- In 2019, there were 37 Medicare Advantage Plans available in Oklahoma.
- 18% of the total Medicare population in Oklahoma was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $11,115 per beneficiary in Oklahoma, which is 10% higher than the national average.
- Available Medicare Advantage Plans range from two to 30 across Oklahoma’s 77 counties.
While Original Medicare provides the same coverage for all enrolled in the program, signing up for a Medicare Advantage Plan can give you greater control over your health care costs. Private health insurance companies manage these plans and, while required to have the same coverage as Original Medicare, may offer varied benefits and cost-sharing responsibilities.
Medicare Advantage Plans in Oklahoma
Types of Medicare Advantage Plans
Oklahoma’s Medicare Advantage program is made up of roughly three dozen plans from various health insurance companies. There are four main Medicare Advantage Plan types in the state, including HMOs, PPOs, PFFS plans, and SNPs. Most plans require you to get care from in-network providers, while a few offer greater flexibility through out-of-network coverage.
Health Maintenance Organizations (HMO)
HMO Plans feature in-network hospitals, doctors, and specialists that you have to get care from to have services covered by your policy. In most cases, these plans include prescription drug coverage. HMO plans often have additional benefits, such as vision and dental coverage, wellness services, over-the-counter drugs, and adult day health services. You’re required to choose a primary care doctor and obtain referrals to see specialists in most cases.
Preferred Provider Organizations (PPO)
Like HMOs, PPO Plans feature in-network providers that you must visit to have a greater portion of your medical expenses covered. However, these plans are more flexible and have limited coverage for services given by out-of-network providers. Most plans have prescription drug coverage among their additional benefits; however, if the plan you choose doesn’t offer it, you can’t add this coverage. You can generally see a specialist without getting a referral, and you don’t need to choose a primary care doctor.
Private Fee-For-Service Plans (PFFS)
PFFS Plans don’t generally have provider networks but can be used to cover services from any doctor, specialist, or hospital that agrees to the plan’s payment terms. If you join a PFFS Plan that does have a provider network, you can still go to a provider outside of the network who accepts the plan’s terms, but your out-of-pocket costs will likely be higher. Many PFFS plans have prescription drug coverage, but you can join a Medicare Part D drug plan if yours doesn’t.
Special Needs Plans (SNP)
SNPs limit their membership to those who meet certain eligibility requirements and have coverage that’s customized to the enrollees’ unique needs. For example, some plans are for those with health conditions, such as dementia, diabetes, or heart disease, while others are for those in nursing homes or who are dual-eligible for Medicare and Medicaid. The provider choices, drug formularies, and benefits are tailored to the needs of the groups the SNP serves.
Enrollment and eligibility for Medicare Advantage Plans in Oklahoma
To be eligible for a Medicare Advantage Plan, you must meet the following guidelines:
- At least 65 years old or have a disability
- Reside in the area of the plan you want to join
- Be enrolled in or eligible for Original Medicare Parts A and B
- The Initial Enrollment Period opens up when you first become eligible for Medicare. It lasts seven months, including three months prior to your 65th birthday, your birth month, and the three months after.
- The Open Enrollment Period runs from October 15th through December 7th. You can join a new Medicare Advantage Plan, switch from Original Medicare to a Medicare Advantage Plan, or drop your Medicare coverage altogether.
- The Medicare Advantage Open Enrollment Period goes from January 1st to March 31st. During this period, you can switch to a different Medicare Advantage Plan or back to Original Medicare.
Outside of these scheduled enrollment periods, you can sign up for a Medicare Advantage Plan if you experience a qualifying event, such as moving to a home outside your current coverage area, becoming eligible for an SNP, or having your current plan terminated by Medicare.
Prescription drug coverage
Prescription drug coverage is called Part D, and Original Medicare members can add it to their policy. If you don’t enroll in prescription drug coverage when you’re first eligible for Medicare and don’t have creditable prescription drug coverage through another source, you’ll pay a late enrollment penalty. To avoid this penalty, it’s a good idea to ensure that the Medicare Advantage HMO and PPO Plan you enroll in has prescription drug coverage. If you have an eligible PFFS Plan, you can add a Part D plan to your policy. SNPs always include drug coverage. If you’re currently taking prescribed medication, check the drug formulary before signing up for a policy that covers prescription drugs to make sure your medication is covered.
Medicare Advantage Resources in Oklahoma
When researching Medicare Advantage Plans, it’s helpful to have the guidance of an expert who understands how the program works and how you can find adequate coverage at an affordable rate. Oklahoma residents can access several resources that can connect them with legal experts and health insurance counselors who provide free, unbiased assistance.
Senior Health Insurance Counseling Program
SHIP is a nonprofit program that provides you with information regarding the Medicare Advantage Plans available in your area and other senior health insurance-related issues. It’s staffed with volunteer counselors who can answer your questions about different types of policies, coverage options, and cost-sharing obligations. Counselors can help you look over medical billing statements to understand charges and dispute denied coverage.
Contact Information: Website | 800-763-2828
Oklahoma Insurance Department
The state’s Insurance Department provides comprehensive information on health insurance for older adults, including recognizing and reporting fraud, qualifying for the Medicare Assistance Program, and comparing policies to determine which one best fits your needs. It maintains an up-to-date database of SHIP counselors throughout the state, helping you find one in your area. The department fields and investigates reports of insurance claims that weren’t handled appropriately.
Contact Information: Website | 405-521-2828
Areawide Aging Agency
Areawide Aging Agency is the Area Agency on Aging in Oklahoma City. This AAA, which is one of 11 in the state, administers services funded by the Older Americans Act to those aged 60 and over. Among its services is SHIP, the statewide program that offers free assistance with Medicare-related issues. Through SHIP, volunteer counselors provide unbiased, one-on-one consultations to help you understand your medical bills, find a Medicare Advantage Plan that includes the services and prescription drug coverage you need, find in-network health care providers, and resolve billing issues or dropped coverage.
Contact Information: Website | 405-942-8500
Legal Aid Services of Oklahoma, Inc.
If you’re at least 60 years old, you can get free civil legal advice through LASO, a statewide nonprofit law firm. This firm is funded through local AAAs and can help you obtain Medicare coverage and other public benefits that you’re entitled to, including Supplemental Security Income and Social Security benefits. Experts can help you resolve issues related to your Medicare Advantage Plan, including suspected fraud or claims that weren’t handled properly. Assistance is available in person by appointment at local offices, over the phone, and through the LiveHelp online chat service.
Contact Information: Website | 888-534-5243
Learn More from Our Sources
- Medicare | How Original Medicare Works
- Medicare | Medicare Advantage Plans Cover All Medicare Services
- Medicare | Health Maintenance Organization (HMO)
- Medicare| Preferred Provider Organization (PPO)
- Medicare | Private Fee-for-Service (PFFS) Plans
- Centers for Medicare & Medicaid Services | Private Fee-for-Service Plans
- Medicare | Special Needs Plans (SNP)
- Medicare | How to Get Prescription Drug Coverage
- Medicare | Part D Late Enrollment Penalty
- Medicare | Joining a Health or Drug Plan
- Medicare | Special Circumstances (Special Enrollment Periods)