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