If you're planning to shop this fall for a private medical insurance policy to cover yourself or your family next year, take care. Don't give out your Social Security number or any personal account numbers, especially if you're not sure you're dealing with a secure source. And that goes for whether you shop on — or off — Oklahoma's new federally-run online health insurance marketplace, for which enrollment opens Oct. 1.
About a month ago, Larry Gundlach of Oklahoma Business Insurors surfed for private insurance on the online search engine Google.com. He purposefully clicked on a Blue Cross and Blue Shield link that he knew wasn't the carrier's home website. He supplied his name, email and phone, and, within a few hours, had a call from one of the many insurance agents who sells Blue Cross and Blue Shield coverage.
When Gundlach explained that he only was doing research, he was told that he'd be put on a Do Not Call List, but he got calls for weeks afterward and still is getting emails. The most recent read: “Good news: you're approved,” which is misleading in itself because come Jan. 1, everyone is approved.
Under new health reform laws, insurers — starting in 2014 — can't deny people medical coverage based on any illnesses or health conditions they may have. Also, beginning next year, most residents — by law — must have health insurance or pay penalty taxes on their 2014 tax returns.
In Sunday's editions of The Oklahoman, medical reporter Jaclyn Cosgrove and I will explain how the new marketplace may help you.
Any Oklahoma resident is welcome to shop in it, and individuals who 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 subsidies, depending on income and family size. For example, starting in January, a resident who qualifies for discounts might pay monthly insurance premiums of $200 versus $400, and the federal government would pay the insurance carrier the remainder.
According to a report by Oklahoma Watch, which The Oklahoman published Sept. 14, five insurance companies will offer plans in the state's individual marketplace.
Before subsidies, most monthly premiums will cost between $200 and $700, based on consumers' ages, tobacco use and where they live in the state, Oklahoma Watch reported. Regardless, the most any consumer in the exchange would pay per year is $6,350, counting deductibles and doctor's office and hospital co-pays.
So if you're young and mainly healthy, you might choose a plan with a $61 monthly premium and $5,000 out-of-pocket deductible before medical coverage kicks in — because you know you don't expect to come close to spending $6,350 in health services and, under health reform, doctor's checkups and other preventive health screenings are covered 100 percent regardless of whether you've met a deductible. Or, if you're older and have a chronic condition like diabetes, you might choose to pay a higher premium and $1,000 deductible, so coverage kicks in sooner.
Many Oklahomans have no option but to choose the latter — and are celebrating the opportunity that comes with the Oct. 1 open enrollment.
• The single mother of a Tulsa teenager who suffers from a constant, and life-threatening, colorectal condition because of a ruptured appendix that went undiagnosed and unattended for days, several years ago.
• A 34-year-old Carney man who's been struck with liver complications and, in compounded bad luck, lost his home and business in the May tornadoes.
• A 64-year-old small-business man in Oklahoma City who, because of the recession and the skyrocketing medical premiums, has risked being uninsured for several years.
Read all about them in Sunday's edition of The Oklahoman. It could be you. It could be me.
There are plenty of opponents of the Affordable Care Act. But one good part of the law is consumers will be able to shop for the insurance, doctors and hospitals they want — not just pick among plans and physician/hospital networks with which their employers present them.
Gundlach believes many state business people who employ fewer than 50 workers and consequently won't be required to offer them quality, affordable health insurance, may drop group plans and instead give their employees a defined benefit of a few hundred dollars extra a month to shop for their own insurance on the new marketplace.
To preregister for, or get more information about Oklahoma's new federally-run health insurance marketplace, visit www.HealthCare.gov (the only official site) or call (800) 318-2596. Devices for the hearing impaired can use (855) 889-4325.