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Select an Affordable Health Care Plan

Posted on Friday, November 20th, 2015


Open enrollment is underway for consumers affected by the Affordable Care Act.

Under the health care law, uninsured adults under age 65 must endeavor to buy health insurance or risk a tax penalty for being insufficiently insured.

December 15 is the ending date to enroll or change plans for those wanting their new health care plan to become effective on January 1, 2016.

January 31, 2016 is the last date to enroll for 2016 coverage.

Area enrollers are busy now counseling consumers on their plan choices. In Marietta are Big 5 Community Services at 276-3154 and State Farm Insurance at 276-3388. In Thackerville is Pearman Insurance at 276-3672.

Oklahoma had four carriers in its marketplace exchange in 2015, but that will be down to two for 2016 plans. New and renewing enrollees will have to choose from a total of 23 plans offered by Blue Cross Blue Shield of Oklahoma and United Health Care.

Blue Cross Blue Shield dropped its Blue Choice plans, leaving about 40,000 insureds in Oklahoma, including a number in Love County, who will need to switch to plans that use the Blue Advantage or Blue Preferred Networks.

Melodie Schaffer at Pearman Insurance said she advised clients to call their doctors to be sure the physicians accept a plan before enrolling in it.

"Consumers need to look over all the plan choices to find the one that best fits their situation," said Kim Staton at State Farm.

Consumers also can self-enroll at the healthcare marketplace website, www.healthcare.gov. The national helpline offers 24-hour assistance at 1-800-318-2596.

About 150,000 Oklahomans are enrolled in a marketplace plan. Most are receiving federal tax subsidies that reduce the cost of coverage to an "affordable" percentage of income.

The subsidies keep pace with the cost of insurance. When plan premiums go up, the person's subsidy goes up to keep the total cost of coverage within the affordable amount, which ranges from 2 percent to 9.5 percent of income.

Generally speaking, an individual earning between $11,770 and $46,650 or a family of four earning between $24,250 and $95,400 is eligible for some kind of assistance to lower the cost of a marketplace plan.

Marketplace plans cover essential health benefits (such as hospital, doctor, prescription drug, specialists, surgery, mental health care, rehabilitative care, medical devices), preexisting conditions, and preventive care.

In 2015, 75 percent of the Oklahomans who enrolled through the marketplace selected a Blue Cross and Blue Shield of Oklahoma plan. The vast majority qualified for tax subsidies that reduced their premiums.

About 150,000 Oklahomans - 1 in 5 remaining uninsured -- are caught in a "coverage crater." They earn too much for traditional Medicaid but not enough to qualify for subsidies to purchase health insurance on the online marketplace.

Oklahoma has actively opposed expanding Medicaid.

Also, in June, the state lost a lawsuit that would have disallowed subsidies on marketplace plans sold in Oklahoma. The U.S. Supreme Court ruled that Oklahoma consumers could keep their subsidies and continue to purchase marketplace coverage through the federally operated healthcare.gov.