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Medicare Advantage in Oklahoma

Last Updated on

October 6, 2016

If you’re a Medicare beneficiary living in Oklahoma, you may have the option to receive your Medicare Part A and Part B benefits through the alternative means of Medicare Advantage (Medicare Part C).  Private insurance companies that contract with Medicare provide these benefits locally.   Your choice of Medicare Advantage plans in Oklahoma depends upon where you live and which plans are available to you.

How Medicare Advantage works in Oklahoma

Medicare beneficiaries in Oklahoma who desire more comprehensive coverage than what’s traditionally provided under Original Medicare, Part A (hospital insurance) and Part B (medical insurance) may want to consider enrolling in a Medicare Advantage plan. The U.S. government requires Medicare Advantage plans doing in business in Oklahoma and other states in the U.S.  to provide at least the same medical and hospitalization benefits as Original Medicare (with the exception of hospice care, which remains covered under Part A). In addition, many Medicare Advantage plans offer prescription drug coverage, as well as vision, hearing, and/or dental benefits.  Medicare Advantage plans may also offer lower deductibles, coinsurance and copayments than provided under Original Medicare to reduce plan members’ out-of-pocket costs for covered services.

In order to enroll in a Medicare Advantage plan in Oklahoma, you must be enrolled in Original Medicare, Part A and Part B. You may sign up for Original Medicare in Oklahoma during your seven-month Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. You may be eligible for Medicare benefits earlier if you have certain medical conditions. You’ll be automatically enrolled in Medicare after receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months.

If you miss your Initial Enrollment Period, you may be subject to a late-enrollment penalty, for as long as you remain enrolled in Medicare. You may enroll in Medicare later during the annual General Enrollment Period, which runs from January 1 to March 31, but you will still have to pay the late-enrollment penalty.

If you want to switch Medicare Advantage plans in Oklahoma, you can do so during the Annual Election Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. You may also switch Medicare Advantage plans in Oklahoma during Special Election Periods, if you go through a major life event. These major life events include, but are not limited to, changes in your current plan that affect your health benefits, losing your current employer-sponsored group health coverage, moving to a location where your current plan is unavailable, or moving into or out of a nursing facility. Special Election Periods in Oklahoma vary depending upon your personal circumstances and why your present coverage is no longer available to you or is inadequate to meet your specific needs.

If you enroll in a Medicare Advantage plan and decide it is not right for you, you can return to Original Medicare  during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14, in Oklahoma and elsewhere in the United States.

Types of Medicare Advantage plans in Oklahoma

Medicare Advantage plans in Oklahoma vary, so it’s important for you to familiarize yourself with each type of Medicare Advantage plan and choose the one with the benefits that suit you best. While all of these options may not be available where you live in Oklahoma, listed below is a brief description of the most common types of Medicare Advantage plans.

A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that requires you to use doctors, health-care providers, and hospitals included in your plan’s network to receive benefits for covered services. A Medicare Advantage HMO plan usually will not pay for services you receive from a health-care provider who does not participate in the plan’s network unless you needed emergency care or received pre-approval from the plan to receive treatment outside the network. You may have to get a referral from your primary doctor to receive coverage for certain health services. An HMO Point-of-Service plan, on the other hand, is a more flexible option, allowing you to go out of network for some health services and receive benefits, but generally you pay a higher out-of-pocket cost for these covered services than you would pay if you received the services from providers in the plan’s network.

If you prefer a Medicare Advantage plan with more flexibility, you may be able to choose a Preferred Provider Organization (PPO)* plan. In a Medicare Advantage PPO plan, you may choose doctors, health-care providers, and hospitals in or outside of your plan’s network.  Your out-of-pocket costs are typically lower when you receive covered services from providers in the plan’s network.

You may be able to select a Private Fee-for-Service (PFFS) plan, which is a type of Medicare Advantage plan that may include a partial or full network of participating providers. It is important to remember to check with the provider before your appointment to make sure she or he will accept the plan.

Another option may be Medicare Advantage Medical Savings Account (MSA) plan, which combines a high deductible with a savings account that you can use to pay for your health care expenses.

If you have specific health conditions, you may want to consider a Medicare Advantage Special Needs Plan (SNP). There are Medicare SNPs for people with certain chronic diseases, those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid. A Medicare SNP can offer coverage tailored to these situations.

And if you’re seeking both health and prescription drug coverage, you may want to choose a Medicare Advantage Prescription Drug (MAPD) plan, which combines into a single plan health and prescription drug coverage (also available as a stand-alone Medicare Part D Prescription Drug Plan if you have a Medicare Advantage plan without prescription drug coverage or Original Medicare).

Always keep in mind that even if you decide to enroll in a Medicare Advantage plan in Oklahoma, you have to remain enrolled in Original Medicare, and continue paying your Medicare Part B premium, in order to retain your health insurance coverage

Comparing Medicare Advantage plans available in Oklahoma

As a Medicare beneficiary in Oklahoma, you may find it useful to compare the various Medicare Advantage plans available in your area.

The availability and cost of Medicare Advantage plans generally vary depending on your state and county of residence. It’s not uncommon for premiums of a Medicare Advantage plan with the same coverage and benefits to vary between different counties within the state of Oklahoma. You may find that some Medicare Advantage plans in Oklahoma offer premiums as low as $0; but always remember that have to keep paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, to keep your Medicare health insurance coverage.

Also be aware that some Medicare Advantage plans may offer benefits beyond what is included in Original Medicare, Part A and Part B.  You will want to determine exactly what kind of coverage you may require, including, but not necessarily limited to whether you want prescription drug coverage through a Medicare Advantage Prescription Drug plan. With so many health insurance options available, you can see why it may be smart to compare each Medicare Advantage plan in Oklahoma offering benefits and costs to find the one that suits your personal budget and health coverage needs.

To start comparing Medicare Advantage plans in Oklahoma today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates. 

View the following pages for helpful details about Medicare in Oklahoma:

 *Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.