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.
Name
|
Total Enrollment
|
Star Rating
|
Min Cost
|
Max Cost
|
Plan Types
|
UnitedHealthcare
|
125,012
|
4
|
$0
|
$29
|
HMO, PPO
|
Humana
|
68,307
|
3.5
|
$0
|
$132
|
HMO, PPO, PFFS
|
CommunityCare Senior Health Plan (HMO)
|
31,141
|
4
|
$25
|
$109
|
HMO
|
Aetna Medicare
|
20,360
|
3
|
$0
|
$15
|
HMO, PPO
|
GlobalHealth
|
10,815
|
4
|
$10
|
$29
|
HMO
|
Wellcare
|
2,185
|
0
|
$0
|
$26
|
HMO, PPO
|
Blue Cross and Blue Shield of Oklahoma
|
1,679
|
3.5
|
$0
|
$0
|
HMO
|
Blue Cross and Blue Shield of OK, TX
|
994
|
0
|
$169
|
$169
|
PPO
|
Cigna
|
838
|
3.5
|
$0
|
$0
|
PPO
|
Blue Cross and Blue Shield
|
308
|
0
|
$0
|
$0
|
PPO
|
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.
Senior Health Insurance Counseling Program (SHIP)
The Senior Health Insurance Counseling Program is one of two divisions offered through Oklahoma’s Medicare Assistance Program. SHIP is a nonprofit organization that helps seniors and disabled individuals understand their public and private health insurance options. It covers information related to Medicare, Medicare Advantage, Medicare Supplement Plans, Medicaid, long-term care insurance and other health care coverage. SHIP representatives offer objective counseling and assistance to current and future Medicare beneficiaries and their representatives.
Senior Medicare Patrol (SMP)
Oklahoma’s Medicare Assistance Program includes Senior Medicare Patrol, which operates the Medicare/Medicaid Fraud, Abuse and Waste Reduction Program. SMP trains individuals to act as SMP Volunteer Advisors. These advisors help senior and disabled Oklahomans learn to recognize health care fraud and protect themselves. They explain Medicare benefits and teach beneficiaries to monitor what Medicare and/or Medicaid has paid on their behalf to find discrepancies. SMP also coordinates community programs and distributes materials that outline how to read a Medicare Summary Notice to further assist recipients in detecting and reporting inconsistencies.
Oklahoma Area Agencies on Aging
Oklahoma Association Area Agencies on Aging, commonly referred to as O4A, oversees a statewide network of nonprofit organizations that provides various services to seniors aged 60 or older. O4A agencies are divided into 11 planning and services areas that serve three or more counties. These agencies offer local aging programs and provide information services on a range of assistance programs for older adults, including help with Medicare and other health-related questions.
LIFE Senior Services
LIFE Senior Services’ Medicare Assistance Program serves seniors in a 17-county region in northeastern Oklahoma. It provides objective information, personalized counseling and assistance with comparing coverage options. Volunteers assist with Medicare, Medicare Advantage, Medicare Supplement Plans, Part D and other health coverage options. They help beneficiaries select and enroll in the right coverage for their needs and apply for the Extra Help program if qualified. LIFE also offers free Basics of Medicare Educational seminars and informative classes. It’s a contracted agency of the Oklahoma Insurance Department and not affiliated with any insurance company.
Social Security Administration (SSA)
The Social Security Administration helps seniors enroll in Medicare Part A and Part B. It also helps them apply for Extra Help if they qualify for Medicare prescription drug coverage. Beneficiaries interested in signing up for Medicare Advantage, Medigap or Medicare Part D must contact a private insurance company offering these plans. SSA can’t help them sign up for these plans. SSA also provides Medicare publications to applicants who need more information. Beneficiaries sign up for Medicare through the SSA, but the Centers for Medicare & Medicaid Services (CMS) manages Medicare and provides most assistance after sign-up.