With increased plan offerings and more robust coverage, Medicare Part C enrollment has nearly doubled over the past 10 years. More commonly known as Medicare Advantage(MA), more than 28 million Medicare beneficiaries had an MA plan in 2022. This page describes Medicare Advantage plans in Oklahoma and explains how the program works.
What Is Medicare Advantage in Oklahoma?
At a minimum, every Oklahoma Medicare Advantage plan must provide the same benefits that you get with Original Medicare. This includes:
- Medicare Part A: Covers inpatient services that you'd receive in a hospital or skilled nursing facility (SNF)
- Medicare Part B: Covers outpatient services, including doctor visits, lab work, outpatient procedures performed in a hospital, durable medical equipment (DME), and more
Original Medicare does not include prescription drug coverage.
Medicare Advantage plans are not limited to the benefits provided by Parts A and B. In fact, over 90 percent of them provide additional benefits like:
- Fitness programs
- Prescription drug coverage
- Routine vision and dental care
Please note that joining an Oklahoma Medicare Advantage plan does not mean that you no longer have to pay the Medicare Part B premium.
Oklahoma Medicare Advantage Plans with Prescription Drug Coverage
Medicare Advantage Prescription Drug plans (MA-PD) are often called all-in-one plans because they include the benefits provided by Medicare Parts A, B, and D.
If the MA plan you choose does not cover prescriptions AND you do not have creditable coverage elsewhere, you'll need to join a standalone Medicare Part D plan. (Creditable means a plan that offers similar benefits as Medicare at a comparable price.) Otherwise, you'll have to pay the Medicare Part D late enrollment penalty when you do finally get Medicare prescription drug coverage.
How Do You Qualify for Medicare Advantage in Oklahoma?
You qualify for Medicare Advantage in Oklahoma once you have both Medicare Parts A and B.
American citizens and permanent legal residents aged 65 or older are eligible for Medicare. Enrollment in Parts A and B is automatic if you begin collecting Social Security benefits at least 4 months before your 65th birthday. Otherwise, you need to apply for Medicare.
Collecting Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months also qualifies you for Medicare, even if you aren't yet 65. Enrollment is automatic in month 25.
When Can You Sign Up for a Medicare Advantage Plan in Oklahoma?
Enrollment in an Oklahoma Advantage plan is limited to certain times of the year.
You can first join a Part C plan during your Initial Enrollment Period (IEP), which starts 3 months before your Medicare eligibility month and lasts for 7 months. So, if your 65th birthday or 25th month of collecting disability benefits is in June, your IEP begins March 1 and ends September 30.
If you didn't sign up for Medicare Part A and/or Part B during your IEP, you may do so during the General Enrollment Period. It lasts from January 1 until March 31. Once you have both A and B, you can join an Advantage plan between April 1 and June 30.
You can sign up for an Advantage plan at any time during the Medicare Annual Enrollment Period (AEP), which starts on October 15 and ends on December 7.
Current Part C enrollees can take part in the Medicare Advantage Open Enrollment Period from January 1 through March 31. Your options are switching to a different MA plan or returning to Original Medicare. If you lose your prescription drug coverage as a result, you may also join a standalone Medicare Part D plan.
People who experience special circumstances can join a Medicare plan during a Special Enrollment Period (SEP). Guidelines are on Medicare.gov.
Types of Medicare Advantages Plans in Oklahoma
There are four common types of Medicare Advantage plans in Oklahoma.
Health maintenance organization (HMO) plans require members to use a provider network for all covered services. Non-emergency care received from an out-of-network provider is rarely covered by an HMO. You'll also need to choose a primary doctor to coordinate your care. Finally, you cannot visit a specialist without a referral.
Preferred provider organizations (PPO) also use provider networks. However, members can get out-of-network services for a higher copay. PPO plans do not require members to choose a primary doctor or get a referral to see a specialist.
Private fee-for-service (PFFS) plans establish price guidelines for all covered services. Most use a provider network but allow members to receive out-of-network care for a higher price. They also don't require enrollees to have a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) tailor their services to certain populations. To join an SNP, you must meet one of the following qualifications:
- Have a chronic condition, such as diabetes, HIV/AIDS, dementia, or ESRD
- Require in-home care or live in an institution, such as a nursing home
- Qualify for both Medicare and Medicaid (i.e. dual eligibility)
SNPs also require members to choose a primary doctor and get a referral before seeing a specialist.
What to Look for in an Oklahoma Medicare Advantage Plan
To get the best Oklahoma Medicare Advantage plan for your unique needs and budget, consider the following:
- Costs: May include a yearly deductible, monthly premium, and copays or coinsurance.
- Coverage: Look closely at the covered services to ensure you compare apples to apples. If it's an MA-PD plan, don't forget to review the drug formulary.
- Network: The plan's network may include any entity that provides healthcare services – doctors, labs, hospitals, etc.
- Ratings: Medicare publishes its Advantage plan ratings each year before Annual Enrollment.
Our Find a Plan tool makes comparing Medicare Advantage plans in Oklahoma easy. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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