Is SoonerCare Medicaid or Medicare? Understanding Oklahoma's Health Program

SoonerCare is Medicaid, not Medicare

SoonerCare is Oklahoma's Medicaid program. It is a joint federal and state health insurance program for people with low to moderate income. Medicare, by contrast, is a federal program based on age or disability status, regardless of income. The two programs have different rules, different coverage, and different ways of signing up.

If you live in Oklahoma and have been told you might be covered by SoonerCare, you are looking at a Medicaid option. If you are 65 or older, you may be covered by both Medicare and SoonerCare at the same time — but they are separate programs with separate enrollment processes.

Key Takeaways

• SoonerCare is Oklahoma's Medicaid program for people with low to moderate income, while Medicare is a federal program for people 65 and older or with certain disabilities.
• You can be enrolled in both SoonerCare and Medicare at the same time if you meet the income requirements for Medicaid and the age or disability requirements for Medicare.
• SoonerCare covers doctor visits, hospital care, prescription drugs, and other services, but the specific coverage depends on which SoonerCare category you are in.
• To learn about you are covered by SoonerCare, contact the Oklahoma Health Care Authority directly or check your mail for a SoonerCare card.

How SoonerCare and Medicare differ

SoonerCare is income-based. To be covered, your household income must fall below a certain level set by Oklahoma. Medicare is age-based: you become covered at 65, or earlier if you have been receiving Social Security Disability Insurance (SSDI) for 24 months or if you have end-stage renal disease or ALS.

SoonerCare is run by the Oklahoma Health Care Authority. Medicare is run by the Centers for Medicare & Medicaid Services (CMS), a federal agency. When you use SoonerCare, you are using a state program. When you use Medicare, you are using a federal program, even though private insurance companies may handle the claims.

The two programs also cover different things. SoonerCare covers preventive care, doctor visits, hospital stays, prescription drugs, dental care for children, and other services. Medicare covers hospital care, doctor visits, and some preventive services, but does not cover dental, vision, or hearing aids unless you buy a separate supplemental plan. If you are on both programs, Medicare pays first, and SoonerCare may cover what Medicare does not.

Who can be covered by SoonerCare

SoonerCare covers children, pregnant women, parents and caretakers, people who are blind or disabled, and seniors with low income. The income limits change each year and depend on family size and which category you fall into. For example, a single adult with no children has a lower income limit than a parent with two children.

You do not have to be a U.S. citizen to be covered by SoonerCare, but you must be a legal resident of Oklahoma. You must also provide proof of income, identity, and Oklahoma residency when you sign up.

If you are 65 or older and have low income, you may be covered by both Medicare and SoonerCare. In that case, SoonerCare is called a "dual may be able to access" program, and it helps pay Medicare premiums and cost-sharing.

What SoonerCare covers

SoonerCare covers a broad range of health services. These include doctor visits, hospital stays, emergency room care, prescription drugs, mental health services, substance use treatment, and preventive care like vaccinations and screenings. Coverage for dental, vision, and hearing services varies by age and category.

Some SoonerCare members are in a managed care plan, which means they choose a primary care doctor and that doctor coordinates their care. Others are in a fee-for-service plan, which means they can see any doctor who accepts SoonerCare. Your SoonerCare card will tell you which plan you are in.

If you are also on Medicare, your coverage works together. Medicare pays first for services it covers, and SoonerCare may pay the remaining cost-sharing, such as copays or deductibles.

How to learn about you have SoonerCare

The easiest way to know if you are covered by SoonerCare is to look for a SoonerCare card in the mail. The card will have your name, a member ID number, and the name of your plan. If you think you should be covered but have not received a card, contact the Oklahoma Health Care Authority at 1-800-987-7752.

You can also check your status online through the Oklahoma Health Care Authority website. You will need to log in with your member ID or Social Security number. If you do not have a member ID, you can create an account and search for your information.

If you are not sure whether you are covered by SoonerCare or Medicare, call the number on whichever card you have. The customer service team can tell you which program you are in and what services are covered.

What to do if you are on both SoonerCare and Medicare

If you are 65 or older and have low income, you may be automatically enrolled in both programs. When you are on both, you have two health insurance cards: one for Medicare and one for SoonerCare. You should carry both cards when you go to the doctor.

When you use both programs, Medicare is your primary insurance. This means Medicare pays its share first. SoonerCare then pays what Medicare does not cover, such as copays, coinsurance, or deductibles. This is called "coordination of benefits."

If you are on both programs, you do not pay a SoonerCare premium. SoonerCare may also help pay your Medicare Part B premium, which is the monthly cost for doctor coverage. This is called a "Medicare savings program," and it can save you money each month.

Frequently Asked Questions

Can I have both SoonerCare and Medicare at the same time?

Yes. If you are 65 or older and have low income, you can be covered by both programs. Medicare is your primary coverage, and SoonerCare helps pay costs that Medicare does not cover. You will have two separate insurance cards.

Do I have to pay a monthly premium for SoonerCare?

Most SoonerCare members do not pay a monthly premium. Some categories of members may have small copays when they use services, but there is no ongoing monthly cost. If you are also on Medicare, SoonerCare does not charge a premium.

What if I move out of Oklahoma?

SoonerCare only covers you in Oklahoma. If you move to another state, your coverage will end, and you will need to sign up for that state's Medicaid program. Contact the Oklahoma Health Care Authority before you move to learn about your options.

How do I know which doctors accept SoonerCare?

You can search for doctors on the Oklahoma Health Care Authority website or call the number on your SoonerCare card. Your plan may also have a provider directory that lists all doctors and hospitals in your network. Always call ahead to confirm a doctor accepts your plan.

What happens if I earn more income and no longer may have access to for SoonerCare?

If your income goes above the limit, your SoonerCare coverage will end. The Oklahoma Health Care Authority will send you a notice before your coverage stops. You may be able to sign up for a private health insurance plan through the federal marketplace or through your employer.