Tuesday, state residents can begin shopping for health insurance in Oklahoma's new federally run health insurance marketplace, and everyone who applies will be approved. That's because — for coverage effective Jan. 1 — insurers, under new health reform laws, can't disqualify applicants because of pre-existing health conditions.
Any Oklahoma resident is welcome to shop in the marketplace, though it's meant to provide affordable insurance to those who don't have it through work, Medicare or Medicaid. Individuals 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, for example) will be eligible for variable subsidies, depending on income and family size.
The Kaiser Family Foundation has posted a calculator at kff.org/interactive/subsidy-calculator/ for people to estimate costs and learn if they qualify for subsidies.
If you qualify, the government will pay that amount directly to the insurance company, and your monthly payment will be lower. Or, you can pay the full premium amount and claim the credit on your federal tax return.
Depending upon your age, whether you smoke and where you live in the state, with subsidies you likely will pay monthly premiums of no more than $300, and in some cases, considerably less, observers say.
Blue Cross and Blue Shield of Oklahoma, Aetna Life Insurance Co., Coventry Health Care Inc., Global Health Inc. and Community Care will offer at least “silver” and “gold” plans on the new marketplace, designed to cover 70 percent and 80 percent of average health care costs, respectively.
If you make your first payment by Dec. 15, coverage will start on Jan. 1. Enrollment runs through March 31.
In addition to monthly premiums, the most any individual consumer in the marketplace will pay per year is $6,350, including doctor's office and hospital co-pays and prescription co-pays.
Researchers estimate some 337,000 Oklahomans — or 9 percent of the state's population — will be eligible to receive subsidized coverage in the marketplace. Still, many observers believe most won't take advantage of the premium assistance. That's because insurance, even with subsidies, still requires a financial commitment, while the fines for not carrying insurance lack teeth — initially anyway.
The penalty for being uninsured in 2014 is $95 or 1 percent of income; $325 or 2 percent of income in 2015; and $695 or 2.5 percent of income in 2016. Meanwhile, hospital emergency rooms still can't deny care to anyone who goes there uninsured.
Sierra Branch, 26, of Moore, an uninsured foster parent recruiter who lacks employer group coverage, doesn't plan to buy in the new marketplace — for now. The Kaiser calculator estimated an annual premium for her of $3,061, she said.
“I can get contacts, have a well woman exam, and have two cavities filled for about $1,000 or less in a year,” Branch said. “Obviously, this is with nothing catastrophic happening — knock on wood. But $3,000 in premiums plus meeting a deductible? I know it is gambling, but not paying still seems like the more logical decision,” she said.
Others, especially the young and healthy, very well may follow Branch's reasoning.
According to a CareerBuilder survey released Monday, 36 percent of U.S. workers live paycheck to paycheck; 53 percent of those earning less than $50,000 do.
Still, there are some expenses workers won't give up regardless of finances, pollsters found. Those are Internet connection, 55 percent; driving, 40 percent; pet, 36 percent; smartphone, 29 percent; cable, 24 percent; travel, 10 percent; and going out to eat, 9 percent.
Time will tell whether health insurance ranks in future surveys.
Oklahoma's new federally run health insurance marketplace: