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Attention Cowboy and Sooner fans: get your head in the health care game

Open enrollment to buy medical insurance in the new health insurance marketplaces kicks off Oct. 1.
by Paula Burkes Published: August 28, 2013

My OSU and OU friends are burning up Facebook with posts about this weekend's football season openers — from a Bomber classmate's pick for the Sooners' starting quarterback to a Theta sister's road trip to Houston. Meanwhile, there's little talk online or off and a lack of awareness of another opener that's just around the corner.

Open enrollment to buy private medical insurance in new health insurance marketplaces kicks off Oct. 1.

For 12 months' coverage effective Jan. 1, Oklahomans will have bronze, silver, gold and platinum options to choose from a variety of plays, er plans — from going deep with Hail Mary passes, or a high out-of-pocket deductible to cover mainly medical emergencies — to playing it closer with off-tackles runs, or higher monthly premiums for more covered benefits — to plans in between.

The marketplaces, which are part of the Affordable Care Act (ACA) signed into law in March 2010, are meant to provide coverage to people who don't have season tickets for health insurance — either through their work, Medicare, or Medicaid, the state-federal insurance for needy women and children.

According to the Kaiser Family Foundation, about 17 percent of people in Oklahoma lack insurance.

Oklahoma's marketplaces — for individuals and families, and small businesses — will be federally-run, and phone or online enrollment will be available. To watch a pregame show of your options now, visit or call (800) 318-2596.

Some employer mandates under the ACA have been postponed by a year — until Jan. 1, 2015. But the law's main game rule — what's known as the “individual mandate” — still takes effect Jan. 1.

That's when most Americans are required by law to have health insurance or pay penalties on their tax returns. Residents who buy health insurance on the exchange and have incomes between 100 percent and 400 percent of the federal poverty level ($11,490 to $23,550, or $31,322 to $94,200 for families of four) will be eligible for variable tax credits depending on income and family size.

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by Paula Burkes
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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Insurers can't deny coverage based on pre-existing conditions.

Most U.S. residents must have health insurance or pay penalty taxes on their 2014 tax returns. This new tax is the greater of $95 or 1 percent of income in 2014, $325 or 2 percent of income in 2015 and $695 or 2.5 percent of income in 2016.

Residents with incomes between 100 percent and 400 percent of the federal poverty level ($11,490 to $23,550, or $31,322 to $94,200 for families of four) will be eligible for variable tax credits depending on income and family size.


Insurers may not deny coverage to a dependent child younger than age 19 because of pre-existing conditions.

Insurers may not impose lifetime coverage limits and, until 2014, may set only restricted annual limits for comprehensive health benefits, including mental health and substance abuse.

Insurers must cover A- and B-level preventive services such as screenings and immunizations, recommended by the U.S. Preventive Services Task Force, with no co-payments or deductibles.

Children who don't receive health care coverage from employers can stay on their parents' plans to age 26, regardless of marital or student status.

A new 80/20 loss-ratio rule requires health insurers to spend no more than 20 percent of customer premiums on administration.


Businesses with 50 or more full-time equivalent employees must offer health insurance to employees who average 30 or more hours per week from the preceding year or pay annual penalties of $2,000 per full-time employee, excluding their first 30.

SOURCE: U.S. Department of Health and Human Services.


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