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Medicare Advantage Plan Choices in Oklahoma

You may know that many people in Oklahoma have their health care covered through the federal government program called Original Medicare (Part A and Part B). Medicare Advantage (Part C) plans are another easy way to get your Original Medicare benefits — as well as additional coverage — in Oklahoma.

If you want to enroll in Medicare Advantage, you must have Part A and B first. Offered by private insurance companies, Medicare Advantage plans are contracted by the Centers for Medicare & Medicaid Services.

More Benefits: Medicare Advantage plans are required to cover at least the level of coverage that Original Medicare does. And they often provide more benefits such as prescription drugs.

Limited Costs: Medicare Advantage plans have a yearly limit on your out-of-pocket costs. After you reach this yearly limit, you won’t have to pay anything for covered services. Yearly limits vary by plan. It’s important to know that Original Medicare does not have a yearly limit, so that’s something to think about.

Here is an overview of benefits

The benefits and costs may vary depending on the plan, insurance company, and the county in Oklahoma where you live.

Medicare Advantage plans cover:

  • Hospital services (Medicare Part A)
  • Medical services (Medicare Part B) – including preventive care

Depending on the plan you choose and where you live, most Medicare Advantage plans may also cover:

  • Prescription drugs (Medicare Part D)
  • Routine vision, hearing and dental care
  • Health, fitness and wellness programs

Types of Medicare Advantage plans in Oklahoma

Here are the key points of each type:

  • Health Maintenance Organization (HMO) plans: HMOs cover your health care through their network of doctors, specialists and hospitals. You will be expected to choose a primary care doctor from the network, and this doctor will coordinate your care and refer you to specialists when needed. For medical emergencies, you will be covered even outside the network.
  • Preferred Provider Organization (PPO) plans: PPOs are different than HMOs in several ways. With a PPO plan, you don’t need to choose a primary care doctor. Also, you don’t need referrals to see specialists. Your share of costs will usually be lower if you see doctors in the network. You can see providers outside of the network – you just may have to pay higher copays and/or coinsurance.
  • Private Fee-for-Service (PFFS) plans: Generally you can get covered care from any doctor, specialist or hospital as long as they are contracted with the PFFS plan. Check first to make sure they accept the plan’s payment terms.
  • Medicare Savings Account (MSA): You may also choose this high-deductible plan that includes a medical savings account. You use the savings account for your covered costs until you reach your deductible.
  • Special Needs Plans (SNPs): These Medicare Advantage plans are for people who have chronic conditions or special health needs, including people who live in an institution. The benefits, providers and covered prescription drugs are carefully chosen for these unique needs.

Hospital, Medical and Prescription Drug coverage all in one plan

Many Medicare Advantage plans have prescription drug coverage together with hospital and medical benefits. These are called Medicare Advantage Prescription Drug plans. This can be helpful, because then you can get all your Medicare benefits through just one plan.

Comparing Medicare Advantage plans in Oklahoma

When you are comparing Medicare Advantage plans, it’s important to balance the out-of-pocket costs and covered benefits. Talking with a Medicare expert and reading your Medicare materials can help you find the right fit for you.

Your Medicare Advantage plan choices may depend on your county or ZIP code. Be sure to ask a Medicare customer service specialist.

Enrolling in Medicare Advantage in Oklahoma

Your out-of-pocket costs (such as monthly premiums, deductibles and copays) can be different for each plan in Oklahoma. Some have monthly premiums as low as $0, although you are still responsible to pay your Medicare Part B premium. All plans have a yearly limit on your out-of-pocket costs.

You can enroll in a Medicare Advantage plan during the Initial Enrollment Period and the Open Enrollment Period. Remember you must have Original Medicare (Part A and Part B) to enroll in a Medicare Advantage plan.

Initial Enrollment Period: If you’re not automatically enrolled in Original Medicare, you can first enroll during the 7-month Initial Enrollment Period. This begins three months before you turn 65, your birthday month, and three months after you turn 65. You can also enroll in a Medicare Advantage plan during this time period.

Open Enrollment Period: Open Enrollment Period: You can also join, change or leave your Medicare Advantage plan during the Open Enrollment Period. This happens every year starting on October 15 and ending on December 7.

Things to remember:

  • Availability of plans in specific areas in Oklahoma depends on the contract between the plans and Medicare.
  • Benefits and costs vary by the plan you choose and where you live
  • With any Medicare Advantage plan, you must continue to pay your Original Medicare Part B premium
  • Review the information and talk with a Medicare expert so you can select the plan that’s right for you

How to sign up for a Medicare Advantage plan

  • Visit Medicare.gov
  • Search the plans you want, choose one and enroll on their website
  • Call the plan you’re interested in for a paper form to fill out
  • Call 1-800-MEDICARE (1-800-633-4227) (TTY: 711)
  • If you have both Medicare and Medicaid benefits, contact your state’s Medicaid office