Comprehensive Guide to Insurance and Health Care Options in 2021
Discover important information on insurance and health care options for 2021, including eligibility criteria, enrollment timelines, premium assistance programs, special enrollment dates, and more. Stay informed about valuable resources and benefits to make well-informed decisions regarding your insurance and health care needs.
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INSURANCE & HEALTH CARE OPTIONS Prepared by: Rebecca Ross, Agency Liaison, PIR April 2021
Message from Oklahoma Insurance Department NOTE The following presentation contains programs and benefits that are time sensitive specific to 2021 and some through 2022 in eligibility and duration. Please check with the appropriate federal and state websites for more information and updates as noted on the slides. Thank you
Check Family Options Spouse Employer Plan You or other dependents can be added, find out: Time frame to enroll Benefits/Network Premium cost (deducted from spouse s check) Not Yet Age 26? Can be added to one of your parent s plans Find out time frame to be added Don t have to live or be dependent on them nor be in college You can be married but your spouse/child(ren) won t be covered with you.
Eligible for Unemployment Insurance Your UI will be your income on www.healthcare.gov Other sources of income must be reported too, if you have any You will want to be approved and receive UI benefits for at least ONE week in 2021 to maximize your UI and COBRA benefits under American Recovery Act
American Rescue Plan NEW!! COBRA Premium Assistance Created premium assistance for those who lost their jobs due to involuntary unemployment or reduction in hours Eligible employees should receive an Employer Notice of COBRA Premium Assistance with enrollment forms likely with your separation packet but before May 31st You must be receiving Unemployment Insurance You do NOT have to pay for COBRA (or 2% Administration Fee) through September 30, 2021. https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/cobra/premium-subsidy
American Rescue Plan NEW!!! Special Enrollment Dates for ACA Compliant Individual Policies Are Different in 2021 Now through August 15, 2021 Open to individuals, families and To new enrollees, never had insurance, etc. If already enrolled, you can change plans Do not have to experience qualified life event: job loss, coverage loss, marriage, birth, etc. Enroll on www.healthcare.gov for subsidies https://www.cms.gov/newsroom/fact-sheets/american-rescue-plan-and-marketplace
ACA Compliant Policies Protect You Group and Individual ACA Compliant Policies must provide: Hospitalization Emergency Services (ex, ground transport) Ambulatory patient services (physician office visits) Maternity/Newborn care Mental Health/Substance Abuse Services/Treatment Prescription Drugs Rehabilitative and habilitative services/devices Laboratory services Preventive/wellness service including chronic diseases Pediatric Services including oral/vision care
American Rescue Plan Premiums Substantially Reduced for ACA Compliant Individual Policies on www.healthcare.gov Household Income Range (% of FPL) NEW!!! Range of Your Expected Contributions (Premiums) for 2021/2022 under American Rescue Plan 100%-133% 0% 133%-150% 0% 150%-200% 0% - 2% 200%-250% 2% - 4% 250%-300% 4% - 6% 300%-400% 6% -8.5% 400% and higher NEW!! 8.5% https://www.cms.gov/newsroom/fact-sheets/american-rescue-plan-and-marketplace
American Rescue Plan Action Items Did you receive your Employer Notice of COBRA Premium Assistance? Did you turn in your COBRA election forms? Have you applied for UI so you can begin UI income? October 1st, you start paying COBRA premiums (102%)* Apply on www.healthcare.gov for Individual Plans (can cover family) to receive zero or reduced premiums for 2021 During Open Enrollment Nov 1-Dec 15, for coverage beginning 2022, renew or change plans to continue receiving zero or reduced premiums. The COBRA final rules by DOL/EBD have not been published. Still awaiting rule regarding SEP for discontinuing COBRA due to costs. Look for updates on: https://www.dol.gov/agencies/ebsa/laws-and- regulations/laws/cobra/premium-subsidy
Other Types of Individual Insurance Non-ACA Compliant Plans: NOT Comprehensive Medical Plans Will ask medical questions and can deny coverage Examples: Short-Term Limited Duration Plans Accident Only Plans Hospital Indemnity Plans Disease Specific Plans and other types of Limited Benefit Plans.
Health Care Plans NOT Insurance Are not regulated by OID and have NO Consumer Protections: Health Care Sharing Ministry Plans Discount Plans, i.e., Dental, Vision, RX cards, Hearing Aids Membership Plans - you pay a monthly fee to receive primary care services from a specific provider, group or facility
Other Government Plans Veteran's Administration Benefits SoonerCare (Medicaid in Oklahoma) Enrollment 24/7 at www.mysoonercare.org Currently covers children in households up to 186% FPL Currently covers the aged, blind, disabled Limited services for adults until Medicaid Expansion is effective 7.1.21.
Expanded Medicaid New Adult Eligibility Eligibility expanded to adult ages 19-64 Benefits are the same as SoonerCare Income at or below $17,796 (1); $36,588 (4), according to size of family (or up to 138% FPL) Enrollment starts June 1, 2021 for coverage beginning July 1, 2021 at www.mysoonercare.org October 1, 2021, SoonerCare transitions to SoonerSelect, new managed care model. NOTE: SoonerCare is currently administered by Oklahoma Health Care Authority (OHCA). The information presented is time sensitive and subject to change. For updates visit: www.Oklahoma.gov/ohca
Contacts Your employer for questions about COBRA Your spouse s employer to get coverage or enroll Your parents if under age 26 to get coverage & enroll www.mysooner.org to enroll your children Need Help? On www.healthcare.gov from the home page you can find an Agent/Broker to assist you, just enter your zip code to find local help. Oklahoma Insurance Consumer Assistance 1-800-522-0071
Oklahoma Insurance Department | Insurance Commissioner Glen Mulready | 800.522.0071
