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Posted by on Sep 3, 2013 in Oklahoma | 0 comments

Oklahoma’s Federally-Facilitated Exchange

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Isn’t Oklahoma still fighting the Affordable Care Act?

Oklahoma Attorney General Scott Pruitt has filed a lawsuit challenging the federal government’s implementation of the Affordable Care Act; arguing that the law states that federal subsidies are available ONLY through state-created exchanges; not through federally-facilitated or partnership exchanges. Without subsidies, the cost of insurance for many American’s would exceed eight percent of income and qualify as “unaffordable”; essentially exempting many from the mandate to obtain health insurance.

While Oklahoma is still fighting the ACA, the Governor has demonstrated her intent to improve health outcomes and control health care costs through state-based solutions, such as the state’s lawsuit reform, designed to curb lawsuits and medical malpractice claims filed in Oklahoma and by focusing on chronic disease prevention and management.

What is the exchange website for Oklahoma?

On November 19, 2012, Governor Mary Fallin announced that Oklahoma would not pursue the creation of a state-based health insurance exchange or Medicaid expansion. The state will have a federally-facilitated exchange and consumers will used the federal website, HealthCare.gov, to compare plans, apply for subsidies (which the federal government intends to offer through all health insurance exchanges), and enroll in health insurance.

Will there be many options for health insurance on the exchange?

Four carriers have applied to offer health insurance through Oklahoma’s insurance exchange; plans are still under review by federal officials. Carriers on the exchange must offer plans at the silver and gold levels, but are not required to offer bronze or platinum plans.

Which companies applied to offer plans through the exchange?

Blue Cross Blue Shield of Oklahoma, a subsidiary of Health Care Service Corp., has applied to offer health insurance coverage statewide. The company intends to offer multiple individual options at the gold, silver, and bronze metal levels as well as a catastrophic plan for qualifying individuals. Products will look familiar to those currently offered, with names like Blue Choice, Blue Preferred, and Blue Advantage. The company has also submitted a multi-state plan. It appears BCBSOK may also intend to offer small group products through the exchange as well as off the exchange.

Community Care only operates in Oklahoma City and Tulsa. Other than the required gold and silver plans, it is unclear what other options the company intends to offer through the exchange

GlobalHealth, Inc. submitted both individual and small group exchange only HMO plans. Plans for both individuals and small groups will be offered at the bronze, silver, gold, and platinum metal levels. Individuals will have a variety of plan options to choose from, especially at the silver level. The company currently offers products statewide.

Coventry Health Care, Inc./Coventry Health & Life Insurance Company, which was recently acquired by Aetna, has submitted their OKC PPO and Rural OK products to be available through the exchange. Plan options will be available for individuals at the gold, silver, bronze and catastrophic levels.

Will coverage and premiums be the same statewide?

While many carriers may offer coverage statewide, they are not required to do so; some carriers plan to only offer health insurance in some regions of the state.

The state of Oklahoma is broken up into geographic rating areas, which are used to help determine health insurance premiums. In Oklahoma, the United States Office of Management and Budget has set four metropolitan statistical areas (MSAs), which are centers of high population that with their surrounding communities demonstrate economic and social integration. MSAs are used to develop rating areas by using the number of MSAs and adding one more area to cover rural regions. In Oklahoma, this means the 77 counties in the state are grouped into five rating areas. Insurance companies can charge different premiums based on Oklahoma’s five rating areas. Here is a breakdown of the counties in each area:

AREA COUNTIES MSA
1 Le Flore, Sequoyah Ft. Smith
2 Comanche Lawton
3 Canadian, Cleveland, Grady, Lincoln, Logan, McClain, Oklahoma Oklahoma City
4 Creek, Okmulgee, Osage, Pawnee, Rogers, Tulsa, Wagoner Tulsa
5 Adair, Alfalfa, Atoka, Beaver, Beckham, Blaine, Bryan, Caddo, Carter, Cherokee, Choctaw, Cimarron, Coal, Cotton, Craig, Custer, Delaware, Dewey, Ellis, Garfield, Garvin, Grant, Greer, Harmon, Harper, Haskell, Hughes, Jackson, Jefferson, Johnston, Kay, Kingfisher, Kiowa, Latimer, Love, Major, Marshall, Mayes, McCurtain, McIntosh, Murray, Muskogee, Noble, Nowata, Okfuskee, Ottawa, Payne, Pittsburg, Pontotoc, Pottawatomie, Pushmataha, Roger Mills, Seminole, Stephens, Texas, Tillman, Washington, Washita, Woods, Woodward Rural Oklahoma

New information is being released every day. Follow this blog to receive updates as new information is released in Oklahoma.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

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