Medicare in Oklahoma: How to Apply, Costs, and More

Medicare is a federal program that provides health coverage for individuals 65 and older, people under 65 who have been receiving Social Security Disability benefits for a certain period of time, or individuals under 65 with end-stage renal disease (ESRD).

More than five million people are enrolled in some type of Medicare plan in Oklahoma, including:

• 2.3 million Medicare Advantage beneficiaries
• 3.2 million Prescription Drug Plan beneficiaries

Whether this is your first introduction to Medicare in Oklahoma, or you're navigating potential changes in your plan, understanding the qualifications and what applies to your unique situation can be difficult. This guide answers some of the most common questions about Medicare in Oklahoma.

Who Qualifies for Medicare in Oklahoma?

Because Medicare is a federal program, the qualifications are the same in every state. You're eligible for Medicare if any of these situations apply to you:

• You're over the age of 65
• You're under the age of 65 with kidney failure
• You're under 65 and receiving SSDI

There are four parts of Medicare:

• Part A provides hospital coverage
• Part B covers outpatient medical care
• Part C, or Medicare Advantage, is a replacement for Part A, B, and sometimes D
• Medicare Part D provides prescription coverage

Different premiums apply for each part of Medicare, depending on your coverage choices.

You may be eligible for premium-free Medicare Part A under these circumstances:

• If you're over the age of 65, and you or your spouse paid Medicare taxes for at least 10 years, you are eligible for Medicare Part A at no additional cost.
• If you are over 65 and receiving, or eligible to receive, retirement benefits from social security or Railroad Retirement, you may also receive Part A with no premium.
• If you have been entitled to get Social Security benefits or Railroad benefits for two years, or you are a kidney transplant patient or currently receiving dialysis treatments, you may be eligible to receive Medicare Part A with no premium.

How Do I Apply for Medicare in Oklahoma?

There are several ways to apply for Medicare in Oklahoma. If you are already receiving certain benefits, you may already be automatically enrolled. For example, if you already get benefits from Social Security or the Railroad Retirement Board, you're automatically eligible for Medicare Part A and Part B.

If you're under the age of 65 and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you'll automatically be enrolled in Medicare Part A and Part B at the beginning of the 25th month of eligibility.

In either of these circumstances, you don't have to do anything to enroll. Your Medicare card will automatically be mailed to you about three months before your effective date.

If you're not currently receiving retirement benefits, but meet the Medicare eligibility requirements, there are a few different ways you can apply.

• Enroll over the phone by calling the Social Security Administration at 1-800-772-1213
• Enroll online for Medicare only
• Visit your local Social Security office in person

If you're already enrolled in Part A and wish to enroll in Part B, you can apply online or by mail during a special enrollment period.

What Does Medicare Cover in Oklahoma?

Your Medicare coverage depends on the plan(s) you choose. Medicare is divided into four general parts and also provides options for additional coverage (Medigap) to help with additional costs. Medicare Part A and B make up Original Medicare and provide coverage for hospital and outpatient medical care. Part C is known as Medicare Advantage and is an alternative bundle that usually replaces Part A, B, and D. Medicare Part D provides prescription coverage.

Part A (Hospital Coverage)

Medicare Part A is part of Original Medicare. It provides coverage for in-patient hospital services, including:

• In-patient hospital care
• Skilled nursing facility care
• Nursing home care
• Hospice care
• Home health care

Some copays and deductibles apply and some services may not be covered in certain situations. Talk to your doctor or health care provider to discuss covered services.

• Part B (Medical Coverage)
• Part B is also part of Original Medicare. It covers outpatient medical services (like your routine doctor visits), including:

Medically necessary services: Services and supplies needed to diagnose and treat your medical conditions Preventive services: Health care to prevent illness or detect it at an early stage

Most preventive services are covered at full cost. However, deductibles and copays usually apply for medically necessary services.

Part C (Medicare Advantage Coverage)

Usually referred to as Medicare Advantage plans, Part C usually covers Part A, Part B, and Part D in a bundled insurance policy. There are four basic types of Medicare Advantage Options with varying levels of coverage:

1. Health Maintenance Organizations (HMO): Covers preventive medical care and pharmacy services supplied by a specific provider in a certain geographical location. Some emergencies are covered at facilities outside the normal service area
2. Preferred Provider Organizations (PPO): Typically covers all services by any doctor or provider that accepts Medicare. You don't need a referral to see a specialist, but out-of-network providers or non-preferred providers will likely cost you more
3. Private Fee for Service (PFFS) Plans: These plans offered by private companies include coverage for Medicare-approved hospitals and doctors and may include prescription coverage. Extra benefits may be included since the private company, rather than Medicare, how much it will pay and what you pay for the services you get
4. Special Needs Plans (SNP): Coverage for people who either live in institutions or require nursing care at home, are eligible for both Medicare and Medicaid, have one or specific chronic or disabling conditions.

