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My Health Insurance Plan
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YOUR STEP-BY-STEP GUIDE
Use the process below to evaluate your options, reduce your premium and medical cost, and review your medical needs. This process will help you determine the right coverage for you and your family.
Step
Description
Actions
Step #1
YOUR COVERAGE OPTIONS
Determine which coverage options are available to you. Doing this will help you organize, compare, and identify the right coverage type for your situation.
Coverage Option
Who Is Eligible?
Resources
Individual Health Insurance (Marketplace)
Everyone is eligible during Open Enrollment (Nov 1st - Jan 15th for 2023 coverage) Outside of open enrollment you may be eligible if you have had a life event, like losing other coverage, getting married, or having a baby, or based on your estimated household income. Your coverage generally starts the first of the month after you enroll.
COBRA
*Contact your employer to get your COBRA options and Pricing.
You may be eligible for COBRA if:
Your employer plan is covered by COBRA and you have experienced a qualifying event such as: Termination of the covered employee’s employment for any reason other than “gross misconduct,” or Reduction in the covered employee’s hours of employment.
Employer Coverage
*Contact your employer to get your Plan options and Pricing.
The general rule is that if an employer offers group health coverage to any full-time employees, the employer must offer coverage to all full-time employees (defined as those working 30 or more hours per week).
Spousal Employer Coverage
*Contact the employer to get your dependent coverage options and pricing.
Generally, coverage must be offered to an employee’s legal spouse and dependent children. Under the Patient Protection and Affordable Care Act, group insurance plans are required to extend coverage to adult dependents through age 26.
Insure Oklahoma (Employer Sponsored Insurance)
Check to see if your employer participates in this program. IF NOT, CONTACT US NOW.
To qualify for Insure Oklahoma’s Employer-Sponsored Insurance program, you must work for a business that has already been approved by Insure Oklahoma, and: Have an annual gross household income within the Employer-Sponsored Insurance income guidelines, Contribute up to 15 percent of monthly premium cost for yourself, and up to 15 percent of premium cost for qualified dependents
SoonerCare (Oklahoma)
Children may qualify for SoonerCare Services if their tax household's Modified Adjusted Gross Income (MAGI) is within the guidelines.
Adults ages 19-64 whose income is 138% (133% with a 5% disregard) of the federal poverty level or lower.
Self Employed / Small Group Coverage
LLC Partnerships filing a 1065 (K-1) or employing a common W-2 employee other than the owner or a spouse are eligible for small group coverage.
Short Term Health Plans
Anyone is eligible for short term coverage. Short term health insurance is a type of health plan that can provide you with temporary medical coverage when you are between health plans, outside enrollment periods, and need some coverage in case of an emergency. Be sure to review the details of the policy and take note of limitations of coverage.
Intermediate Term Health Plans
Anyone is eligible for Intermediate term coverage. Intermediate term insurance allows you to get short-term coverage for a longer period of time (UP TO 3 YEARS). These plans can be customized more than "Marketplace Coverage" which allows for lower premiums with higher self insurance. Be sure to review the details of the policy and take note of limitations of coverage.
Health Sharing Plans
Anyone is eligible for these plans. Health care sharing plans are provided by organizations whose members “share” medical costs. As part of a health care sharing plan, you are responsible for paying in a certain share amount each month (like a premium) as well as an “annual unshared amount” for your own expenses (like a deductible) that your medical expenses must exceed before the plan shares your expenses. Beyond that, all medical expenses are shared among members of the organization.
Altrua Healthshare
A unique health care sharing ministry that does not require a pastor, elder or representative from a local church to sign an acknowledgement verifying church attendance or validation of medical needs being submitted to the membership for sharing.
Medi-share
Christian Care Ministry is a community of believers committed to connecting and equipping Christians to share each other's everyday burdens through the sharing programs we offer. Christians are able to share their resources, faith, lives, and talents, much like the early church did in the book of Acts.
Samaritan Ministries
Samaritan Ministries is a Biblical solution to health care. It is not insurance. We deliver authentic, compassionate, and personal service in the name of Christ to enable and inspire members to provide for one another’s medical needs through prayer, encouragement, and financial support.
Christian Healthcare Ministries
CHM is a voluntary health cost sharing ministry through which participating Christians work together to share the burden of medical expenses. The powerful outcome of this harmonious relationship is that members have shared billions of dollars for medical bills while also keeping participation costs low. The ministry is a 501(c)(3) tax-exempt organization.
Liberty Healthshare
Our supportive community commits to bearing one another’s burdens in prayer, encouragement, and financial support. By emphasizing good stewardship of our bodies and our healthcare spending, and providing helpful advice, we help our members stay in good health, budget for medical needs, and reduce the overwhelming complexity of navigating our nation’s current medical care system.
Limited Benefit Plans
Limited-benefit plans are medical plans with much lower and more restricted benefits than major medical insurance, but with lower premiums. Limited-benefit plans include critical illness plans, indemnity plans (policies that only pay a pre-determined amount, regardless of total charges), and “hospital cash” policies.
Step #2
COST REDUCTION AND FINANCIAL AID
Step two helps you maximize your savings. Get eligibility, income, and cost sharing reduction information that will help you save money.
