Medicare Plan Options
While Original Medicare has the same coverage for everyone enrolled, there are several ways to customize your coverage to fit your unique needs. Private insurers in Oklahoma sell policies that give you more robust or affordable coverage. Oklahoma’s Medicare Advantage program features all-in-one alternatives to Original Medicare with more coverage options. Some options help you cover your cost-sharing responsibilities or pay for prescription drugs.
Original Medicare is the federal health insurance plan that you become eligible for once you turn 65. It’s made up of two parts, including Part A, which covers inpatient hospital stays and skilled nursing at home or in a facility, and Part B, which covers preventative and outpatient care. This plan has a deductible that resets at the beginning of each year. You pay for 100% of health care costs until you reach your deductible. After that, you generally pay 20% of the cost of a given service, called coinsurance. There’s no annual out-of-pocket limit. You can go to any provider that accepts Medicare, and you usually don’t need referrals to see specialists.
Medicare Advantage Plans
Medicare Advantage Plans are provided by private health insurance companies and offer the same scope of coverage as Original Medicare. These plans are popular options because they typically include coverage that Original Medicare doesn’t, such as prescription drug coverage and vision and dental coverage. You still pay the Part B deductible, and some plans have additional monthly premiums. You may also have to meet a deductible before coverage begins, and most plans have annual out-of-pocket limits to help you control health expenses. Depending on your plan, you may have to obtain care from in-network providers, and you may need to choose a primary doctor and get referrals to see specialists.
Medicare Prescription Drug Coverage Plans
Even if you don’t rely on prescription medications when you first sign up for Medicare, chances are that at some point, you will. Prescription drug coverage helps you control out-of-pocket drug costs by paying for a portion of the cost of the medications your doctor prescribes. Unless you have creditable prescription drug coverage when you enroll in Medicare, you should purchase a prescription drug plan to avoid late enrollment penalties. Each plan has a drug formulary, which details the drugs covered in the plan, and drug tiers, which outline how much your policy pays for a given medication.
Medicare Supplement Insurance Plans
Original Medicare’s basic coverage may be sufficient for those who don’t need more than preventative and routine care. However, if you’re managing a chronic condition, your cost-sharing responsibilities may become burdensome. Medicare Supplement Insurance Plans, also called Medigap, cover expenses such as deductibles, coinsurance, and copays. There are 10 plans available, though the plans available to you depend on what private insurance companies sell in your region. Plans are standardized, meaning that each plan type has the same coverage regardless of the company you buy it from, making it easy to compare plans.
Medicare in Oklahoma by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|560,578||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Oklahoma
While Medicare provides flexibility to accommodate a broad range of health care needs and budgets, finding the right coverage can be a challenge. To help you enroll in the policy that’s the best fit for you, Oklahoma has several government and nonprofit agencies that can help you assess your current and future health needs, budgetary considerations, and health insurance options.
Oklahoma Insurance Department
The Oklahoma Insurance Department regulates health insurance plans sold in the state. It offers two programs to help you get the most from Medicare, including the Senior Health Insurance Counseling Program and Senior Medicare Patrol. SHIP is a nonprofit program that provides free health insurance counseling for older adults. It’s staffed by trained counselors who can answer questions regarding Original Medicare and available Medicare Advantage and Medigap plans. SMP is also a volunteer-driven program that helps you recognize, prevent, and address Medicare fraud and waste. The department also fields consumer complaints regarding unfair insurance practices.
Contact Information: Website | 405-521-2828
Areawide Aging Agency
Areawide Aging Agency serves seniors in the most populous region of the state through a broad range of programs and services. Through this agency, you can connect with a SHIP counselor for free, unbiased health insurance options counseling. While SHIP counselors aren’t authorized to sell insurance policies or affiliated with a provider, they can help you evaluate your health needs and budget, find a prescription drug plan that fits your needs, and determine whether you qualify for cost-saving programs. SHIP counselors can also help you understand your medical bills and resolve billing errors. To find your local agency, refer to this directory.
Contact Information: Website | 405-942-8500
Legal Aid Services of Oklahoma, Inc.
Legal Aid Services of Oklahoma, Inc. is a nonprofit legal agency that partners with local AAAs to provide free legal advice and representation to state residents aged 60 and over. Through your local LASO office, you can get legal assistance with obtaining public benefits such as Medicare, prescription drug coverage, and Medicare Savings Plans. The office can also advocate on your behalf and help you resolve issues such as canceled policies, overcharges, and denied claims.
Contact Information: Website | 888-534-5243
Learn More From Our Sources
- U.S. Census Bureau QuickFacts| Oklahoma | Last accessed June 2021
- Medicare | What’s Medicare | Last accessed June 2021
- Medicare | Medicare Advantage Plans | Last accessed June 2021
- Medicare | What Medicare Part D drug plans cover | Last accessed June 2021
- Medicare | Part D late enrollment penalty | Last accessed June 2021
- Oklahoma Insurance Department | state health insurance assistance programs | Last accessed June 2021
- Oklahoma Insurance Department | About SMP | Last accessed June 2021
- Oklahoma Insurance Department | Last accessed June 2021
- Oklahoma Care Planning Council | Oklahoma Area Agencies on Aging | Last accessed June 2021
- Areawide Aging Agency | Last accessed June 2021
- Legal Aid Services of Oklahoma, Inc. | Senior Legal Help | Last accessed June 2021