Oklahoma is a large expanse of flat farm land and prairie, expanding into four mountain ranges, with quaint towns throughout the state. A frequent target during tornado season, the state is also a stop on cross-country road trips via Route 66. Oklahoma has traditional American roots and is home to the most Native American tribes in the nation. Residents have access to larger cities Tulsa and Oklahoma City, as well as beautiful national parks such as Turner Falls Park with the largest waterfall in the state.
Oklahoma is served by many companies for individual health insurance, including Aetna, Celtic, Coventry, Humana, IHC Group, and UnitedHealthcare. Depending which area you live in, company availability may vary as will premium rates. Enter you zip code below to get a quote and view options in your town. For any additional questions or to help in choosing a plan, call us at 888 803 5917.
Oklahoma residents have been declining in overall health and comprise one of the least health populations in the nation. As a result multiple factors, they received the 48th place in the UnitedHealth rankings for 2011. This is caused by the state having one of the largest percentages of smokers in the U.S., at nearly 24% of all adults despite a 2% decrease over two years. Obesity is a frequent and growing problem in Oklahoma, currently affecting 883,000 individuals over 18 in the state, which is over 31% of all adults. Diabetes has also become more prevalent. Now almost 11% of all adult residents (293,000 people) have the condition.
Oklahoma is also neglecting to use its health care system, and does not have an adequate one at that. Not enough primary care physicians are available to accommodate the population, and the state has a very high percentage of uninsured residents – 17.5% of all residents. Public health funding is adequate, however, and earned 11th place out of all states for dollars available per individual. If more individuals in Oklahoma get a health plan or use public programs (if eligible), the state could make some positive improvements in the future and prevent conditions from worsening and growing among more residents.
Health Insurance Plans
- Open Access Managed Choice PPO plans feature a greater amount of coverage from the Value plan, with a wider range of deductibles. In Oklahoma, these plans have deductible options of $2,500, $3,500, and $5,000 (for individuals) with additional benefits of unlimited primary care visits and dental coverage. Preventive care is covered in full as soon as your plan begins, including immunizations, routine physicals, GYN exams, well-child care and more. After you meet the deductible, your plan will cover 80% of your costs on medical services such as hospitalization, lab work, diagnostic testing, skilled nursing and physical therapy. When you select a higher deductible, more services including unlimited primary care visits and dental coverage are also available.
- Open Access Managed Choice Value plans in the state of Oklahoma provide necessary coverage for a lower monthly rate. With Value plans, you can choose between $5,000 and $7,500 deductibles. Value plans are connected to Aetna’s Preferred network of providers for a discounted rates, or the option of non-network care for slightly more. From the day your plan starts, these plans offer preventive care for no charge when using in-network providers. Value plans come with a basic set of benefits, including your first three primary care doctor’s visits for a $40 copay, as well as prescription drug benefits before deductible. Once you have met the deductible, you can receive inpatient and outpatient hospital care for either 20% or 40% of coinsurance.
- Open Access Managed Choice High Deductible plans are also PPOs, with the capability of seeing in-network or out-of-network doctors, as well as adding a health savings account. HSAs help you gain more control over your health care spending by providing you with tax-advantaged funds for use on medical expenses, including deductibles and cost sharing. These plans offer a very comprehensive level of benefits, including either 90% or 100% coverage after deductible on most health care such as doctor’s office visits, prescription drugs, inpatient and outpatient hospital care and surgery. Before your deductible has been reached, you can receive preventive services for no cost with a preferred network provider. These plans are ideal for those who wish to manage their health care costs, save for the future, and want access to as many services as possible.
- Open Access Managed Choice Savings Plus plans are available in annual deductibles of $3,000 or $5,000 for individuals, and twice the cost for family enrollment. Savings Plus plans offer your first three doctors office visits for a $35 copayment, and $15 for generic prescriptions as first-dollar benefits. Preventive care is also covered in full before you meet the deductible, when using providers from Aetna’s Maximum Savings network. When the annual deductible has been fulfilled, your plan covers 60% of in-network hospitalization and skilled nursing costs, and 80% for physical therapy, specialists, and home health care services. With an affordable monthly premium and several services for a copayment, these plans offer basic care and a solid network.
- Preventive and Hospital Care plans in Oklahoma are limited benefit options for individuals and families who want a low premium for major medical care as well as preventive care coverage. When using Aetna’s network of providers, preventive services are offered from the start date of your plan for no cost. After you have met the yearly deductible, which is $2,750 for individuals, you receive coverage at 80% on select types of care. Covered services include inpatient hospital stays, skilled nursing, and home health care for 20% coinsurance in-network. As these plans are PPOs, you still have the freedom to use out-of-network providers, though it will cost more.
- Celtic Basic plans in Oklahoma offer essential health coverage for an affordable rate, with the option of either 70% or 80% coverage after deductible on in-network services. With deductible options of $2,500, $3,500, $5,000, or $7,500, and low premiums, members can receive preventive care for no charge in network as soon as the plan begins. Also available instantly are generic prescription drugs and the first two visits to a primary care physician or specialist for a $30 copay. Once the deductible is met, these plans offer hospital stays, outpatient surgery, emergency care and lab work for an additional deductible of $350 – $500 with coinsurance after deductible.
