Medicare Advantage Plans in Oklahoma
Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: October 15, 2020
Original Medicare consists of separate Part A and Part B plans that cover hospital insurance and medical insurance, respectively, but doesn't include drug coverage without a separate Part D prescription plan. Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. It's a bundled plan that includes everything Medicare Part A and B covers, plus it often has Part D and extra benefits not covered by Original Medicare, such as dental, vision, and hearing services. Medicare Advantage plans are provided by approved, contracted private insurance companies, while Original Medicare is provided directly by the federal government.
- 1 In 2019, there were 37 Medicare Advantage plans available in Oklahoma.
- 2 18% of the total Medicare population in Oklahoma is enrolled in Medicare Advantage plans as of 2018.
- 3 In 2018, Original Medicare spent an average of $11,115 per beneficiary in Oklahoma, which is 10% higher than the national average.
- 4 Available Medicare Advantage plans range from 2 to 30 across Oklahoma’s 77 counties.
When seniors join Medicare Advantage plans in Oklahoma, Medicare pays a fixed portion of the coverage amount to the private insurance companies providing these plans. Medicare Advantage enrollees have all the same rights and protections as they would under Original Medicare. The companies providing Medicare Advantage coverage must follow Medicare’s rules and must notify plan participants of any plan changes before the next enrollment year begins. There are various types of plans to choose from, including Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service, and Special Needs Plans.
Medicare Advantage Plans in Oklahoma
Types of Medicare Advantage Plans
Several insurance companies offer Medicare Advantage plans in Oklahoma, and HMOs and PPOs are the most common type of plans offered. There are also a few PFFS plans and one SNP available in a limited area. Oklahoma’s Medicare Advantage program has specific rules regarding eligibility and enrollment requirements and prescription drug coverage. Seniors have several state and local resources that provide additional information about Medicare Advantage coverage and assist them with finding the right plan.
Health Maintenance Organizations (HMO)
HMO plans have a network of doctors and hospitals. Plan participants must see one of the providers within this network for their health care costs to be covered. If participants choose to see someone outside the network, they’ll be responsible for the full cost of care themselves. Common out-of-network services include emergency services, urgent care, and dialysis. Most HMOs require that participants choose a primary care provider, who determines the type of treatment needed and provides referrals to specialists if necessary. Although they have strict requirements, HMO plans typically have the lowest premiums and low or no deductibles.
Preferred Provider Organizations (PPO)
PPO plans also have a network of providers, but they offer more flexibility when choosing a doctor or hospital and fewer restrictions on seeing non-network providers. Unlike HMOs, PPOs may pay for the cost of care when plan participants see a doctor or use a hospital outside the network, but it’s usually at a lower rate. Participants receive the lowest copay and coinsurance rates when they stay within the network. Plan members can also see a specialist without a referral from a PCP. Premiums are generally higher, and these plans typically require a deductible.
Private Fee-For-Service Plans (PFFS)
PFFS plans may have a provider network that always agrees to treat all plan members. Plan participants can see any provider in this network, or they may be able to see their own Medicare-approved health care providers if the provider agrees to the plan’s payment terms. Members don’t have to choose a PCP or get referrals to see specialists. Because the insurance companies decide how much they’ll pay for health services and how much plan members pay, instead of costs being set by the Medicare program, out-of-pocket expenses tend to be higher with PFFSs compared to other Medicare Advantage plans.
Special Needs Plans (SNP)
SNPs are limited to beneficiaries with certain types of chronic or disabling diseases or illnesses, so not all Medicare recipients qualify for these types of plans. SNPs tailor their care providers, benefits, and drug coverage to fit the specific needs of plan members, so members may receive better coverage for their conditions than other plans provide. Members must usually receive their care from a network provider and need a referral to see specialists. Besides chronic condition SNPs, there are also institutional SNPs and dual-eligible SNPs. Currently, there’s only one SNP available in Oklahoma in the greater Ardmore area.
Enrollment & Eligibility for Medicare Advantage Plans in Oklahoma
To be eligible for Medicare Advantage plans in Oklahoma, enrollees must:
- Be eligible for Original Medicare Parts A and B
- Live in an area of the state where Medicare Advantage plans are sold
- Not be enrolled in Medigap insurance
- Be aged 65 or older
- Been receiving disability benefits for at least 24 months
- Be a United States citizens or permanent resident
- Not have end-stage renal disease, although enrollment in an SNP may be possible
Oklahoma seniors who already receive Social Security or Railroad Retirement Board benefits are automatically enrolled in Medicare Parts A and B when they turn 65. If they prefer a Medicare Advantage plan, they must switch their coverage during an approved enrollment period.
There are four enrollment periods, but some are for first-time enrollment in Oklahoma’s Medicare Advantage program, and others are just for making changes.
- Initial coverage election periods are when anyone can join for the first time and spans the seven-month period between the three months prior to the enrollees’ 65th birthday month and the three months following.
