Obamacare in Oklahoma

Health Insurance Marketplace in Oklahoma

If you live in Oklahoma, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov. Specific plans and prices are available now and coverage can start as soon as January 1, 2014.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Oklahoma has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Oklahoma’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)

Get local help

Oklahoma Community Health Centers, Inc.

Oklahoma Community Health Centers, Inc., a consortium comprised of a variety of non-profit organizations will apply a statewide approach to providing enrollment assistance to Oklahomans. Consortium members will have Navigators located in 57 cities across the states, enabling them to provide services in 45 counties in Oklahoma. Among other activities, funds will be used to target outreach to small business and small business groups, conduct outreach at community events and health fairs, target outreach to special populations served by consortium partners, and develop state-specific outreach materials for use by consortium members.

Little Dixie Community Action Agency, Inc.

Little Dixie Community Action Agency, Inc. plans on providing enrollment assistance to lower income families and individuals in local communities in Oklahoma by forming a consortium with 14 additional Community Action Agencies across Oklahoma, serving 63 counties in Oklahoma. Funding will be used to provide Navigator services in each of the 15 service areas, with an emphasis on leveraging existing staff with local ties to be trained as Navigators.

Information for:

Individuals and Families

Small businesses

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Accountable Care Organizations in Oklahoma

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

Health care facilities where Innovation Models are being tested

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Oklahoma

On November 19, 2012, Governor Mary Fallin (R) announced that Oklahoma would not pursue the creation of a state-based health insurance exchange.1

Prior to the announcement, Oklahoma had established the Joint Committee on Federal Health Care Law to explore the state’s options regarding federal health reform, including exchange implementation in the state.2 The Joint Committee convened in 2011 and released final exchange recommendations to the Governor and the Legislature in late February 2012.3,4 Committee recommendations included establishing a state-based private marketplace network to avoid federal involvement in the state; this would resemble a Utah model for small-businesses but would not include an individual exchange. A bill based on these recommendations was introduced in the 2012 legislative session (SB 1629) but failed at the end of the legislative session.5

The Oklahoma Health Insurance Exchange Project, led by the Secretary of Health as liaison to the Governor’s Office and State Legislature, the Oklahoma Department of Mental Health and Substance Abuse Services, the Insurance Department, and the Oklahoma Health Care Authority, began planning efforts in early 2011; however, the Project suspended activities in 2012 due to the exhaustion of federal grant funds.

On April 4, 2011, Governor Fallin signed into law a measure prohibiting any health insurance plans offered in the exchange from covering abortions except in cases of rape, incest, or life endangerment of the pregnant woman (SB 547).6 The bill allows health plan enrollees the option to purchase additional abortion coverage if desired.

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Oklahoma has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Oklahoma- BlueOptions PPO.

Exchange Funding

Oklahoma’s Department of Mental Health and Substance Abuse Services received a $1 million federal Exchange Planning grant. In addition, the Oklahoma Health Care Authority received a $54.5 million Early Innovator grant to develop model technological infrastructure for a health insurance exchange.7 In April 2011, Governor Fallin announced that Oklahoma planned to return the Early Innovator grant funding.8

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Oklahoma is considering an alternative proposal that would use money from the expansion and tobacco tax revenue to help state residents purchase coverage.

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in Oklahoma beginning in 2014.

For more information on Oklahoma’s health insurance exchange planning, visit: http://www.okhealthcare.info/


1. Press Release Governor Mary Fallin. Oklahoma will not pursue a state-based Exchange or Medicaid Expansion. November 19, 2012.http://www.ok.gov/triton/modules/newsroom/newsroom_article.php?id=223&article_id=9750
2. Press release. Health Care Law to be Studied over Interim. May 18, 2011.http://www.okhouse.gov/OkhouseMedia/ShowStory.aspx?MediaNewsID=4000
3. Summary of the Meetings of the Joint Committee on Federal Health Care Law. September 14, 2011- November 3, 2011.http://garystanislawski.net/okhealthcare.info/Presentations/Joint%20Comm%20Fed%20Health%20Care%20Laws%20summ.pdf
4. Final Report of the Joint Committee of Federal Health Care Law. Oklahoma Legislature. February 22, 2012.http://www.tulsaworld.com/webextra/content/items/FINAL%20Joint%20Committee%20on%20Federal%20Health%20Care%20Law%20Report.pdf
5. SB 1629. 2012 Regular Session. http://www.ok.gov/redirect.php?link_id=332
6. Senate Bill 547. Approved by Governor April 20, 2011.http://www.oklegislature.gov/BillInfo.aspx?Bill=sb547
7. Early Innovator Grant Awards. HHS announcement. February 16, 2011.http://www.healthcare.gov/news/factsheets/exchanges02162011a.html (Accessed August 23, 2011)
8. Politico. ‘Oklahoma governor returns $54M health care grant.’ April 14, 2011.http://www.politico.com/news/stories/0411/53216.html

Also of interest

Provided by the Henry J. Kaiser Family Foundation

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