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Oklahoma promotes affordable health insurance

KM | March 10, 2009


In an address delivered at the Governor's Office on March 9, 2009 Oklahoma Insurance Commissioner Kim Holland reports that the state ranked 42nd in overall health and 43rd in percentage covered by health insurance coverage according to the 2008 "America's Health Rankings" report compiled by the Centers for Disease Control and Prevention. About 20% of all Oklahomans have no health insurance (as compared with about 16% nationally) and half of the uninsured are young adults between 18 and 32. The Insurance Commissioner says that confusion about affordable health insurance plans, and a lack of urgency about health care issues contribute to the problem. The commissioner notes that while affordable health insurance plans are available, they often have high deductibles that are unattractive to consumers with a moderate income.

Although most Oklahomans receive their health insurance through an employer-sponsored plan, the trend in this type of coverage is declining each year due to the high costs of state mandates and federal requirements. Employer sponsored coverage is expected to cover less than half of all Americans within a decade regardless of government intervention. MedSave.com reports that Oklahoma's mandates add almost 10% to the cost of employer-provided insurance and the recently enacted federal COBRA subsidy program will add a significant but yet unknown amount to group health insurance coverage. The number of Oklahomans who must find their own health insurance will  continues to grow each year regardless of which government approach is taken to reform the overall health care system.

Speaking at the "State Coverage Initiative' meeting on March 9, 2009 the Insurance Commissioner presented an update1 to the plan to expand private commercial health insurance within the next 18 months. The message of the campaign is that affordable health insurance is available in Oklahoma and although we are far from a perfect health care environment, each resident must realize the importance of taking steps to provide for their own health protection.

Availability of affordable health insurance

MedSave.com reports that their are currently at least 15 health insurance plans categorized as "low cost insurance" in Oklahoma although cost, availability and suitability vary widely from person to person. The best approach to reducing the number of uninsured in the state and across the U.S. is to improve consumer education about the available choices, according to sources compiled in an earlier report titled "Covering the Uninsured: Plan for 2009".  Most low cost individual and family health insurance policies are now issued online rather than through an insurance agent or by mail.

Suitability, Exclusions and Limitations

Those with serious or ongoing medical problems should not switch health insurance without considering the effect of pre-existing coverage limitations. Most individual health insurance policies include limitations or exclusions for pre-existing medical conditions, including pregnancy.

In many cases it makes more sense to buy insurance that excludes coverage for reasonably predictable medical costs as long as that policy provides a "Certificate of Creditable Coverage" or takeover benefits are reasonable assured in the near future. For example, a person that uses an inhaler for asthma is usually smarter to pay for the medication outside of individual insurance and take a policy that excludes pre-existing conditions to save hundreds of dollars each month knowing that the financial risks are minimal. In contrast, an obese diabetic person with signs of complications and other medical symptoms should not take this approach because the costs are not known and may not be manageable outside of insurance. In this case the only logical option is the more expensive employer-provided policy or other guaranteed-issue major medical insurance.

Popular affordable health insurance brands in OK

The most popular short term health insurance plan in Oklahoma is the American Health Shield. This is a "plain vanilla" major medical insurance policy that covers ordinary and necessary medical expenses, including doctor visits, hospital charges, lab costs, prescriptions, and other items expected to be covered by a traditional major medical plan above the chosen policy deductible. This policy provides members with a qualified "Certificate of Creditable Coverage" at the termination of coverage to be used to prove eligibility for immediate takeover of pre-existing medical conditions on a future group insurance plan. The big distinction that makes this a low cost insurance is that short term insurance policies do not cover pre-existing medical conditions. As a result, this insurance is priced at a fraction of the cost of group insurance plans that pay for pre-existing medical conditions. Younger applicants typically choose a $500 policy deductible to save premium, but other options are available. The policy does not cover pregnancy expense or the cost of treating pre-existing medical conditions. This policy is available only to U.S. citizens.

Other high quality choices for short term major medical insurance are Celtic Insurance, and Secure STM. All of these policies can be issued on a semester-by-semester basis. Secure STM is available in 6 month, 12 month and 36 month policy terms. All of these provide coverage throughout all 50 states and allow treatment with any doctor or hospital without the need for a referral.

International travelers moving to the United States prefer the Inbound Immigrant policy. This policy actually provides more liberal benefits than it U.S. counterparts, but coverage must be purchased within 2 years after first arriving in the United States.

U.S. residents spending time studying overseas should consider one of the International Health Insurance polices available, depending on the length of their overseas stay.

Other policies are available with special medical considerations. All of these policies are significantly less expensive than a typical group health insurance policy in Oklahoma. Coverage for specific situations is described below.

Self-employed coverage

The two most popular plans for self-employed individuals are the 36 month version of Secure STM known as "Secure 12x3 STM" and the high deductible consumer-driven and Health Savings Account qualified health insurance from Celtic Insurance. The former is more popular with new, cash hungry startup businesses and the latter is more popular with established and successful self-employed people. The primary advantage of each is the longer span of coverage and the lower cost (as compared with group plans) due to the paring (and presumable less important to the self-employed who buy their own insurance) of mandated coverage provisions.

