Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Original Medicare and Medicare Advantage are two different ways seniors and qualifying disabled individuals get their Medicare benefits. While both options provide the same level of hospital insurance, called Part A, and medical insurance, called Part B, there are several distinct differences between them. One primary difference is under Original Medicare, the federal government directly pays for health care services beneficiaries receive. Alternately, private insurance companies offer Medicare Advantage, sometimes known as MA Plans or Medicare Part C. These companies must be approved by the Centers for Medicare and Medicaid Services(CMS) and follow the rules set by CMS.
Oklahoma had almost 750,000 Medicare recipients in 2020. Around 181,000 of these beneficiaries enrolled in Medicare Advantage instead of Original Medicare, or about 24%. The number of beneficiaries opting for MA plans jumped to 30% in 2021. Enrollees in Medicare continue to rise yearly, with nearly 759,000 Medicare recipients reported in Oklahoma for the 2022 plan year. The number of Medicare Advantage plans available in Oklahoma rose to 72 in 2022, compared to 57 in 2021. However, the average monthly Medicare Advantage premium remained essentially unchanged, dropping from $13.67 in 2021 to $13.66 in 2022. In contrast, many other states reported a relatively substantial drop in average premiums in 2022.
This guide provides a comprehensive overview of Medicare Advantage plans in Oklahoma, including what these plans cover and how they work. It also discusses some top MA plan providers, eligibility requirements and how to enroll.
The Top 10 Medicare Advantage Plans in Oklahoma
Seniors in Oklahoma benefit from the big bump in available Medicare Advantage plans, which may provide them with several more options, depending on where they live. They will likely also have several providers to choose from, as many serve various counties within the state. The table below features the top 10 Medicare Advantage providers in Oklahoma based on total enrollment. Because providers usually have multiple plans available, the enrollment numbers for each plan were added together to provide a total. The list also includes each provider’s range of costs for all plans highlighted and Medicare star rating for easy comparison. The information provided was last updated in April 2022, and beneficiaries can also visit Medicare.gov to get the most recent data.
HMO, PPO, PFFS
CommunityCare Senior Health Plan (HMO)
Blue Cross and Blue Shield of Oklahoma
Blue Cross and Blue Shield of OK, TX
Blue Cross and Blue Shield
How Medicare Advantage Plans Work in Oklahoma
While several insurance carriers offer Medicare Advantage plans in Oklahoma, not every plan is available in every county. However, 100% of Oklahoma’s Medicare recipients have access to at least one MA plan in their area. Options may include one or more of the four primary types of plans available through Oklahoma’s Medicare Advantage program. The two most common options are health maintenance organizations, referred to as HMOs, and preferred provider originations, referred to as PPOs. Oklahoma insurers may also offer private-fee-for service, called PFFS plans, and special needs plans, called SNPs. Below are descriptions of each of these plan types.
What Medicare Advantage Plans Cover in Oklahoma
Besides Parts A and B coverage, Medicare Advantage plans typically cover extra benefits not found in Original Medicare and usually at a lower deductible than traditional Medicare. Therefore, Medicare recipients signed up on Medicare Advantage have the same inpatient/hospital coverage and outpatient/doctor care level, with additional perks. Nationwide, over 90% of Medicare Advantage plans provide access to vision, dental, fitness, hearing and telehealth benefits. The odds are good that many MA plans in Oklahoma do, too. Most MA plans also provide prescription drug coverage, referred to as Medicare Part D, and Original Medicare recipients must get this coverage separate.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Oklahoma
Oklahomans qualify for Medicare Advantage if they have Medicare Parts A and B because the eligibility requirements are the same. Recipients must be aged 65 or older or younger than 65 with a disability that qualifies them for coverage. Recipients of Social Security Disability Insurance (SSDI) qualify under the disability that results in their SSDI benefit. Applicants diagnosed with specific medical conditions, such as permanent kidney failure, known as end-stage renal disease, or Lou Gehrig’s disease, officially known as amyotrophic lateral sclerosis or ALS.
Medicare Advantage recipients also must be U.S. citizens or authorized non-citizens. To qualify for a specific MA plan, they must reside within the area the plan serves. Some MA plans have additional eligibility criteria, especially SNPs. Qualified Medicare recipients must sign up for Medicare Advantage or switch their existing plans during one of the set enrollment periods that occur annually, as detailed below.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Oklahoma
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
The free Medicare Assistance Program offered statewide through the Oklahoma Insurance Department includes the Senior Health Insurance Counseling Program, known as SHIP, and the Senior Medicare Patrol, known as the SMP. Certified MAP counselors are trained annually to counsel Medicare beneficiaries and assist them with comparing Medicare Advantage plans, choosing a Medicare Part D prescription drug plan and unraveling Medigap policies and Medicare Supplemental Insurance plans. Alternatively, the SMP utilizes volunteer advisors who help Oklahoma seniors learn how to protect themselves from health care fraud and how to read their Medicare Summary Notices to detect and report discrepancies.
The Oklahoma Insurance Department Assistance Division handles all types of inquiries. You can contact the Oklahoma City office directly at 405-521-2828, or the Tulsa office at 918-295-3700 or call 800-522-0071 toll free from anywhere in Oklahoma. You can also request assistance online.
