Oklahomans will likely be offered plans by four companies when the state's health insurance exchange opens Oct. 1, but options and prices depend on where they live, their age and whether they smoke.
Officials have told the Tulsa World four companies applied to offer health insurance on the website known as Oklahoma's insurance exchange under the Affordable Care Act, or "Obamacare." The exchanges are on track to open Oct. 1, federal officials said.
The companies are Blue Cross Blue Shield of Oklahoma, CommunityCare, GlobalHealth and Coventry Health Care Inc., acquired by Aetna in late May.
Two companies - CommunityCare and GlobalHealth - confirmed they have applied to offer plans in the exchange. Officials with Blue Cross Blue Shield and Aetna declined to confirm whether they were offering coverage.
The websites are intended to allow consumers to compare prices and features of health insurance plans.
Mike Rhoads, deputy commissioner for the Oklahoma Insurance Department, named the four companies as the providers "we think anecdotally are going to be the four carriers here in the state" on the exchange. Federal officials are still reviewing plans to ensure they comply with the law.
Two other state officials confirmed those four companies had applied, saying the deadline to apply has passed so additional companies are unlikely to be added.
There are at least 10 companies currently offering health insurance in Oklahoma, records show.
Rhoads said it is "remarkable" that four carriers applied to offer coverage under the exchange in Oklahoma.
"In some states, they have suffered. Mississippi had one QHP (qualified health plan). ... You don't have much of a marketplace if you have one plan."
Companies may offer up to four plans on the exchanges: bronze, silver, gold and platinum. The least expensive plan, bronze, covers 60 percent of health-care costs, and the platinum plan covers 90 percent, according to CMS.
Insurers on the exchanges must offer a qualified plan at the silver and gold levels, which cover 70 percent and 80 percent of health-care costs, but aren't required to offer bronze or platinum plans, federal officials said.
John Giles, director of health planning and grants for the state Health Department, said companies may take only three factors into account when setting rates in the exchange: a person's age, region of Oklahoma in which they live and whether they smoke. The law bans insurers from refusing coverage due to pre-existing conditions.
Because the state refused to create its own exchange, federal officials are in charge of the process.
"While it is not a function of the state, what we have tried to do is remain knowledgeable about the impact and sort of stay abreast," Giles said.
The Health Department and other state agencies will direct citizens to the appropriate places for information about the plans, he said.
"We don't want consumers to come in, ask a question and just pretend it doesn't exist," Giles said.
A spokesperson for the federal agency overseeing the law - the U.S. Centers for Medicare and Medicaid Services - said the agency is prepared to open the exchanges on time. The official spoke only on background.
"We are working every day to establish individual and small business marketplaces where many Americans will have access to quality, affordable coverage for the first time. We have already met key milestones and are on track for open enrollment to begin on October 1, 2013," the CMS official said in an email to the World.
CMS is expected to announce details of plans next month for federally created exchanges. The deadline for insurance companies to sign final agreements with CMS is Sept. 9, records show.
Rhoads and other officials said the state will be divided into five regions for the insurance exchange. The regions are the areas surrounding Tulsa, Oklahoma City, Lawton, an eastern Oklahoma area and a catch-all region for the rest of the state, Rhoads said.
Insurers don't have to offer plans in all regions and one company - GlobalHealth - confirmed its plans will not cover the entire state.
Scott Vaughn, CEO of GlobalHealth Inc., said the company's service area covers about half of the state, in central and northeastern -Oklahoma. GlobalHealth is an Oklahoma-based health maintenance organization founded in 2004.
Vaughn said the company applied to take part in the insurance exchange. Many Oklahomans are not aware of how the plans will work due to controversy surrounding the law, he said.
"Because there's been so much discussion politically about rejecting Obamacare, a lot of the folks who are eligible for coverage and eligible for subsidies are not aware of that," Vaughn said.
Members of Congress have voted 40 times to repeal the law, which has been upheld by the U.S. Supreme Court. A lawsuit filed by Oklahoma Attorney General Scott Pruitt challenging the law remains pending in the Eastern District of federal court.
Insurance rates have not been announced, but Frank Stone, chief actuary for the state Insurance Department, said there are limits on how widely they can vary. Stone said a plan cannot be more than three times as expensive for the oldest category of people as the plan for the youngest people.
Cindy Giddings, director of marketing for CommunityCare of Oklahoma, confirmed the company will be offering coverage through the state insurance exchange. The company will price rates depending on age, geographic rating area and smoking status, she said.
"We are excited about the exchanges and look forward to competing in this marketplace," Giddings said.
In a letter to insurance companies on April 5, CMS states it will compare benefits, rates and deductibles of similar plans offered by companies within the same region. Companies proposing rates that are "outliers" will be referred to state insurance departments for review, the letter states.
"If the state confirms that the rate is justified, CMS expects to certify the QHP (Qualified Health Plan) if the QHP meets all other standards," the letter states.
The law does not affect people who receive health insurance through their employer. About four out of every 10 Oklahomans receive employer-provided insurance.
There are about 680,000 uninsured people in Oklahoma - about 18 percent of the state's population - and more than 180,000 people covered by individual plans, according to a 2010 study commissioned by the state.
Unless they fall into an exempt category, individuals must have health insurance or pay a fine under the law next year, estimated to cost about $95 initially. However there are nine exemptions, including Native Americans, prisoners and people who can't afford insurance, records show.
Under the law, premium subsidies are available for individuals and families earning from 100 percent to 400 percent of the federal poverty level.
A family of four earning a combined $96,000 could qualify for a small subsidy paying about 15 percent of the premium costs. A family earning $50,000 annually would qualify for a subsidy paying nearly 70 percent of the policy's annual cost.
However, the poorest uninsured people in the state may not be eligible for coverage of any kind.
Gov. Mary Fallin rejected an expansion of Medicaid that accompanied the law, saying the state couldn't afford the future costs. Federal officials informed Fallin that the state's Insure Oklahoma program that provides health care for low-income people would not be able to continue operating after the year's end.
That leaves more than 8,000 people on the program and anyone below 100 percent of the poverty level - $23,550 for a family of four - without health insurance.
The Affordable Care Act provides 100 percent federal funding for benefit costs in the first three years of Medicaid expansion to cover adults earning up to 133 percent of the federal poverty level. After that, a share of the benefit costs would shift to the state, capping at 10 percent in 2020.
Affordable Care Act key dates
Here are key dates that apply to the Affordable Care Act, according to the U.S. Centers for Medicare and Medicaid Services:
Oct. 1, 2013: Insurance exchanges open, providing online ability for consumers to apply for individual health-insurance coverage and compare rates. Subsidies are available for families making as much as $96,000
Jan. 1, 2014: Coverage begins for plans purchased through the exchange.
March 31, 2014: Open enrollment in the exchanges closes.
Jan. 1, 2015: Large employers mandated to provide health insurance for employees or face a penalty.
Source: U.S. Centers for Medicare and Medicaid Services
Required insurance benefits
The Affordable Care Act requires individual and small-group health insurance plans - both inside and outside the health-insurance exchanges - to offer the following "essential health benefits:"
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance-use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
Source: U.S. Centers for Medicare and Medicaid Services
Ziva Branstetter 918-581-8306
ziva.branstetter@tulsaworld.com
Original Print Headline: Companies get in line for health exchange