 

Student health insurance in Oklahoma

There is also good news for students in Oklahoma. All MedSave.com insurance policies listed above are also available to full-time and part-time students without regard to current course load. Unlike other student health insurance plans, this insurance is not cancelled if the student takes time off from school. All of the insurance plans listed here can be retained after graduation or other leave from school. All of these policies provide coverage nationwide with any doctor or hospital of your choice without the need for a referral.

Coverage area

Group insurance coverage provided by an employer tends to focus on a specific geographic coverage area. In contrast, all MedSave.com individual insurance policies provide equal treatment with any U.S. doctor or hospital. Please note that if overseas travel is anticipated, a supplemental international health insurance policy should be added separately for the period of travel.

Cost

Most individually purchased health insurance policies cost between $75 and $125 per month for young adults and the cost increases with age. Payment are usually made on a month-to-month basis and coverage can easily be cancelled by the member when it no longer needed. A small discount is available when paying for more than one month at a time. Price varies based primarily on location.

How soon can coverage start?

Coverage can be started as soon as midnight following online enrollment and electronic payment. Many health insurance companies now offer the option to allow an immediate download of the health insurance ID card immediately at the time of enrollment.

Supplemental health insurance

Oklahomans have recently become interested in purchasing low cost limited benefit supplemental health insurance like Basic Health Insurance to cover policy deductibles and other out-of-pocket medical expenses. This coverage provides cash benefits directly to the policyholder in addition to other coverage that may be made through other health insurance. This insurance should not be used in place of major medical insurance. Other similar supplemental insurance plans in Oklahoma are the "Value Benefit" plans - five inexpensive policies that provide specified supplemental limited benefits for hospitals, doctor visits, and emergency room coverage.

The primary distinctions between major medical insurance and supplemental insurance are: 1) supplemental insurance benefits are paid in addition to other insurance (not reduced by other insurance) and 2) the maximum benefits are lower than for major medical insurance.

Some supplemental insurance and mini-med policies provides a higher level of benefits so that some are satisfied to use these in place of major medical insurance. It should be cautioned that the catastrophic coverage is not sufficient in these policies but members still enjoy more up-front benefits under these plans and the lack of a policy deductible. The most popular Oklahoma health insurance policy in this category is Core Health Insurance. A detailed review, pricing and more information are available elsewhere on this site.

PPO discount plans (not insurance)

According to a survey cited by Insurance Commissioner Kim Holland in her presentation, Oklahomans value a wide range of different types of health benefits. Almost everyone should utilize some type of discount pricing system for medical, dental, prescription and other ancillary expenses. Discount pricing is often built into the insurance policy but free-standing PPO discount programs are available to fill in any gaps and a wider range of health products and services. For example, if a health insurance provides only discounts for doctor bills, hospital charges and prescription medicines, then a supplemental non-insurance PPO discount program might be used to reduce the out-of-pocket cost of dental, orthodontic and eye care expenses. These plans provide a discount, perhaps 20-25% on average, for out-of-pocket expenses that are usually paid in cash rather than by insurance.

 

 Remember that one enrollment covers the entire household, including students who are away at school. These non-insurance discount plans are inexpensive, ranging from $100 per year for a dental/vision plan to about $300 per year for a full medical/dental/vision plus plan. Most families find that makes good financial sense to have this benefit. See www.ehealthdiscountplan.com for more information.

Managed care considerations

Most individual medial insurance policies are not designed to provide full pregnancy coverage, or take over an existing plan of treatment for a pre-existing medical condition. When pre-existing medical conditions are the primary concern, we recommend the article "Finding Health Insurance for Pre-Exiting Medical Conditions". Individuals with medical conditions should be fully aware of the laws known as COBRA and HIPAA continuation coverage. The low cost policies are typically exempt from the COBRA and HIPAA requirements in order to allow them to remain more affordable. Those who need to consider more expensive policies should consider the individual insurance plans from the large managed care providers like Blue Cross, Kaiser Permanente, Wellpoint, Aetna, Pacific Life and Cigna. Although not all plans are available in all areas, a good place to start narrowing the search for policies is InsureMe. Do not assume that every pre-existing medical condition makes you ineligible for coverage. For example, many insurers, including Celtic Insurance, offer standard rates for those with high blood pressure controlled by medication.

Support

Free personal enrollment support is available through OnlineAdviser by e-mail to help choose the best-suited health insurance policy. See the contact information on the right margin of this page.

Resources

Many more articles and resources devoted to reducing health insurance expenses are available through MedSave.com. See the "Articles" page or the "Knowledge Base" page for more ideas and suggestions. "Cover the Uninsured" group also publishes a more generic "Guide to Finding Health Insurance in Oklahoma" in PDF format that is available for download and printing.

1 The Insurance Commissioner's 3/9/09 Power Point presentation updating the state's 10 point individual health insurance proposal HCR 1010 to expand coverage through a private insurance/public policy initiative is available online at http://www.ok.gov/oid/Consumers/Public_Policy_Initiatives/State_Coverage_Initiative/index.html. In our opinion, Oklahoma's State Coverage Initiative model may prove more effective than the programs being pursued or planned in other states.

 






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