The individual states are all working to bring their insurance regulations in line with the provisions of the 2010 Patient Protection and Affordable Care Act, which will be fully implemented nationwide in 2014. Major changes already affect children, who can no longer be excluded from coverage based on the presence of a pre-existing condition. Additionally, children are now allowed to remain on their parents’ coverage to age 26 regardless of educational or marital status.
Temporary high-risk pools have been put in place in most states to help adults with pre-existing conditions, but this system will be replaced on January 1, 2014 by the new health care exchanges.
General Insurance Regulations
Oklahoma health insurance companies must offer guaranteed renewability and policies cannot be terminated based on current health status. Initial policies may, however, be denied according to health condition, or the premium rates can be raised.
Health Care Exchanges
There has been no substantive action in Oklahoma toward the creation of a health care exchange, however, the governor did sign a law in April 2011 prohibiting any insurance plan offered by any exchange operating in the state from covering abortions except in cases of rape, incest, or danger to the pregnant woman’s life. If Oklahoma does not create a health exchange by January 1, 2013, the U.S. Department of Health and Human Services will assume responsibility for the process.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in the state is run by the Oklahoma Health Insurance High Risk Pool, and offers both primary and specialty care, coverage for hospitalization, and benefits for prescription drugs. Monthly premiums are $121 to $704 with a medical deductible of $2000 and a drug deductible of $200.
Medicaid
Eligibility for Medicaid is based on income as a percentage of the Federal Poverty Level, the same formula applied to the Children’s CHIP-funded Medicaid Expansions. From infancy to age 5, children are qualified for Medicaid at 133% FPL and for SHIP at 185%. The 6-19 age bracket is eligible at 100% and 185% respectively.
Pregnant women may access Medicaid assistance at 185% FPL, parents at 36%, adults at 200%, and non-elderly disabled Social Security recipients at 74%.
Medicare
Approximately 16 percent of the population of Oklahoma receives Medicare benefits with more than 581,000 receiving prescription drug benefits.
Rx for Oklahoma provides additional aid to Medicare enrollees for prescription costs, while the Senior Health Insurance Counseling Program supplies counseling and educational services.
