Medicare in Oklahoma

Medicare is a health insurance program managed by the federal government. The program predominantly covers seniors aged 65 or older, but individuals under 65 with a qualifying disability, end-stage renal disease (ESRD) or amyotrophic lateral sclerosis may also be eligible for coverage. Original Medicare includes hospital insurance and medical insurance, Part A and Part B. 

Medicare Advantage, also referred to as Part C, provides the same coverage as Parts A and B, along with additional coverage, and often includes Part D, which provides prescription drug coverage. The federal government administers Parts A and B, while Medicare-approved private insurance companies sell Parts C and D.

Estimates indicate that annual enrollment in Medicare will grow by about 1.5 million beneficiaries from 2021 to 2029 nationwide. In Oklahoma, 758,786 individuals enrolled in Medicare during the 2022 plan year. Oklahoma has a population of nearly 4 million residents, and about 19% of them receive Medicare. The state spent over $6.2 billion on the Medicare program in 2019, the latest year with information available, which works out to $10,822 per enrollee.

Medicare Advantage, the private plan alternative to traditional Medicare, has grown over the last decade. It’s also gaining popularity in Oklahoma. About 24% of Medicare beneficiaries in Oklahoma chose Medicare Advantage in 2020, but that number jumped to 30% in 2021. Medicare Advantage replaces Original Medicare. It provides Parts A and B coverage and usually includes prescription drug coverage (Part D) and other health-related services that aren’t included in traditional Medicare plans.

This guide provides more information about Medicare in Oklahoma, including the top 10 Medicare Advantage plans available in the state. It also includes a comprehensive overview of Medicare coverage options and a list of resources that help current and future Medicare recipients make informed health insurance decisions.

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 is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage renal disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

Medicare Advantage Plans, sometimes called MA Plans, offer an all-in-one solution that combines Medicare Parts A and B and often Part D. MA Plans must provide the same level of care as Original Medicare (except hospice care which Part A covers) and often include additional health care services. These benefits may include fitness club memberships and vision, hearing and dental exams. Private insurance companies sell MA Plans and must follow the rules set forth by Medicare.

In Oklahoma, beneficiaries may choose MA Plans if they:

• Are entitled to Part A
• Are enrolled in Part B
• Aren’t enrolled in Medigap
• Don’t have end-stage renal disease
• Live in a plan’s geographic service area

Oklahoma’s average monthly Medicare Advantage premium changed from $13.67 in 2021 to $13.66 in 2022. The state had 72 MA Plans in 2022, compared to 57 in 2021. Medicare Advantage options in Oklahoma may include:

• Health Maintenance Organizations
• Preferred Provider Organizations
• Private Fee-for-Service Plans
• Special Needs Plans
• Medical Savings Accounts

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 April 2022. 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 2022 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.