Navigating the maze

many nonprofits, the foundation uses its limited funds not for outward
appearance but for providing services to people in need.

this case, it offers life skills training, socialization and therapy to
central Oklahomans with developmental disabilities who may otherwise
have few enriching activities during the day.

resources at nonprofits also create lower employee salaries and less
access to affordable health care. But since OKFD began providing Insure
Oklahoma, the state-based health insurance program for low-income
residents, its employees now have better coverage.

“Before Insure Oklahoma, I had no insurance, and I couldn’t go to the doctor,” said Jessica Washington, OKFD floor supervisor. “If I did, it was straight to the emergency room to get a sky-high bill that I couldn’t pay.”

IO provides primary care, the OKFD can no longer afford to offer
supplemental coverage such as dental. It has been two years since
Washington went to the dentist, when she had to receive treatment for a
root canal. She also isn’t able to have eye exams.

coworker, Sheronda Davis, a certified nurse’s aide, said she has
problems with her teeth but she is unable to go to the dentist because
of the cost.

Williams, who works in human resources at OKFD, makes too much to
qualify for IO, so she uses a more traditional health care plan.

Still, since she pays $400 each month for her insurance, she regularly thinks about dropping it to help pay for other expenses.

“The general consensus of all of us around here is it’s just almost unaffordable,” Williams said.

struggle with it.” Providing comprehensive, low-cost health care
coverage is a continued debate at the state and federal levels. And the
multiple options available are often confusing to consumers.

Oklahoma, three key programs designed to help those with low incomes
are Insure Oklahoma, the federal health insurance marketplace (offering
enrollment from Oct. 1) and SoonerCare (the state’s Medicaid).

insurance programs of all varieties and employers must work in the
coming months to follow new guidelines under the Affordable Care Act.

Insure Oklahoma
state health analysts agree Insure Oklahoma provides needed, affordable
insurance and is a positive public-private partnership. However, they
also believe gaps in coverage should be addressed by state leaders.

First authorized in 2004, IO covers about 30,000 Oklahomans with state tobacco tax revenue, federal funding and a percentage paid by employers and individuals to subsidized private health insurance. Washington and Davis pay about $50 per month in premiums for the program.

“I don’t notice it’s missing,” said Davis about the monthly cost.

In early September, the federal government gave IO a one-year extension through December 2014.

the coming year, Governor Fallin will encourage federal officials to
review Insure Oklahoma’s many successes,” said Michael McNutt, Gov.
Fallin’s spokesman, via email. “Her hope is that the Obama
administration will announce its support for a permanent, ongoing

The federal
government was considering not giving the Medicaid waiver, which allows
IO to operate, an extension because it didn’t meet certain ACA
regulations. This includes concerns with the cap on enrollment (35,000),
a measure that hasn’t changed.

this extension, authorities did require Oklahoma to reduce IO
copayments for medical services and prescriptions. Those receiving
coverage through their employers may stay on the program. Individuals
using the IO plan who are making above 100 percent of the federal
poverty level (FPL) ($23,550 for a family of four) will have to transfer
to health insurance through the marketplace. This equals around 8,000
people. The open places in IO will likely become available to other
Oklahomans who make below 100 percent FPL.

fear their costs will increase when making the transfer. But since the
marketplace rates are highly specific, it’s difficult to create a cost
comparison with Insure Oklahoma, finds Carter Kimble, spokesman for the Oklahoma Health Care Authority.

“Somebody who is 57
and a smoker, their cost is going to be larger on the marketplace than
someone who is 37 and a nonsmoker, so it’s hard to say blankly one is
more expensive,” said Kimble.

Health insurance marketplace
opens Oct. 1 and lasts six months for the health insurance marketplace
created by the Affordable Care Act. Coverage begins in January.

and families making between 100 and 400 percent FPL who don’t have
access to other affordable health insurance options are eligible for
subsidies to help purchase the insurance plan.

Oklahoma, three insurance companies offering services in the
marketplace have released their rates: Blue Cross Blue Shield of
Oklahoma, Coventry Health and Life Insurance and Aetna Life Insurance.
Consumers may choose from companies competing in the marketplace.

Several organizations in the state are providing certified trainees to assist with questions.

“People should make sure the information they’re getting is accurate from someone who has official
certification,” said Patricia Christensen, policy and program analyst
for the Oklahoma Primary Care Association. “If you’re feeling
overwhelmed, reach out for assistance because there are a lot of people
to help.”

called navigators are there to help both small businesses and
individuals, while certified application counselors give advice to
individuals and families.

monthly premium rates vary from less than $100 to around $1,000 before
subsidies. Costs are determined by a number of factors, including age,
tobacco use and the region in which a participant lives in the state.
The young are offered lower rates than older participants, and tobacco
users face additional costs, which differ in each plan from 10 to 20

companies must provide essential health benefits, which include, among
others, maternity care, emergency room services, preventive measures and
prescription coverage.

Children younger than 19 must have dental and
vision care, but adults aren’t included in this condition.

company will provide different plan choices. A “catastrophic” plan,
only minimal coverage, is available to participants younger than 30 and
some with particularly low incomes. Other choices include a bronze
(basic) coverage and continue with more services at the silver and gold

With a bronze
level, the monthly costs are low, but the deductibles and copayments are
higher than other plans. Participants will pay 40 percent of medical
fees in this plan.

someone can afford insurance but chooses to stay uninsured, they will
face a $95 per person penalty in 2014 and $695 by 2016. Those with
higher salaries may have to pay a percentage of their incomes if this
exceeds the flat fees.

enrollment for the marketplace ends March 31, it won’t be possible to
receive health coverage until the next enrollment period.

already covered by employer-sponsored insurance, Medicaid, Medicare or
other qualifying health insurance plans also doesn’t face a penalty.
Oklahomans who have incomes below 100 percent FPL and don’t qualify for
traditional Medicaid aren’t required to have health insurance next year.

Statewide action
In the coming months, health care experts and state officials will help educate Oklahomans about these insurance options.

636,000 Oklahomans (17 percent) are uninsured according to the most
recent results from the U.S. Census Current Population Survey.

Oklahoma has chosen not to expand its Medicaid program, an Urban
Institute Health Policy Center estimated 172,000 low-income Oklahomans
would be ineligible for either subsidies in the insurance marketplace or
the current state Medicaid system.

Useful resources

Insure Oklahoma:

Enroll in the health insurance marketplace (Oct. 1 to March 31): or call 800-318-2596

Calculate your insurance marketplace subsidies:

Receive help with your health care questions:

for additional Oklahoma health care coverage in the coming weeks,
including what state leaders say about the SoonerCare (Medicaid)
program’s future, understanding who is ineligible for low-cost health
insurance and how the Affordable Care Act affects employers.

Angela Chambers

This material falls under the archives category because it was imported from our previous website. It will eventually be filtered into the proper category as time allows.

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