Medicare in Oklahoma

Oklahoma was among the first states to ensure access to Medigap plans for people under age 65

At a glance: Medicare health insurance in Oklahoma

Medicare enrollment in Oklahoma

2020 Medicare enrollment datesAs of late 2018, there were 722,917 Oklahoma residents with Medicare coverage. That’s a little more than 18 percent of the state’s population, which is about the same as the percentage of the total US population enrolled in Medicare.

For most people, Medicare eligibility begins when they turn 65. But people also become eligible for Medicare after they’ve been receiving disability benefits for 24 months, and 18 percent of Oklahoma’s Medicare beneficiaries are enrolled due to a disability rather than age. Nationwide, 16 percent of all Medicare beneficiaries are eligible due to disability.

Medicare Advantage in Oklahoma

In most areas of the country, private Medicare Advantage plans are available as an alternative to Original Medicare. People who enroll in Original Medicare get their coverage directly from the federal government, and have access to a nationwide network of providers. But Original Medicare enrollees need supplemental coverage (from an employer-sponsored plan, Medicaid, or privately purchased plans) for things like prescription drugs and out-of-pocket costs.

Original Medicare includes Medicare Parts A and B. Medicare Advantage includes all of the benefits of Medicare Parts A and B, and Advantage plans typically have additional benefits, such as integrated Part D prescription drug coverage and extras like dental and vision. But provider networks are limited with Medicare Advantage, and out-of-pocket costs are often higher than they would be under Original Medicare plus a Medigap plan. There are pros and cons to either option, and no single solution that works for everyone.

Only 18 percent of Medicare beneficiaries in Oklahoma were enrolled in Medicare Advantage plans as of 2017, compared with an average of 33 percent nationwide. As of November 2018, there were 140,692 Oklahoma Medicare beneficiaries with private Medicare plans (as opposed to Original Medicare; that figure does not include people who had private coverage to supplement Original Medicare). The other 582,225 enrollees had Original Medicare.

For 2019, Medicare Advantage availability ranges from just two plans in Beaver, Ellis, Greer, Harmon, and Texas counties, to 27 plans in Tulsa County.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). As of 2019, Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in Oklahoma

More than half of Original Medicare beneficiaries have supplemental coverage under an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) will pay some or all of the out-of-pocket costs that Medicare beneficiaries would otherwise have to pay themselves. Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage; Medigap plans are what’s available for people who don’t have access to an employer-sponsored plan (including retiree plans) or Medicaid.

Although Medigap plans are sold by private insurers, the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits offered by a particular plan (Plan A, Plan F, etc.) are the same regardless of which insurer is selling the plan. So it’s easier to compare Medigap policies than it is to compare other types of health insurance; consumers can base their decision on premiums and less tangible factors like customer service, since the benefits themselves are uniform.

Forty-eight insurers were licensed to offer Medigap plans in Oklahoma as of 2018, although 13 of those companies did not have plan availability or pricing listed on the state’s Medigap shopper’s guide as of 2018; the other 35 insurers offered a variety of plans. According to an AHIP analysis, there were 188,452 Medicare beneficiaries in Oklahoma who had Medigap coverage as of 2016.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules give enrollees a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and 18 percent of Medicare beneficiaries in Oklahoma are under age 65. Federal rules do not guarantee access to Medigap plans for people who are under 65, but Oklahoma is among the majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans.

Oklahoma was one of the first states to address this issue, and has guaranteed access to Medigap plans for people under age 65 since 1994. The initial rule just required Medigap insurers to offer at least one plan to applicants under the age of 65. But since 2017, state law has also required insurers to offer that policy without charging a higher premium to disabled enrollees [see OAC 365:10-5-129(d)]. Medigap insurers in Oklahoma have to offer at least one plan to enrollees under the age of 65, during a six-month open enrollment period that begins when the person is enrolled in Medicare Part B. And insurers cannot charge a premium higher than the lowest available age-based premium that applies to that plan (ie, the rate that would be charged for a 65-year-old enro`lling in the plan after gaining eligibility for Medicare due to age).

Almost all of Oklahoma’s Medigap insurers have opted to offer Plan A as their option for enrollees under the age of 65, but Globe Life & Accident offers Plan B, and United American Insurance offers Plan B and high-deductible Plan F.

People who have Medicare prior to age 65 are granted another six-month Medigap open enrollment period when they turn 65, during which they can select any available plan from any insurer. Many more Medigap options are available to people who are turning 65, so this is an opportunity for an enrollee to obtain more robust coverage if they prefer it (Plan A, which is the option that most insurers make available to people under age 65, is the least comprehensive Medigap plan).

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those rules don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months, if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the insurer can consider your medical history in determining whether to accept your application, and at what premium.

Medicare Part D in Oklahoma

Original Medicare does not provide coverage for outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage.

But people who are enrolling in Medicare and do not have drug coverage through Medicaid or an employer-sponsored plan need to obtain Medicare Part D prescription coverage. Part D coverage can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan with integrated Part D prescription drug coverage.

There are 28 stand-alone Part D plans for sale in Oklahoma in 2019, with premiums that range from about $16 to $144/month.

As of late 2018, half of Oklahoma’s Medicare beneficiaries (362,856 people) had prescription coverage under stand-alone Part D plans. Another 119,988 had Part D prescription coverage integrated with their Medicare Advantage plans.

Medicare spending in Oklahoma

In 2016, Original Medicare’s average per-beneficiary spending in Oklahoma was $10,278, based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage.

Nationwide, average per beneficiary Original Medicare spending was $9,533 per enrollee, so Medicare spending in Oklahoma was about 8 percent higher than average. Oklahoma was one of just six states where average per-beneficiary spending for Original Medicare exceeded $10,000 that year. Per-beneficiary Original Medicare spending was highest in Louisiana, at $11,399, and lowest in Hawaii, at just $6,441.

You can read more about Medicare in Oklahoma in our state Medicare guide. You can also contact the Oklahoma Senior Health Insurance Counseling Program with questions related to Medicare coverage in Oklahoma.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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