Part D (Prescription Coverage)

Medicare Part D provides coverage for prescription medicines. A variety of plans are available that provide coverage for different medications. Each plan includes a formulary (list of covered drugs) which may change at any time.

How Much Does Medicare Cost in Oklahoma?

The cost of your Medicare plan in Oklahoma may vary depending on your choice of coverage, your income, and the amount of time you worked before you retired. Medicare costs include monthly premiums, deductibles, and copays.

Part A

Original Medicare (Part A and Part B) has uniform costs across all states. Most people don't pay a premium for Part A. If you don't qualify for premium-free Part A, the standard premium is $471. Deductibles and copays for Part A include:

• $1,484 deductible for each period
• $371 coinsurance per day for in-patient stays ranging from 61 to 90 days
• $742 coinsurance per day after 90 days spent in the hospital (Note: these lifetime reserve days have a limit of up to 60 days in your lifetime)

Part B

Costs for Part B will include monthly premiums, copays, and deductibles. Monthly premiums for Part B depend on your annual income. The standard monthly premium for Part B is $148.50. Most people pay this amount. However, if your annual income is more than $88,000 (or $176,000 for couples filing jointly), you may have to pay more.

Deductibles and copays for Part B include:

• $203 deductible for the year
• 20% copay after the yearly deductible is met for most doctor services, outpatient therapy, and durable medical equipment (DME)
• 20% copay for mental health care services after the deductible
• Deductible usually applies to Part B services with the exception of preventive services.

Part C (Medicare Advantage)

The part C Medicare monthly premiums, deductibles, and copays vary by plan. The average monthly Medicare Advantage premium in Oklahoma is $14.65 in 2021. This cost is paid along with your monthly premium for Medicare Part B.

Part D

Prescription coverage costs vary by plan and are based on your monthly income. Your monthly costs will include your plan premium and an additional fee based on income above $88,000 annually ($176,000 for couples filing jointly). Deductibles and copays may apply to prescriptions as well. 30 stand-alone prescription drug plans are available in Oklahoma. The lowest monthly premium is $7.80 for one of these plans. However, deductibles vary from one plan to the next, as do covered medications. Always check your plan to understand out-of-pocket costs and ensure your prescriptions will be covered by your plan.

Medigap

Medicare supplement plans are used to cover the costs of gaps in coverage left by Part A and Part B. These plans are available through private insurance companies and premiums vary by plan.

Medigap plans in Oklahoma are attained-age rated, meaning your premiums are based on your current age each year.

Medicare Advantage in Oklahoma

Every person eligible for Medicare is eligible for a Medicare Advantage plan. These plans are designed to bundle the benefits of Original Medicare and often include Part D prescription coverage within the plan. Medicare Advantage plans may offer additional services beyond Original Medicare like dental, vision, fitness programs or gym memberships, and adult day-care programs.

What is the Best Medicare Advantage Plan in Oklahoma?

The best Medicare Advantage plan in Oklahoma depends on your needs and budget. The Medicare Advantage plan you choose must be available within your zip code.

For most people, a PPO or HMO plan is the best Medicare Advantage plan in Oklahoma. However, if you have special needs, or suffer from certain chronic illnesses, a special needs plan (SNP) might provide more benefits. Choosing a plan will depend on your specific needs. Ask these questions to determine which plan is best.

• Can I afford the yearly deductible?
• Is dental care included?
• Is vision coverage included?
• Does the plan include prescription benefits?
• How much is the monthly premium?
• Is there an out-of-pocket limit?
• What services are covered by the plan?

Learn More About Medicare in Oklahoma

Learning about your eligibility for Medicare and the options that best suit your needs can help you save on healthcare. Still, with all the choices available, getting the right plan can be a challenge. Whether you want to compare Medicare plans in your area or talk to a Medicare advisor, we're standing by to help. Finding your Medicare plan just got simpler. Get started right away.