SoonerCare is Medicaid, not Medicare

SoonerCare is Oklahoma's Medicaid program. It is a state and federal health insurance program for people with low income, not a Medicare program. If you live in Oklahoma and have been told you might be on SoonerCare, you are on Medicaid — the program that serves working-age adults, children, pregnant people, and seniors with limited income and resources.

The confusion is understandable. Both Medicaid and Medicare are federal health programs with similar names, and both cover hospital and doctor visits. But they work differently, cover different groups of people, and have different rules. SoonerCare is Medicaid only.

If you are a senior in Oklahoma, you may have both Medicare (because you are 65 or older) and SoonerCare (because your income is low enough). When you have both programs, Medicare is your primary insurance and SoonerCare helps pay what Medicare does not cover. This combination is sometimes called "dual may be able to access."

Key Takeaways

  • SoonerCare is Oklahoma's Medicaid program for people with low income, not Medicare.
  • Seniors in Oklahoma can have both Medicare and SoonerCare at the same time if their income and resources are low enough.
  • SoonerCare covers doctor visits, hospital stays, prescription drugs, and long-term care services that Medicare may not cover.
  • To learn about you are on SoonerCare or to learn about coverage, contact the Oklahoma Department of Human Services or call the SoonerCare Member Services line.

How SoonerCare differs from Medicare

Medicare is a federal program you become part of when you turn 65, regardless of income. You paid into Medicare through payroll taxes while you worked. SoonerCare is a joint state and federal program based on income and resources — how much money and property you own. You do not have to be 65 to be on SoonerCare.

Medicare has four parts: Part A covers hospital stays, Part B covers doctor visits and outpatient care, Part D covers prescription drugs, and Part C is an alternative plan. SoonerCare is one program with one set of rules, though it may be delivered through different managed care plans depending on where you live in Oklahoma.

Medicare is the same in every state. SoonerCare rules vary by state because each state runs its own Medicaid program within federal guidelines. What SoonerCare covers in Oklahoma may differ from what Medicaid covers in Texas or Kansas.

Who SoonerCare covers

SoonerCare covers Oklahoma residents with low income and limited resources. The income and resource limits change each year. Generally, SoonerCare covers:

  • Children under 19 in households with income below a certain level
  • Pregnant people and parents of young children with low income
  • Adults ages 19 to 64 with very low income (this group expanded under the Affordable Care Act in some states, but Oklahoma's rules are more limited)
  • Seniors 65 and older with low income and limited resources
  • People who are blind or have disabilities

If you are a senior and receive both Social Security and Medicare, you may also be on SoonerCare if your monthly income is below the state limit. The limit for a single person varies by year but is typically around $1,000 to $1,100 per month, depending on the category you fall into.

What SoonerCare covers that Medicare may not

SoonerCare covers many services that Medicare does not, or covers them differently. If you have both programs, SoonerCare can fill gaps in your Medicare coverage.

SoonerCare covers long-term care in a nursing home or assisted living facility, which Medicare covers only for a limited time after a hospital stay. SoonerCare also covers dental care, vision care, and hearing aids — services Medicare does not cover. Prescription drug coverage through SoonerCare may be broader than what you get through Medicare Part D, depending on your plan.

SoonerCare also covers transportation to medical appointments, which Medicare does not. If you are homebound or have mobility problems, this can make a real difference in whether you can get to your doctor.

How to know if you are on SoonerCare

If you applied for health insurance in Oklahoma and were told you are on Medicaid, you are on SoonerCare. You should have received a member ID card in the mail. The card will say "SoonerCare" or "Oklahoma Medicaid" on it.

If you are not sure, you can contact the Oklahoma Department of Human Services to check your status. You can also call SoonerCare Member Services at the number on your ID card, or visit the SoonerCare website to log into your account and see your coverage details.

If you are a senior who receives Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), you may be automatically enrolled in SoonerCare. Check the mail you receive from the state or call to confirm.

What to do if you think you should be on SoonerCare

To learn whether you may be on SoonerCare based on your income and resources, contact the Oklahoma Department of Human Services. They can tell you what the current income limits are for your situation and what documents you would need to provide.

You can reach the Oklahoma Department of Human Services through their website or by calling their main line. They can direct you to the right office for your county. The process involves providing proof of income, resources, and citizenship or legal residency.

If you are already on Medicare and think you might also be on SoonerCare, ask your doctor's office or your local senior center to help you contact the right agency. Many communities have benefits counselors who work with seniors for free and can help you understand whether you are on both programs.

How SoonerCare works with Medicare for seniors

If you are 65 or older and have both Medicare and SoonerCare, the programs work together. When you go to the doctor, you show both your Medicare card and your SoonerCare card. Medicare pays first, and then SoonerCare pays what Medicare does not cover — up to what SoonerCare allows.

This means you may have lower out-of-pocket costs than someone on Medicare alone. Your copayments and deductibles may be reduced or waived. However, not every doctor or hospital accepts SoonerCare, so you should always check before you go.

If you are on both programs, you should receive information about your coverage from both Medicare and SoonerCare. Keep both cards with you and bring them to every appointment.

Questions to ask your doctor or SoonerCare

If you are unsure whether a service is covered by SoonerCare, ask before you receive it. Ask your doctor's office to check your coverage or call SoonerCare Member Services yourself. It is better to ask than to receive a bill you were not expecting.

Ask whether your doctor accepts SoonerCare. Ask whether a specialist or hospital is in your SoonerCare network. Ask what your copayment will be. Ask whether you need a referral from your primary care doctor. These questions can save you money and prevent delays in your care.

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 and limited resources, you can have both. Medicare is your primary insurance, and SoonerCare helps pay costs Medicare does not cover. This is common for seniors with fixed incomes.

Does SoonerCare cost money?

SoonerCare itself does not have a monthly premium for most people. However, you may have small copayments when you see a doctor or fill a prescription. The amount depends on the service and your specific SoonerCare plan.

What happens to my SoonerCare if my income goes up?

If your income exceeds the SoonerCare limit, you may lose coverage. You should report any change in income to the Oklahoma Department of Human Services right away. They can tell you whether you still may have access to and what your options are.

How do I find a doctor who takes SoonerCare?

You can search the SoonerCare website for doctors and hospitals in your area that accept SoonerCare. You can also call SoonerCare Member Services and ask for a list of providers near you. Your primary care doctor can also refer you to specialists who take SoonerCare.

What should I do if SoonerCare denies a service I need?

You have the right to appeal a denial. Ask SoonerCare for the reason in writing and ask how to file an appeal. You can also contact a patient advocate or legal aid organization in Oklahoma for help understanding your rights.