Getting Medicare in the Sooner State? Read this first.
While Oklahoma may not be on every retiree’s mind, it’s a fantastic state for retirement. A low cost of living, low taxes, lots of sunshine, and relatively mild winters make this state ideal for many. Couple in the luxuries of Tulsa and Oklahoma City and the stunning beauty of the badlands, and you can see why Oklahoma is growing in popularity among seniors.
Oklahoma’s Medicare system is growing too. In fact, you’ll have hundreds of options and thousands of combinations of options. But how do you sort through so many options? This article will show you how. Let’s jump right in.
Did you know that you can use the Insurify Medicare comparison tool to find the right Medicare plan for you? Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!
Oklahoma Medicare at a Glance
|Number of Original Medicare Enrollees||608,007|
|Number of Medicare Advantage Enrollees||134,929|
|Total Number of Medicare Beneficiaries||742,936|
*Source: Kaiser Family Foundation
What Is Medicare?
Medicare is a federal health insurance program designed to make healthcare services affordable for:
- People 65 years and older and
- People with certain health conditions.
A social safety net by design, the federal Medicare program protects citizens and permanent residents physically and financially. However, the system is complicated. Since its inception in 1966, Medicare has gone through many changes to answer the needs of a diverse populous and changing medical world. The Centers for Medicare & Medicaid Services (CMS) sets the rules and some of the costs of Medicare.
Medicare is made of several parts. Some parts can work in tandem. Some cannot. These parts are:
- Medicare Parts A and B are more often called Original Medicare. Part A covers inpatient care, while Part B covers outpatient care. They are regulated and administered by the U.S. government.
- Medicare Part C is more often called Medicare Advantage. Part C covers everything that Parts A and B cover. It is regulated by the U.S. government but administered by a private health insurance company.
- Medicare Part D is more often called Medicare prescription drug coverage. Part D covers the cost of prescriptions. It is regulated by the U.S. government but administered by a private health insurance company.
- Medicare Supplement Insurance is more often called Medigap. Medicare Supplement plans cover some of the costs of Original Medicare. For example, coinsurance and deductibles. It is regulated by the U.S. government but administered by a private health insurance company.
Who Qualifies for Medicare in Oklahoma?
There are a few ways to qualify for Medicare. The most common way is to do so by age— people 65 years or older can enroll in Medicare. However, people of any age can qualify for Medicare if:
- They are diagnosed with end-stage renal disease (ESRD).
- They are diagnosed with amyotrophic lateral sclerosis (ALS).
- They have drawn from disability (SSDI) for at least 24 months.
Finally, you must be a U.S. citizen or permanent resident of at least five years.
How Much Does Medicare Cost in Oklahoma?
The cost of your Medicare plan may not be the same as your friend’s cost. That’s because costs depend on:
- The type of plan(s) you’ve enrolled in
- The private health insurance company administering your plan, if applicable
- Your location and the health system where you live
- The extent of coverage in your plan
The Cost of Original Medicare in Oklahoma
Original Medicare has fixed costs across the nation. Anywhere you go in the country, you’ll pay the same rate so long as Medicare is accepted. Your costs are broken down into a few categories:
- Other costs
The premium for Part A is free for most beneficiaries. All you need is 40 work credits—roughly 10 years of working history—to qualify. If you don’t qualify for premium-free, you can still get Original Medicare, but you’ll pay a premium. People with at least 30 credits pay $252 a month, and people with fewer than 30 pay $458.
The Medicare Part B premium is $144.60 for most beneficiaries. However, the Part B premium works on a sliding scale—people with high income in retirement will pay a little more. The most one can pay is $491.60, but only if making more than $500,000 as a single person or $750,000 as a couple.
The deductible for Part A is $1,408. The deductible for Part B is $198. But you’ll also need to cover other costs like co-payments and coinsurance. For example, you’ll be responsible for 20 percent of your Part B healthcare costs after your deductible is met.
There is no out-of-pocket limit with Original Medicare. Because these coinsurance rates can be so expensive, many people with Original Medicare choose to also purchase Medigap plans. These plans come with additional premiums but often make the cost of care much lower.
The Cost of Medigap Plans in Oklahoma
Medicare Supplement Insurance plans—a.k.a. Medigap plans—lower the overall cost of Original Medicare and only Original Medicare. These plans cannot be combined with Medicare Advantage plans.
Medigap plans come in 10 different types, designated by a letter— Medigap Plan A, Medigap Plan F, etc. These plans must meet strict requirements set by the CMS, which means that any two Medigap plans of the same type are virtually the same.
For example, Company 1’s Medigap Plan L is virtually the same as Company 2’s Medigap Plan L.
Where these plans differ is on a company level. Insurance companies have different pricing structures, which is why premiums for plans can vary by company. Each plan also varies by the company’s customer service, accessibility, and technology. Company 1 may charge more for Plan L than Company 2, but they may also have better customer service.
The Cost of Medicare Advantage in Oklahoma
Oklahoma Medicare Advantage plans at a glance:
|Total Number of Plans||846|
|Average Monthly Premium||$62.94|
|Average Drug Deductible||$288.61|
Medicare Advantage plans must meet specific requirements in order to get a contract with the CMS. However, once those requirements are met, the plans can offer additional Medicare benefits. Many plans may include coverage for:
Medicare Advantage health plans also offer different coinsurance rates, deductibles, and out-of-pocket limits. Plus, health insurance companies use different networks of providers and different pricing structures.
All of these differences can influence your costs. Generally, a plan with more comprehensive Medicare coverage will have a higher monthly premium than a plan with less comprehensive coverage. However, plans with more health coverage often cost less overall than plans with less coverage.