- Annual election periods run from October 15 to December 7 each year. They are open to current Medicare recipients wanting to enroll in Medicare Advantage or anyone already enrolled who wants to change plans.
- Open enrollment periods run from January 1 to March 31 annually and are only open to current Medicare Advantage enrollees who want to switch plans or switch back to Original Medicare.
- General enrollment periods run from April 1 to June 30 and are open to Medicare beneficiaries who enrolled in Medicare Part B during the open enrollment period and want to switch to a Medicare Advantage plan.
Prescription Drug Coverage
Many Medicare Advantage plans in Oklahoma include prescription drug coverage at various costs. Most HMOs and PPOs have prescription drug plans, often with a higher or separate monthly premium. However, enrollees can’t sign up for an individual Medicare Part D plan if their plan doesn’t include prescription drug coverage, or they’ll lose their Medicare Advantage plan and be switched back to Original Medicare. PFFS plans usually include prescription drug coverage, but if they don’t, members can get a separate Medicare Part D plan. SNPs are required by law to provide prescription drug coverage.
Medicare Advantage Resources in Oklahoma
Oklahoma’s Medicare Advantage program provides coverage to aging adults who might otherwise go without health insurance. Unfortunately, some Medicare-eligible seniors are overwhelmed by the complex application and enrollment process or simply don’t understand how to sign up or how the program works. Various Oklahoma organizations step in to help by providing personalized Medicare counseling, which is usually free and helps ensure qualified recipients find the right Medicare Advantage program for them.
Oklahoma Insurance Department
The Oklahoma Insurance Department oversees the free statewide Medicare Assistance Program, which includes the Senior Health Insurance Counseling Program. Certified MAP counselors assist Medicare beneficiaries with comparing Medicare Advantage plans and choosing a Medicare Part D prescription drug plan. SHIP counselors operate out of nonprofit organizations around the state and provide assistance with Medicare, Medicaid, Medicare Advantage, Medicare supplements, and long-term care.
Contact Information: Website | 800-522-0071 or 800-763-2828
Oklahoma Association of Area Agencies on Aging
The Oklahoma Association of Area Agencies on Aging, also called the O4A, is a nonprofit statewide network of 11 agencies that advocate for and serve the elderly population. Services include assisting Medicare beneficiaries with one-on-one counseling to help them review their Medicare options, including Medicare Advantage and Medicare Part D plans. Those interested can contact the O4A or locate their local Area Agency on Aging office online and contact the appropriate office directly.
Contact Information: Website | 580-562-5022
LIFE Senior Services
LIFE Senior Services’ Medicare Assistance Program provides objective information and assistance with Medicare, Medicare Advantage, Medicare supplements, and other health coverage options to current and future Medicare beneficiaries living in a 17-county region of northeastern Oklahoma. Services are free of charge, including educational seminars and virtual classes that help beneficiaries understand and acquire the services they need. LIFE’s Medicare specialists also offer personalized counseling to help beneficiaries compare and enroll in Medicare or Medicare Advantage plans that best fit their requirements and provide information on Medicare Part D and the Extra Help program.
Contact Information: Website | 918-664-9000 ext. 1189
Northwestern Oklahoma Community Action Agency – Opportunities, Inc.
Northwestern Oklahoma Community Action Agency, Opportunities, Inc., assists seniors in a 16-county region of northwestern Oklahoma with four insurance and prescription assistance programs. All programs are free, including SHIP and the Medicare Improvements for Patients and Providers Act program. SHIP counseling helps beneficiaries understand their Medicare, Medicare Advantage, Medigap, and Medicaid benefits. MIPPA provides Medicare Part D counseling and promotes new Medicare prevention and wellness benefits to Medicare beneficiaries in rural areas.
Contact Information: Website | 580-623-7283
Southern Oklahoma Development Association
The Southern Oklahoma Development Association assists beneficiaries in a 10-county region of southern Oklahoma as a chapter of the Area Agency on Aging. Its Medicare Assistance Program operates the area’s SHIP counseling program to assist current or future Medicare beneficiaries with Medicare, Medicare Advantage, Medicare supplements, Medicaid, long-term care, and other health-related plans. SODA also helps enroll low-income Medicare-approved seniors into the Low Income Subsidy for Medicare Part D and Medicare Saving Programs through the MIPPA program.
Contact Information: Website | 1-800-211-2116
- Sources [-]
https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/special-needs-plans-snp Last accessed April 2021
https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b Last accessed April 2021
https://www.medicare.gov/blog/medicare-enrollment-period-2020 Last accessed April 2021
https://www.medicare.gov/Pubs/pdf/11135-prescription-drug-coverage-with-ma-mcp.pdf Last accessed April 2021
Roseann Birch, Medicare Consultant
With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.
Leron Moore, Medicare Consultant
With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.