In 2018 approximately 548,000 Oklahomans did not have health insurance, representing 14.2% of the population. The state has the 2nd highest uninsured rate in the United States. The Affordable Care Act makes private insurance more affordable, and more than 150,000 Oklahomans purchased private insurance through the federal exchange for 2019.
Every year there are insurance questions and decisions to make during the Oklahoma health insurance open enrollment period. Some of those questions may be answered by reviewing our health insurance facts. Keep reading for great information that will assist you when comparing insurance plans.
1. Smoking Increases Health Insurance Premiums by 30%
Oklahoma has a higher percentage of smokers than the U.S. average. In the U.S one out of every five Americans smoke, but in Oklahoma 23.7% of the state residents are smokers. It is a sad fact that there are more than 7,000 new smokers under the age of 18 in Oklahoma every year.
Because of this fact, the University of Oklahoma Health Sciences Center’s College of Public Health and the Oklahoma Tobacco Settlement Endowment Trust is promoting a tobacco cessation program. By calling the Oklahoma Tobacco Helpline at 1-800-QUIT-NOW callers will receive a “quit coach” to help them to stop smoking.
Smokers average a 30% higher cost in health care than non-smokers and this impacts your insurance costs. This is because of the impact smoking has on your health, including:
- 30% of all atherosclerosis diagnoses
- 40% of all ischemic heart disease diagnoses
- 68% of all pharynx, oral cavity, and lip cancers
- 82% of chronic obstructive pulmonary disease diagnoses
- 85% of trachea, lunch and bronchus cancers
- 91% of bronchitis and emphysema diagnoses
When you consider that smoking a pack a day of brand-name cigarettes will cost you about $1,800 per year, giving up the habit can help fund your health insurance premiums.
2. Oklahoma Insurance Department Rules Title 365
In Oklahoma, your health care insurance is regulated by the Oklahoma Insurance Department Rules, Title 365. Chapter 10 contains requirements including a uniform health insurance claim form, requirements for the policy of insurance, elimination of unfair discrimination, and providing insurance policy information.
Part 19 of Chapter 10 covers the Oklahoma Health Care Freedom of Choice Regulation. This requires the health care provider to provide a good faith estimate of the allowable fee for services within 72 hours of receiving a request.
Being aware of the requirements and regulations for your state provides you with power in the event you encounter problems with insurance coverage.
3. 68% Of Health Insurance Premiums Paid Out as Claims
During 2020 the State of Oklahoma paid out 68% of premiums it collected as insurance claims. This is a decrease from 2016 when the state paid out 99% in claims. The ratio is determined by dividing the number of claims paid by the total amount of premiums each provider collects.
4. Oklahomans are Dying at Twice the U.S. Population
In Oklahoma, residents are dying from COVID-19 at twice the rate of the U.S. population. More than 90% of those hospitalized with COVID-19 are not vaccinated. Since July 11, 2021, there have been 395 deaths in Oklahoma from COVID.
The COVID-19 vaccine is free of charge to everyone, regardless of whether or not you have insurance. Your health insurance company is not legally able to question whether or not you have the vaccine. Your health care costs for being unvaccinated may increase.
Waivers that were put into place at the beginning of the pandemic are beyond their expiration date. This means that if you have hospitalization charges of $50,000 to $75,000 for a COVID-19 stay of 1-5 days, those charges may be covered by your insurance if you have hospitalization coverage. If your stay exceeds five days, the costs will be higher and you may have to pay out-of-pocket for the overage.
If you do not have medical insurance, then the hospital and doctors will bill you in full for those expenses. With ongoing insurance costs due to the pandemic, the cost of premiums will likely increase between 3% to 5% for 2022. Now is the time to shop for your health insurance, locking in your rates and making sure you have the coverage you need.
5. There Are Two Kinds of Health Insurance
In Oklahoma, you have the option of two kinds of health insurance, public and private. Public health insurance is available through the government, such as Medicaid, Medicare, and CHIP (Children’s Health Insurance Program). Public health insurance plans you obtain through an employer or by shopping on your own through a marketplace.
A public healthcare plan is funded and run by the government, but that does not mean it is free. You will still be responsible for premiums, deductibles, and out-of-pocket expenses.
Most people obtain private insurance through a group plan at work. In this type of plan, the employer pays part of the insurance cost, allowing you to have lower premiums.
6. There Are Four Types of Health Insurance Plans
When selecting health insurance, in addition to public or private, it is further categorized by the type of plan you select. The four plan types are PPO, HMO, EPO, or POS. This is an important factor, as it determines how the plan is run.
An HMO (Health Maintenance Organization) does not cover health care costs from providers who are outside the network. If you need to see a specialist it requires a referral from your primary physician.
A PPO (Preferred Provider Organization) insurance does not require a primary physician referral. It is also more likely to pay for treatment received outside your network with a higher co-pay.
EPO (Exclusive Provider Plan) will only pay for doctors within your network. You do not need a referral to use a specialist.
POS (Point-of-Service) plans mandate the selection of a primary care physician that must be used for referrals. They are also likely to require preauthorization from the insurance plan prior to receiving certain medical procedures.
7. Medical Insurance vs Major Medical Insurance
Many believe these two terms are interchangeable, but they are not. Your basic medical insurance will pay for some, but not all of your medical treatments. Major medical insurance provides coverage for everything from a routine checkup to a major catastrophic event.
Basic medical insurance provides less coverage for a lower premium. It works as a supplement to traditional medical insurance. You are able to visit any doctor in the United States without obtaining a referral or approval.
The insured receives a set amount of cash to reimburse them for doctor visits, lab tests, and surgery. The amount of reimbursement you receive is usually lower than the cost of the services. It is usually easier to obtain approval for this type of insurance than for major medical.
The premiums for major medical insurance are higher and usually cover doctor visits, outpatient medical treatment, and hospital care. This type of insurance operates on a deductible basis.
This means you pay a co-pay portion set by the insurance. The insurance company pays the remaining fees to the medical provider.
Major medical provides better coverage. In addition to paying for doctor visits and surgery, it usually covers prescription drugs, rehabilitation, physical therapy, mental health, and nursing home care. There usually is a yearly out-of-pocket limit on your costs, even if you have costly medical procedures done.
Getting Oklahoma Health Insurance Quotes Is Easy
Now that you have heard a few insurance statistics, you understand how important it is to compare Oklahoma health insurance rates.
Healthplans.com offers coverage across all 50 states and Washington DC. Pricing is fixed by law, so you will not find lower rates anywhere else. We invite you to do a price comparison of several providers using our easy online format. Get your quote today!