Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and enforcement began in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare’s Effect on Oklahoma Health Insurance
In Oklahoma, the main proponents of Obamacare have not been implemented (expanded Medicaid and a state exchange). As a result, the Affordable Care Act has not had a significant impact on reducing the number of uninsured individuals. Some small improvements, however, have dropped the uninsured rate in Oklahoma from 21.4% to 16.5%.
What Oklahoma Residents Should Know About Obamacare in Oklahoma
The Pros and Cons of Oklahoma Obamacare
Oklahoma Obamacare has made health insurance coverage available to many that could not previously afford care. It has also been successful in eliminating denial of care based on pre-existing conditions and has disabled Oklahoma companies from charging a higher premium based on race or gender.
There have been criticisms of Obamacare in Oklahoma due to the lack of options available on the exchange. In 2017, there will only be one private insurance option available for purchase. In addition, rates could increase as much as 40%, which would create a significant financial burden for those that do not qualify for subsidies to offset the cost.
Obamacare Health Plan Categories and How Much You Will Pay
When shopping in the Oklahoma Obamacare Marketplace, there are four primary health plan categories you can choose from: bronze, silver, gold, and platinum. These categories determine the percentage of healthcare costs that the plan will pay for over a course of a year. The remaining percentage is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. For example, if the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay for the remainder 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount of healthcare services each plan pays for:
- Bronze plan - 60%
- Silver plan - 70%
- Gold plan - 80%
- Platinum plan - 90%
How do I sign up for Obamacare in Oklahoma?
The Oklahoma Obamacare Marketplace and exchange can be accessed through the federal government website or by calling 1-800-318-2596.
What are the Obamacare Marketplace and exchange?
The Marketplace is a central location to shop for insurance options and enroll for selected coverage. In the case of Obamacare, Oklahoma has applied to be a state-based, federally supported exchange, which means that the state manages the program, but uses the federal infrastructure to deliver it.
Do I need to use an exchange?
To access public health insurance, you will need to go through the government exchange. The only exception to personally using the exchange to sign up for Obamacare in Oklahoma is if you are able to seek help from an Oklahoma certified counselor or a private insurance agent who can discuss your options and select a plan, on your behalf, through the exchange.
How do I use an exchange?
You can use the exchange one of four ways:
- Visit healthcare.gov
- Use the telephone support assistance available by calling 1-800-318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing health insurance coverage from the Obamacare Oklahoma Marketplace while off-exchange normally refers to purchasing private health insurance coverage from a private company.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in Oklahoma is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short-term individual private insurance to avoid a penalty.
What is the Obamacare penalty if I don’t buy health insurance?
If you do not buy Obamacare or other qualifying health coverage (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 yrs of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
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What if I cannot afford Obamacare?
If you cannot afford to pay for Obamacare coverage, you may be able to qualify for a government subsidy. For more information on government subsidies visit the HealthCare.gov website.
What are the alternatives to Obamacare?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange.
There are several alternatives available when selecting coverage. You can select one of the available alternatives on the Marketplace, purchase one of the many options available on the private exchange, or see if you are eligible for subsidized programs through Oklahoma’ Medicaid program.