Medicare in Oklahoma

Medicare is a federally funded health insurance program for adults aged 65+, young people with qualifying disabilities and citizens with end-stage renal disease. There are two parts: A and B. Part A provides coverage for crucial services, such as stays in hospitals and nursing homes, blood transfusions and certain facets of home health care. Part B covers outpatient care costs, including doctors’ visits, medical transportation and medical supplies or equipment. The majority of beneficiaries don’t pay a premium for Part A, but everyone pays a monthly premium for Part B, which is currently $164.90 as of 2023. Based on data from 2021, Medicare’s annual cost to the state of Oklahoma is $6 billion. 

Medicare Advantage, also known as Part C, combines the coverage provided by Parts A and B into one plan, excluding hospice care. As of 2023, Oklahomans can choose from 89 Medicare Advantage Plans, 17 more than in 2022. Premiums start at 0% but increase with added coverage, such as hearing, dental and vision care. Consequently, the state’s median monthly premium is $14.42. Medicare Part D covers prescription drugs, with premiums varying due to each individual’s personal prescription and the tier their drugs have been assigned. Medicare won’t pay for coinsurance, copayments or deductibles, so many seniors purchase Medicare Supplement Insurance, known as Medigap, to cover their out-of-pocket expenses. 

The Centers for Medicare and Medicaid Services (CMS) administers Original Medicare, while approved private insurance companies oversee Medicare Advantage. As of July 2023, 38% of eligible residents in Oklahoma have purchased a Medicare Advantage Plan. Although this is 10% below the national average, it’s a 3% increase on 2022’s figure, suggesting Oklahomans are warming to Part C. The pace of adoption appears to be accelerating, as the number of eligible residents joining Medicare Advantage in 2023 was 10.69% higher than the previous year’s adoption rate.

This guide provides a detailed review of Medicare in Oklahoma. It discusses the options available to eligible residents and other resources that can help them get more from the health insurance program. Additionally, it looks at how to make purchasing Medicare more affordable.

Options for Medicare Coverage in Oklahoma

Original Medicare is available nationwide, and it’s the primary way people receive their Medicare Parts A and B coverage. However, there’s more than one way to get Medicare coverage, as well as additional coverage. Original Medicare enrollees can get separately Medicare Part D to cover prescription drugs and Medicare Supplemental Insurance (Medigap) to help pay for expenses. Most Medicare Advantage Plans include prescription drug coverage (Part D) and Medigap is not needed for these plans.

Original Medicare (Parts A & B)

Original Medicare beneficiaries qualify for identical care services wherever they are in the country, including when they’re on vacation or are moving to another state. However, the program is restricted to the United States. Therefore, Americans planning trips outside the country are strongly advised to purchase health insurance valid at their destination before they leave. 

Seniors with Original Medicare must pay an annual deductible of $1,600 for Part A and $226 for Part B. They must also pay for their medical care when they receive it, with the program covering 80% of the eventual cost and the senior covering 20%.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

While Original Medicare’s coverage is uniform, Medicare Advantage is flexible. There are five types of Medicare Advantage Plans:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Private Fee-for-Service plans (PFFS)
• Special Needs Plans (SNPs)
• Medicare Savings Account (MSA)

Insurance companies can modify plans to provide personalized coverage, so long as the plan satisfies the rules and regulations imposed by the CMS. For example, a senior willing to pay higher premiums for access to a wider network of health care specialists may opt for a PFFS plan, while another wanting lower premiums may accept a restricted network with an HMO plan.

Who Should Consider Medicare Advantage

Medicare Advantage may benefit enrollees who:

• Want lower premiums due to their general good health
• Prefer all-in-one managed care plans
• Want additional benefits not offered by Original Medicare , such as dental, vision and hearing care

The Top 10 Medicare Advantage Plans in Oklahoma

Compare the 10 most popular Medicare Advantage providers in Oklahoma based on combined enrollment for all plans offered by each provider. Most providers offer multiple plan types and price points, so costs are presented in a range. This information was last updated in August 2023. Learn more about Medicare Advantage by visiting the Medicare Advantage Plans in Oklahoma page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Oklahoma

The Medicare program provides health insurance to seniors who might not otherwise be able to afford coverage. Signing up for Medicare and determining which options are ideal for their health care needs can be confusing. Luckily, Oklahoma has many free resources that can help them understand how Medicare works and their private insurance options to ensure they receive the best inpatient and outpatient coverage for their needs.