Non-profit organizations operate the Senior Health Insurance Counseling Program, which is dedicated to informing Oklahoma seniors about Medicare and other health insurance issues. Counselors provide accurate, objective assistance and advocacy relating to Medicare, Medicaid, Medicare Advantage, Medicare supplements, long-term care and other health coverage plans for current and future Medicare beneficiaries and their representatives. This service is free of charge and available throughout the state.
Local callers can reach the Senior Help Line at 405-521-6628 for assistance with Medicare counseling, or call the helpline toll free at 800-763-2828.
Oklahoma Area Agencies on Aging
The Oklahoma State Council on Aging serves in an advisory capacity to the Oklahoma Department of Human Services’ Aging Services Division and acts as an advocate for older Oklahomans. As part of this program, 11 Area Agencies on Aging exist throughout the state to assist Medicare beneficiaries with one-on-one counseling and help review Medicare options, including Medicare Advantage plans, Medicare Part D enrollments, the Low Income Subsidy, SMP Medicare Fraud Awareness and other health insurance issues.
Through its Medicare Assistance Program, LIFE Senior Services provides assistance with Medicare, Medicare Advantage, Medicare supplements and other health coverage options for current and future Medicare beneficiaries and their representatives. LIFE serves seniors in northeastern Oklahoma throughout a region consisting of 17 counties without charge. Trained counselors help Medicare beneficiaries compare, select and enroll in the Medicare plans that best fit their needs through personalized counseling. LIFE also offers educational seminars throughout the year to help Medicare beneficiaries understand and acquire the services they need. Medicare Part D assistance clinics are held annually from October through December to help seniors compare their drug plan options. During these clinics and throughout the year, LIFE also assists those wanting to apply for the Extra Help program, which can significantly reduce the cost of prescription medications for low income seniors.
Reservations are required for Medicare Part D clinics, and appointments are necessary for counseling. Call LIFE Senior Services at 918-664-9000, ext. 1189, for more information or to make reservations/appointments. You can also email your questions and requests to [email protected].
As an Area Agency on Aging, the Southern Oklahoma Development Association offers a Medicare assistance program as a free referral service to Oklahomans aged 60 and over seeking information and/or assistance. Service areas include the counties of Atoka, Bryan, Carter, Coal, Garvin, Johnston, Love, Marshall, Murray and Pontotoc. The Southern Oklahoma Development Association also operates the Senior Health Insurance Counseling Program in southern Oklahoma, providing advocacy, assistance and counseling to senior residents who are current or soon-to-be Medicare beneficiaries. Through this program, seniors get their Medicare questions answered and receive assistance with Medicare plans, Medicare Advantage, Medicare supplements, Medicaid, long-term care and other health-related plans. This agency also oversees the area’s Senior Medicare Patrol to help beneficiaries protect themselves from health care fraud, and learn to monitor what has been paid by Medicare or Medicaid on the beneficiary’s behalf. As part of the Medicare Improvements for Patients and Providers Act Program, the agency also conducts outreach programs and helps enroll low-income Medicare-approved seniors into Medicare Saving Programs and the Low Income Subsidy for Medicare Part D.
Seniors residing in any part of the service area may schedule Medicare counseling with the Southern Oklahoma Development Association in Durant by calling the Senior Information Line toll free at 800-211-2116.
Long Term Care Authority of Enid
The Long Term Care Authority of Enid offers senior Medicare counseling as an Area Agency on Aging and Oklahoma Insurance Department’s Medicare Assistance Program provider. The LTCA of Enid provides certified counselors to answer Medicare and other health insurance-related questions. It also offers free Medicare Part D prescription plan comparisons and assistance with enrollment or coverage changes during open enrollment periods. Counselors will also help Medicare beneficiaries determine if they qualify for the Extra Help program, which helps pay Medicare Part D prescription drug costs. Reduced costs for qualified beneficiaries may include lower prescription co-payments, annual deductibles and monthly premiums.
You may request Medicare counseling over the phone or in person, and complete an application for the Extra Help program over the phone. Schedule an appointment or request more information by calling LTCA of Enid staff at 580-234-7475, or contact the Director of the Area Agency on Aging via email.
Through Opportunities, Inc. at Northwestern Oklahoma Community Action, seniors in Alfalfa, Beaver, Beckham, Blaine, Cimarron, Custer, Dewey, Ellis, Harper, Kingfisher, Major, Roger Mills, Texas, Washita, Woods and Woodward counties receive assistance with health services through four insurance and prescription assistance programs. These programs include the Senior Health Insurance and Medicare Improvements for Patients and Providers programs to provide counseling services to Medicare beneficiaries in rural areas, and promote new Medicare prevention and wellness benefits. Others are the Senior Medical Patrol to help seniors prevent Medicare fraud, and Rx for Oklahoma, a referral program that connects income eligible individuals with pharmaceutical companies that offer free or low-cost medications.
For more information about the SHIP, MIPPA, SMP or Rx for Oklahoma programs, contact Opportunities, Inc. by calling the main office in Watonga at 580-623-7283, the Clinton office at 580-323-4373, the Guymon office at 580-338-7878 or the Woodward office at 580-256-2899 or 844-290-3914.