Medicare Options in the Oklahoma State
Till late 2018, around 722,917 residents of Oklahoma were enrolled in Medicare, which is little more than 18% of the state’s population. Medicare eligibility for individuals start when they turn 65 and also people who have been receiving disability benefits for 24 months. Around 18% of Medicare beneficiaries in Oklahoma are enrolled due to disability rather than age. Medicare beneficiary in Oklahoma are offered with several Medicare coverage options. Though, residents need to have proper understanding of these options to find the best Medicare coverage in Oklahoma that perfectly meets their insurance coverage and needs.
Original Medicare, Part A and Part B, is the federally administered health care program offered in Oklahoma like other U.S states to citizens and legal permanent residents of five continuous years or more of age 65 or older or people under the age of 65 with qualifying disabilities. According to Centers for Medicare & Medicaid Services, 570,595 residents of Oklahoma were enrolled in Original Medicare as of January 2018. Around 80% of Medicare beneficiaries in Oklahoma prefer Original Medicare. Comprising of two parts, Medicare Part A covers skilled nursing and nursing home care, inpatient hospital care, home health care and hospice care whereas Medicare Part B covers doctor’s visits and preventive services like annual wellness exams, outpatient medical and mental health care as well as cost of durable medical equipment. Residents in Oklahoma like any other states are automatically enrolled in Original Medicare when they turn 65. Even the disabled people under the age of 65 receiving SSA disability benefits or RRB disability benefits for 24 consecutive months are also automatically enrolled in Original Medicare. About three months before the start of the Medicare coverage, people receive their Medicare card including enrollees details like Medicare number, parts of the program in which they are enrolled along with the coverage date.
Medicare Part C or Advantage Plans in Oklahoma
Oklahoma Medicare beneficiaries who wish to have more comprehensive coverage than traditional benefits provided under Original Medicare may opt to enroll in a Medicare Advantage plan. This plan provides the same medical and hospital benefits as Original Medicare with the exception of Hospice care along with some additional coverage like prescription drug, vision, hearing and dental benefits. Medicare Part C or Advantage plan is an alternative way to obtain Original Medicare benefits. Offered by private insurance companies these plans have lower deductibles, coinsurance and copayments compared to Original Medicare that considerably reduces member’s out-of-pocket expenses for the covered services. Medicare beneficiaries enrolling in Medicare Part C do not actually leave Original Medicare and continue paying their Part B premium to obtain extra benefits such as routine vision, hearing and dental coverage. However, to enroll in Medicare Part C plan beneficiaries must be enrolled in Original Medicare Part A and Part B.
In Oklahoma different types of Medicare Advantage plans are available which the beneficiaries can choose the plan offering benefits that suits them best. Some of the most common types of Medicare Part C plans available in Oklahoma include:
Medical Savings Account
Special Needs Plan
Medicare Part D
Medicare Part D plan is designed especially for Medicare beneficiaries, who wish to have prescription drug coverage, since Original Medicare doesn’t cover most of the medications. Medicare Part D or Prescription Drug Plan is a government sponsored private insurance to help people cover prescription drug costs. The private insurance companies have contract with Medicare to offer prescription drug coverage to beneficiaries in their area. There are two Medicare plans offering prescription drug coverage like:
Medicare Advantage Prescription Drug Plans
Medicare Advantage Prescription Drug Plans, which combine health and prescription coverage into a single plan. Medicare Advantage Prescription Drug plans offer same level of coverage as Original Medicare along with other additional health benefits like dental, vision, hearing, and prescription drug coverage. To enroll in this Medicare Advantage Prescription Drug plan beneficiaries must have Medicare Part A and Part B plan and they must be living in the plan’s service area.
Stand-alone Medicare Part D Prescription Drug Plans
Medicare Part D plans work along with Original Medicare and beneficiaries can enroll in this plan only if they have Medicare Part A and Part B to receive prescription drug coverage. To complement their health benefits through medicare Part D beneficiaries must also live in the plan’s service area. People enrolled in this plan are required to pay a monthly premium to obtain Part D coverage and some of the plans also have annual deductibles. Insured are also required to pay coinsurance and co-payments for the covered medications.
Both the prescription drug plans comprises of a formulary, which is a list of covered prescription drugs and the formulary changes with every prescription drug plan. Therefore, people should check the formulary before enrolling in a plan to ensure that the plan which they are choosing include the drug taken by them. About 75% of the Medicare beneficiaries living in Oklahoma get their Medicare Part D Prescription Drug coverage from a stand-alone Medicare Part D plan and the remaining 25% enrolled in a Medicare Advantage Prescription Drug Plan. According to CMS in 2018, there were around 23 stand-alone Medicare Part D plans and 35 Medicare Advantage plans offering coverage in Oklahoma.
Medicare Supplement or Medigap Plans in Oklahoma
Out-of-pocket expenses like copayments, coinsurance, or deductibles are not covered under Original Medicare, Part A and Part B and therefore Medicare beneficiaries in Oklahoma who wish to have coverage for some of these costs may enroll in a Medicare Supplement insurance plan, also known as Medigap. Oklahoma like most of the other U.S. states have ten 10 standardized Medigap plans available, which is labeled with a different alphabet. Benefits received under each Medigap plan is same in every state regardless of insurance company or location. Besides filling some of the gaps of Original Medicare coverage Medicare Supplement insurance also helps to pay for costs like the first three pints of blood, excess charges of Medicare Part B, and overseas emergency coverage, usually these charges Medicare beneficiary have to pay out of pocket. In order to enroll in the Medicare Supplement plans must be enrolled in Medicare Part A and Part B. In Oklahoma, insurance companies offering Medicare Supplement insurance plans are suppose to offer at least one Medigap plan option to certain Medicare beneficiaries under 65. Every insurance company offering Medicare Supplement plans sets its own monthly costs for each plan. Therefore, Medicare beneficiaries in Oklahoma should carefully choose the plan that best meet their coverage needs at an affordable price.