What Are Medicare Advantage Plans in Oklahoma?
Medicare Advantage (MA) plans are a bundled alternative to Original Medicare offered by Medicare-approved private insurance companies. These plans provide Medicare Part A and B benefits, and most offer Medicare Part D (prescription drug) as well. MA plans may also offer services not provided by Medicare, including vision, hearing and dental care.1
About 190,000 Oklahomans are signed up for MA plans, with a penetration rate of 22%. The penetration rate is the percentage of people eligible for Medicare who have enrolled in an MA plan.
What You Need to Know
Oklahomans have access to several types of MA plans, the majority of which are health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Most MA plans include Medicare Part D, which is prescription drug coverage.
The average cost of an MA plan in Oklahoma in 2021 is $14.65, which is below the national average of $21.
What Types of Medicare Advantage Plans Are Available?
Oklahomans have access to several types of MA plans. Many of these plans provide care through a network of healthcare providers and facilities that have contracted with an insurance company. Here’s more on your plan options and how they work:
- Health maintenance organizations (HMOs): With this plan type, you must seek care from in-network providers. HMOs typically won’t cover care from out-of-network providers unless it’s an emergency. You also may need a referral from your primary care doctor to visit a specialist. HMOs are the most common type of MA plans.2
- Preferred provider organizations (PPOs): You can visit out-of-network providers if you have a PPO plan, but you pay less if you seek treatment from those in the network. You usually don’t need a referral to visit a specialist.
- Private fee-for-service (PFFS) plans: With this option, you can go to any provider that accepts the terms of your plan. Some PFFS plans have a network, and you pay less if you seek care from an in-network provider.
- Special needs plans (SNPs): These plans are for people on Medicare who have specific healthcare needs. There are three types of SNPs:
- Chronic special needs plans (C-SNPs): These plans serve people with chronic health conditions, including autoimmune disorders, diabetes, HIV/AIDS, chronic lung conditions and chronic, disabling mental health conditions.
- Institutional special needs plans (I-SNPs): These plans serve people who live in nursing homes or who need nursing care at home.
- Dual eligible special needs plans (D-SNPs): These plans serve those who are eligible for both Medicare and Medicaid.
- Medical Savings Accounts (MSAs): The components of these plans are a high-deductible MA plan and a medical savings account (MSA). Your deductible is the amount you pay for covered healthcare services before your plan starts paying. The insurance company you sign up with puts money into your MSA, and you can use those funds to pay for healthcare. If you run out of MSA funds before you meet your deductible, you’re responsible for the costs. Once your deductible is reached, your plan pays for your Medicare-covered services.3
When to Enroll
You have two opportunities each year to change your Medicare Advantage plan—during open enrollment, from October 15 to December 7, and during Medicare Advantage open enrollment, from January 1 to March 31.
What Are Your Prescription Drug Options with Medicare Advantage?
Most MA plans include Medicare Part D, or prescription drug coverage, with the exception of MSAs and some PFFS plans. If you have one of those plans, you can purchase a separate Part D plan. If you join an HMO or PPO without prescription coverage, you can’t join a separate Part D plan.
Important: If you don’t join an MA plan with prescription coverage or a plan that allows you to purchase separate coverage, you may have to pay an ongoing late enrollment penalty when you do purchase Part D coverage4. 5
How Do You Choose a Medicare Advantage Plan?
To choose an MA plan, consider the costs and benefits. Costs include:
- Monthly premiums: Many MA plans have a $0 premium, but some cost more.6
- Deductibles: The amount you pay for Medicare-covered services before your plan starts to pay for them.
- Coinsurance: A set percentage you pay for a covered service or supply. Coinsurance typically applies after you meet your deductible.
- Copayments: A copay is a fixed dollar amount you pay for covered care or medical items. Copays may apply before or after you reach your deductible.7
- Out-of-pocket maximums: This is the most you will pay out of pocket for Medicare-covered healthcare in a year.8
While MA plans cover Medicare Parts A and B, and many cover Part D as well, plans may offer extra benefits. These may include dental, vision and hearing care, and fitness memberships as well as funds to help pay for over-the-counter items such as medications. Nearly all plans offer telehealth benefits.9
When and How Do You Enroll in a Medicare Advantage Plan?
You can only enroll in an MA plan at specific times, known as enrollment periods. They are:
- Initial enrollment: This period starts three months before your 65th birthday month and lasts for three months after that month. You can enroll in an MA plan during this time.
- Open enrollment: Also known as your annual election period, you can join, switch or drop an MA plan from October 15 to December 7 each year. Your choice takes effect on January 1.
- General enrollment: If you start Medicare Part B between January 1 and March 31, you can join an MA plan. The coverage may not start until July 1.
- Medicare Advantage open enrollment: If you’re enrolled in an MA plan, you can change plans or disenroll and return to Original Medicare from January 1 to March 31 annually.10
- Special enrollment periods: If you experience a life event that impacts your coverage, you may be entitled to a special enrollment. Reasons for a special enrollment include:
- Moving outside your plan’s service area
- Gaining or losing coverage from an employer or union
- Medicare terminating your current plan’s contract
- Being diagnosed with a health condition that would be better served by a C-SNP11
To enroll in an MA plan, contact the insurance company directly or enroll using the Medicare Plan Finder.
How Much Do Medicare Advantage Plans Cost in Oklahoma?
The average monthly cost for an MA plan in Oklahoma in 2021 is $14.65, which is below the national average of $21.
Oklahoma City residents have access to 26 MA plans from seven health insurance providers. Fourteen plans have a $0 premium and 11 plans have a premium of $10 – $76 per month. The most expensive plan is $131 per month.
Tulsa residents have access to 32 MA plans from six health insurance providers. Eighteen plans have a $0 premium, 12 plans have a monthly premium of $10 – $76 and the rest are over $100 per month. As in Oklahoma City, the most expensive plan is $131 monthly.
What If You Want to Change Your Medicare Advantage Plan?
You have two opportunities to change your MA plan each year. One is during open enrollment from October 15 to December 7 and the other is during Medicare Advantage open enrollment, which is from January 1 to March 31.12
What Are Medicare Resources in Oklahoma?
Oklahoma’s Medicare Assistance Program offers two programs to assist people with Medicare. The first is the Senior Health Insurance Counseling Program (SHIP), which provides free counseling to Medicare beneficiaries. The second is the Senior Medicare Patrol, which helps Oklahomans learn how to avoid healthcare fraud and paying more than they need to for healthcare. You can reach both at 1-800-763-2828.
If you have a complaint about your MA plan, you can contact the Oklahoma Insurance Department for assistance at 1-800-522-0071.
Oklahoma’s Senior Health Insurance Counseling Program (SHIP) provides free counseling to Medicare beneficiaries, and its Senior Medicare Patrol helps Oklahomans avoid healthcare fraud and overpaying for healthcare.
To find the best MA plan for you, visit the Medicare Plan Finder or the insurance companies’ websites to review the details of each plan you’re interested in and to compare plan premiums and benefits.
If you have a preferred doctor, confirm they’re in the network of any plan you’re considering and check to ensure your prescription medications are covered.
Finally, choose an MA plan that provides the services you need at an affordable price.