Task
Description
Links
Income Analysis
Calculate your Modified Adjusted Gross Income (MAGI) as it pertains to your health coverage options.
Check Eligibility
Based on your calculated income, use the eligibility guidelines provided to determine your eligibility for savings programs offered in your situation.
Lower Income - No Employer Coverage
SoonerCare
SoonerCare is a Primary Care Case Management (PCCM) program in which each member has a medical home. The medical home provider will coordinate all health care services to qualifying Oklahomans.
Lower Income - Eligible For Employer Coverage
Insure Oklahoma
Through this state-operated program, premiums are split between the employee (up to 15 percent), the employer (25 percent) and Insure Oklahoma (60 percent or more). Insure Oklahoma’s share is paid with state tobacco tax and federal matching dollars. You may be able to get assistance in paying premiums for qualified family members, too.
Middle Income
Advanced Premium Tax Credits
A tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). When you apply for coverage in the Health Insurance Marketplace®, you estimate your expected income for the year. If you qualify for a premium tax credit based on your estimate, you can use any amount of the credit in advance to lower your premium.
Higher income / not eligible for financial aid
Small Group / Self Employed
Getting coverage through a small business health insurance plan can be more affordable than buying coverage by yourself. Coverage is generally guaranteed issue. You need at least one employee to qualify. You must contribute toward employee premiums. And you can shop for coverage at any time of the year.
NO INCOME VERIFICATION REQUIRED
Savings Strategies
Learn the savings strategies that will further reduce your cost, both in premium and medical expenses.
IRA Contributions - The benefits of contributing to an IRA include tax deductions, tax-deferred or tax-free growth on earnings, and tax credits if you're eligible.
The deductibility of your contributions is determined by your income and your tax-filing status.
HSA Contributions - Reduction in adjusted gross income means increased premium discounts (and potential medical cost reduction). Your contributions reduce your taxable income, any investment growth within the account is tax-free, and qualified withdrawals (that is, ones used for medical expenses) are tax-free.
Business Expenses - A 100 percent tax deduction is a business expense of which you can claim 100 percent on your income taxes. For small businesses, some of the expenses that are 100 percent deductible include the following:
- Furniture purchased entirely for office use is 100 percent deductible in the year of purchase.
- Office equipment, such as computers, printers and scanners are 100 percent deductible.
- Business travel and its associated costs, like car rentals, hotels, etc. is 100 percent deductible.
- Gifts to clients and employees are 100 percent deductible, up to $25 per person per year.
- If you’re self-employed and pay your own health premiums, you can deduct those at 100 percent.
- Your annual business phone bills are 100% deductible.
Tax Reference Guide
Use the tax reference guide to evaluate additional deductions that may be available to you.
Step #3
YOUR MEDICAL NEEDS
Step three focuses on your medical needs. This is the most important aspect of making your coverage plan work when it's needed most.
Need
Task
Links
Medical Conditions
Organize past, present, and future medical events; this will be essential in the plan selection process.
Provider Needs
Compile a list of necessary medical providers so you can confirm they are in a plan's network.
Prescription Needs
Take inventory of your families prescription medication needs. This is one of the leading drivers of cost.
Step #4
PRICING, COMPARISON & ENROLLMENT
Step four guides you through the plan selection process and gives you the steps to enroll in the best coverage for you and your family.
Type
Description
Quotes
Individual (Marketplace)
ACA Accredited policies, Tax Credit & Cost Sharing Reductions possible
Self Employed / Small Group
No income qualification required. Small group eligibility must be met.
Short Term
Enroll any time. Coverage for less than 1 year. Medical Questions will be asked.
Intermediate Term
Enroll any time. Coverage for up to 3 years. Medical Questions will be asked.
Limited Benefit
Indemnity benefit plan. No time limit for coverage. Enroll any time. Coverage for less than 1 year. Medical Questions may be asked.
Health Sharing Plans
No income qualification required. Small group eligibility must be met.
Altrua Healthshare
A unique health care sharing ministry that does not require a pastor, elder or representative from a local church to sign an acknowledgement verifying church attendance or validation of medical needs being submitted to the membership for sharing.
Medi-share
Christian Care Ministry is a community of believers committed to connecting and equipping Christians to share each other's everyday burdens through the sharing programs we offer. Christians are able to share their resources, faith, lives, and talents, much like the early church did in the book of Acts.
Samaritan Ministries
Samaritan Ministries is a Biblical solution to health care. It is not insurance. We deliver authentic, compassionate, and personal service in the name of Christ to enable and inspire members to provide for one another’s medical needs through prayer, encouragement, and financial support.
Christian Healthcare Ministries
CHM is a voluntary health cost sharing ministry through which participating Christians work together to share the burden of medical expenses. The powerful outcome of this harmonious relationship is that members have shared billions of dollars for medical bills while also keeping participation costs low. The ministry is a 501(c)(3) tax-exempt organization.
Liberty Healthshare
Our supportive community commits to bearing one another’s burdens in prayer, encouragement, and financial support. By emphasizing good stewardship of our bodies and our healthcare spending, and providing helpful advice, we help our members stay in good health, budget for medical needs, and reduce the overwhelming complexity of navigating our nation’s current medical care system.