- CeltiCare Preferred plans provide comprehensive major medical coverage to individuals and families with multiple options to customize your care. Based on the deductible you choose, these plans give you 80% or 100% coverage on in-network hospital care once you have met the deductible. Deductibles range from $1,000 to $10,000 for individuals, and double the price for additional dependent members. These plans have an incredibly low rate for physician office visits at $15 for a PCP or specialist, though limited to two per year. Generic prescription drugs are offered for a $10 copay as soon as your plan begins, and brand names are $40 after the separate $500 pharmacy deductible.
- CelticSaver HSA plans come in a range of high deductibles, from $1,500 to $5,000 for individuals, and give members the option of opening a health savings account (HSA). Preventive services are available for no cost through the Celtic PPO network from the day your plan begins, and all other types of care are covered at 80% or 100% after deductible. Prescriptions are included in the annual deductible, and covered at the chosen level of coinsurance after it has been met. If you choose to connect an HSA to your plan, you can receive tax deductions on your federal and state taxes, and withdraw funds tax-free. Money in the HSA can only be used for out-of-pocket costs on qualified medical services.
- PPO plans for the state of Oklahoma come in an array of deductibles, ranging from $500 to $5,000 for individuals. Each of these plans covers in-network primary care physician office visits and specialist services for a low, affordable copayment before you meet your deductible. Some plans are specified as “GO” plans, or Generic Only for a $10 copay on generic drugs as soon as your plan begins with no deductible involved. Other PPO plans include full prescription coverage for every tier, with $10 generics, $35 brand names, and $60 non-formulary drugs. Coverage options are 50% or 80% after you meet the deductible for in-network hospital services including surgery, X-ray, and inpatient stays. Some of these plans also cover chiropractic care and mental health treatment.
- HSA plans are high-deductible PPOs from CoventryOne with 100% coverage after you meet the deductible. Individuals can choose an annual deductible of $2,500 or $5,000, both of which offer in-network preventive care for no charge as soon as your plan begins. Covered services include nearly every type of physician and hospital care, such as inpatient stays, surgery, lab work and X-rays, emergency room visits, chiropractic care, and office visits. Out-of-network care is offered for 20% coinsurance after deductible.
- Copay plans are offered in Portrait Share 80 and Autograph Share 80 Plus Rx types to Oklahoma residents. Each of these copayment plans offers a selection of in-network benefits when your plan begins, including physician’s office visits and prescription drugs. Portrait Share 80 plans have an individual deductible of either $1,000 or $2,500, and Autograph Share 80 plans have deductibles of either $5,000 or $6,000. After the deductible amount is reached, Portrait and Autograph plans cover 80% of in-network hospital services including surgery, inpatient stays, outpatient diagnostic labs and X-rays, emergency room visits and more.
- Monogram plans are a budget-friendly way to receive comprehensive coverage through Humana’s PPO network. For an individual deductible of $7,500, and $15,000 for families, all care with network providers is free of charge after paying up to the deductible amount. Once the deductible is met, services such as non-preventive physician office visits, inpatient hospitalization, emergency room visits, and chiropractic care for no cost. There is a separate deductible for prescription drugs, though it does not apply to generics. Preventive care is available from the day your plan begins, covered in full when using network doctors.
- Health Savings Account plans are qualified high-deductible health plans, offering the opportunity to open an HSA to take responsibility over your health care spending in exchange for tax advantages. Autograph Total HSA or Autograph Total HSA Plus Rx are the available plan types for Oklahoma residents, giving you either coverage on all tiers of prescriptions or no pharmacy benefits. Each plan covers in-network physician office visits and hospital services at 100% after deductible. Individual deductibles range from $1,500 to $5,000 for Autograph Total HSA plus Rx, and $2,000 to $5,200 for Autograph Total HSA plans. The only immediate benefits with HSA plans are preventive services, which are no cost when using a network provider.
- Freedom Choice plans come in a range of individual deductibles, from $1,500 to $20,000, and variable upon which you select, your coinsurance after deductible will be 30% or 20%. The higher the deductible, the lower the cost-sharing, which also includes lower monthly premiums. Regardless of the deductible level, Freedom Choice plans cover physician office visits with a primary care doctor or specialist for a $50 copayment as soon as your plan becomes effective. Pharmacy benefits are offered with a separate deductible, covering all levels of prescriptions for an affordable copay. Many covered services are available with in-network and out-of-network providers when the deductible amount has been fulfilled. Qualified services for coverage include emergency care, outpatient lab, surgery, limited chiropractic, and inpatient stays.
- Freedom HDHP plans come in a range of deductibles from $2,000 to $20,000, and give members the opportunity to open a health savings account. In-network coverage beginning after you meet the deductible can either be 80% or 100%, contingent upon the plan you select. Before you reach the deductible, preventive care is available through in-network doctors for no charge. Prescription drugs are either no cost to you or 20% coinsurance after you meet the annual deductible. HSAs allow individuals to pay for medical cost sharing with funds that receive benefits when annual income taxes are filed.
