurers have proposed the following average rate changes for 2025:³ 

Source: RateReview.HealthCare.gov³

The proposed rate changes apply to full-price premiums, but most Oklahoma Marketplace enrollees qualify for premium subsidies and thus do not pay full price for their coverage.⁹

Most of the filings have their enrollment numbers redacted, but BCBSOK’s filing notes that they have 147,775 enrollees in individual market plans in Oklahoma.¹⁵ In most states, virtually all of the individual market is on-exchange, and Oklahoma’s entire on-exchange enrollment stood at 194,387 people as of early 2024.⁹ So BCBSOK likely had about three-quarters of the market share, giving their proposed 4% rate increase a lot of weight in terms of an overall weighted average.

Oklahoma is one of only three states that do not have their own effective rate review programs, so Oklahoma health insurance rates are reviewed by federal regulators.¹⁶

For perspective, here’s an overview of how full-price (pre-subsidy) premiums have changed over time in Oklahoma’s individual/family market:

• 2015: Average increase of 12.2%¹⁷
• 2016: Average increase of 25.8%¹⁸
• 2017: Average increase of 76%¹⁹ (CSR cost added to 2017 rates, a year ahead of other states)²⁰
• 2018: Average increase of 8.7%²¹
• 2019: Average decrease of 1.9%²²
• 2020: Average increase of 2.7%²³
• 2021: Rates mostly unchanged²⁴
• 2022: Average increase of 4.4%²⁵
• 2023: Average increase of 8%-10%²⁶
• 2024: Average increase of 4.4%²⁷

Oklahoma submitted a 1332 waiver proposal to the federal government in 2017. The goal was to create a reinsurance program to reduce full-price premiums in the state’s individual market, followed by additional extensive state-led reforms. But amid approval delays the state withdrew the waiver proposal and has not revisited the issue since.²⁸

During the open enrollment period for 2024 coverage, 277,436 people enrolled in private individual market plans through Oklahoma’s exchange.²⁹ This was the sixth year in a row that Oklahoma’s exchange enrollment had hit a record high, and the enrollment growth was particularly large for 2024 (see chart below). 

The surge in enrollment during these years was due in part to American Rescue Plan (ARP) provisions that made ACA’s premium subsidies more substantial. Under the ARP – now extended by the Inflation Reduction Act – subsidies are more significant and accessible through the end of 2025.³⁰

The 2024 enrollment growth was also partially due to the “unwinding” of the pandemic-era Medicaid continuous coverage rule. By April 2024, CMS reported that nearly 118,000 Oklahoma residents had transitioned from Medicaid to a Marketplace plan by that point during the unwinding period.³¹

Source: 2014,³² 2015,³³ 2016,³⁴ 2017,³⁵ 2018,³⁶ 2019,³⁷ 2020,³⁸ 2021,³⁹ 2022,⁴⁰ 2023,⁴¹ 2024⁴²

HealthCare.gov
800-318-2596

State Exchange Profile: Oklahoma
The Henry J. Kaiser Family Foundation overview of Oklahoma’s progress toward creating a state health insurance exchange.

Oklahoma Insurance Department
Assists people insured by private health plans, Medicaid, or other plans in resolving problems pertaining to their health coverage; assists uninsured residents with access to care. (405) 521-2991 / Toll Free in OK: (800) 522-0071 / [email protected]