But cost shouldn’t be everything you consider. Ease of use, breadth of network, and customer satisfaction are all important.
The Cost of Prescription Drug Plans in Oklahoma
Oklahoma prescription drug plans at a glance:
|Total Number of Plans||734|
|Average Monthly Premium||$59.23|
|Average Annual Deductible||$309.27|
Medicare prescription drug coverage is essential for people who take medications on a regular basis. However, everyone can benefit from a comprehensive prescription drug plan. Stand-alone Medicare Part D prescription drug plans can be added to Original Medicare or a Medicare Advantage plan that doesn’t have prescription drug coverage.
Each plan will differ on price, company practices, and levels of coverage for medications on the market. Medication pricing is broken down into four tiers, with Tier 1 being the least expensive and Tier 4 being the most expensive. This tiered system is referred to as a plan’s “formulary.” The formulary looks like this:
- Tier 1: cheap generics
- Tier 2: expensive generics and cheap name brands
- Tier 3: expensive name brands
- Tier 4: specialty drugs
If you take medications regularly, you should absolutely be sure that your medications are covered in either Tier 1 or Tier 2 of a plan’s formulary, if possible.
Cost of Special Needs Plans in Oklahoma
Oklahoma Special Needs Plans at a glance:
|Total Number of Plans||62|
|Average Monthly Drug Premium||$27.66|
|Average Annual Deductible||$435.00|
Special Needs Plans are most similar to Medicare Advantage plans but are designed for people with health conditions that make it difficult to afford Medicare. Health conditions often covered by SNPs include:
- chronic heart failure
- end-stage renal disease (ESRD)
- amyotrophic lateral sclerosis (ALS)
People with low income may also be eligible for an SNP. For most people, you must be dual-eligible—eligible for both Medicare and Medicaid—to enroll in an SNP.
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How Do I Choose Between Original Medicare and Medicare Advantage?
Arguably, the biggest decision in your Medicare planning is choosing between the public and private options. Unfortunately, there is no universally recognized “best plan.” For some people, the public option will make more sense. For others, the private option is a better fit.
To help you understand what’s best for you, we made this chart showing the basic advantages and disadvantages of each option.
How Do I Apply for Original Medicare in Oklahoma?
Luckily, you can apply in one of three easy ways:
- Over the phone
Apply over the phone by calling 1 (800) MEDICARE—TTY users call 1 (877) 486-2048. You’ll need to have your personal information ready, and you may need to fax in a form.
Apply online by logging into your account at SSA.gov. Alternatively, you can also create and apply through your account with Medicare.gov.
To apply in person, simply go to your local Social Security office and apply there. We recommend that during the COVID-19 pandemic, you avoid in-person contact as much as possible. Wait until you receive a coronavirus vaccine if you can.
How Do I Apply for Medicare Advantage in Oklahoma?
To apply for Medicare Advantage, you first need to apply for Original Medicare. It may seem strange, but you’ll need your Medicare number to apply for Medicare Advantage. Once you have this information, you can usually apply through the private health insurance company’s website or by calling their customer service line.
You should be prepared to share your information with the representative. You may also be required to submit copies of your Medicare card and other personal information.
What’s the Best Medicare Advantage Plan in Oklahoma?
We wish there was an easy answer, but Medicare Advantage plans just aren’t universally good or bad. The suitability of any Medicare Advantage plan will depend entirely on the needs of the person using the plan—their needs, preferences, and budget.
When you shop for MA plans, be sure to start with yourself. Make a list of your likes and dislikes, as well as medications or treatment plans you use. For example, do you need to see a chiropractor on a regular basis? How about a psychotherapist? With this information in hand, look for programs that have generous coverage options for your needs.
Finally, consider your budget. How much annually can you afford? Remember that you’re not just covering monthly premiums. You’ll also cover co-payments, deductibles, coinsurance, and 100 percent of any treatment not covered by insurance. For many, the least expensive plan isn’t the plan with the least expensive monthly premium.
FAQ: Oklahoma Medicare
When should I apply for Medicare?
You should apply for Medicare during your Initial Enrollment Period. For most people, this period begins three months before the month of their 65th birthday and extends to the end of the third month after their 65th birthday.
How do I get free health insurance in Oklahoma?
If you have low income or other issues getting affordable health insurance, there are many free healthcare community clinics around the state. If you have some income, you will be asked to make a contribution to your care, but it will be minimal. Beyond accessing these clinics, you should also apply for assistance through Medicaid.
What are the qualifications for Medicaid in Oklahoma?
Eligibility for Medicaid—a.k.a. SoonerCare—relies on a few things. You must be an American citizen or permanent resident. Most Medicare Beneficiaries qualify by age—anyone 65 or older can apply. However, people with disabilities, people caring for children or a family member with a disability, pregnant women, and people who are blind can also apply. The final qualifier is your income. Medicaid is designed for people who simply don’t have means. Generally, the annual income for a single person must be below $16,972. For a household of two, income limits are $22,930. That amount rises as the household increases. If you make a little more than the limit, you should still apply. These limits are a guideline, and the state has measures in place to ensure that everyone who needs help gets it.
Is SoonerCare covered by Medicare?
No. SoonerCare is Oklahoma’s Medicaid program. Medicare and Medicaid are separate programs. If you are dual-eligible for SoonerCare and Medicare, your costs will be much lower.
Conclusion: Compare Oklahoma Medicare Plans Before You Buy
Getting the best Medicare plan depends on you: your needs, preferences, and budget. You should start with yourself first. Then, you need to know your options—understand the different types of Medicare (as outlined above) and the options available in your area.
To see the options in your area, be sure to use the Insurify Medicare comparison tool. Just enter your ZIP code to discover the products available to you.
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