- Copay plans are available in two different variations, including Copay Select and Copay Select Value. While the two plans similarly offer predictable copayments for physician’s office visits, prescription drugs, and emergency care, Copay Select plans encompass a larger number of benefits. Copay Select plans have the benefit of unlimited office visits with a primary care physician or specialist, in addition to copays and coinsurance for every level of prescription drugs. Copay Select Value plans provide coverage on your first four office visits and generic medications, though this could be optimal for those who prefer saving money and keeping health care services limited. After deductible, Copay Select plans cover either 70, 80 or 100% of in-network hospital care, and Value plans cover 70%.
- High Deductible plans in Oklahoma are offered in Plan 100, Saver 80 and Plan 80 types, with deductibles ranging from $1,000 to $10,000 for individuals. In-network coverage after deductible can be either 80 or 100%, based on your chosen plan type. High deductible plans are very comprehensive, giving members access to benefits such as preventive care for no cost immediately, as well as hospitalization, diagnostic testing, surgery, emergency care and more. Prescription drugs are available through either a preferred price card, which is no charge after deductible, or a copay additional benefit discount card.
- Health Savings Account plans provide total coverage for in-network and out-of-network care, with in-network coinsurance options of either 70% or 100% coverage after deductible. HSA plans cover all types of medical services, including office visits with a PCP or specialist, hospital care including emergency room visits, surgery, inpatient room and board, as well as physical therapy once you have met the deductible. As soon as your plan starts, you can use the UnitedHealthOne network for preventive services at no cost. With funds from a health savings account, you have the opportunity to save for retirement or you can pay for cost sharing and other medical expenses.
Public Health Options
There are a myriad of state-funded health programs and services for uninsured residents of Oklahoma. Such programs are in place to provide assistance to the low income population of individuals and families whose budget does not allow for a plan with a private health insurance company. Medicaid (called SoonerCare in Oklahoma) is the most notable and recognized of these, providing medical coverage to pregnant women, children, parents, SSI beneficiaries and more. For more information about who qualifies for Medicaid in Oklahoma, visit our Medicaid Eligibility by State page. Additional insurance programs offered through the state include PCIP plans, CHIP, and Medicare for those over 65. Other health care services include free mammograms, immunizations, and family planning options. For an exhaustive list of programs offered, visit the Oklahoma Department of Human Services.
- SoonerCare: a traditional Medicaid fee-for-service plan for eligible low-income families and children of Oklahoma.
- Medicaid: a variety of health insurance programs for many different groups of residents of Oklahoma including children, American Indians, pregnant women, those in need of long-term care, and women who require breast or cervical cancer treatment.
- Pre-Existing Condition Insurance Plan (PCIP): provides adults who have been rejected for a private plan due to their health status or uninsured for a minimum of six months with medical coverage.
- Medicare: health insurance for individuals over the age of 65 of varying income levels and stages of health.
Health Insurance Laws
In Oklahoma, the health insurance companies have certain liberties by law that make them able to deny people for health insurance. They also, however, must abide by other regulations in order to help keep their clients insured. A very important set of regulations in the private health insurance market of Oklahoma has to do with pre-existing conditions and coverage. Insurers define such conditions by recognizing any condition they deem worthy of receiving care, regardless of whether the person sought treatment or not, in the 5 years prior to applying for health insurance. After is has been decided that an individual has a pre-existing condition, the insurer can refuse to sell them a policy, or accept for an elevated rate.
Insurance companies may decide to include an exclusion period onto a plan for such an individual. Exclusion periods in Oklahoma can be any length of time chosen by the insurer, where the insurance company will not pay for any treatment of the condition. Another possibility is the use of elimination riders, which is legal in Oklahoma. These state that the insurer never has to cover care related to the pre-existing condition. The Affordable Care Act set up a system of care for people who have been treated unfairly due to their health status or medical history in the Pre-Existing Condition Insurance Plan, however.
PCIPs are operated by the state in Oklahoma, and offer a reasonably priced solution to being uninsured after an insurer denies coverage. These plans are also considered “bridge” plans, as they are temporarily in place to fill the gap between today’s legislation and laws that take effect in 2014. As of January 1, 2014, adults with pre-exisiting conditions will not be turned down for health insurance through private companies any longer. Additionally, elimination riders and exclusion periods will cease to exist. Though this is seen as an expensive endeavor to government and health insurance entities, it will hopefully achieve the goal of insuring more Americans.
Individuals who purchase a health plan are protected by the same law that helps to avoid fraud and identity theft when using personal medical information, HIPAA. One of the laws in this act is the guaranteed renewability provision, which requires health insurers to ask their clients if they wish to renew their plan for another year before their term ends. It also makes it possible for responsible policy holders to hold on to their benefits if they happen to get some kind of condition after their plan begins. This provision is essential to keep in mind when buying a health plan and reading over your policy agreement.