SoonerCare and Medicare at a glance
| Question | Medicare | SoonerCare |
|---|---|---|
| What it is | Federal health insurance | Oklahoma's Medicaid program, paid for by the state and federal government |
| Who runs it | The Centers for Medicare & Medicaid Services (CMS); Social Security handles most enrollment | The Oklahoma Health Care Authority (OHCA); Oklahoma Human Services (OKDHS) decides eligibility for people 65 or older, blind or disabled |
| Who it's for | People 65 or older, people under 65 who have received Social Security disability benefits for 24 months, and people with ALS or end-stage renal disease | Oklahomans with limited income (and, for people 65 or older, blind or disabled, limited resources), including children, parents, pregnant women, adults 19 to 64, and aged, blind or disabled people |
| Based on | Age, disability or kidney failure, and work history for premium-free Part A; not income | Income and, for aged, blind and disabled programs, resources |
| Where it works | Anywhere in the U.S. with Original Medicare; plan networks vary | Providers in Oklahoma (and some nearby) that accept SoonerCare |
What each one costs you
| Cost | Medicare (2026) | SoonerCare |
|---|---|---|
| Monthly premium | Part A is premium-free for most people; Part B is $202.90 a month for most, more with higher income (IRMAA) | OHCA says there are no premiums for adults in the expanded SoonerCare group; members pay small copays instead |
| Deductibles | Part A: $1,736 per benefit period. Part B: $283 a year | Not part of SoonerCare's cost sharing, which uses per-service copays |
| Copays and coinsurance | Usually 20% for Part B services after the deductible with Original Medicare | Small copays for some services; some groups and services are exempt, such as nursing home and hospice care, and a household's total copays are capped at 5% of its income each month |
| Drug costs | Set by your Part D plan, with a $2,100 yearly cap on out-of-pocket drug costs | With Medicare, drugs come from Part D; Extra Help lowers copays to no more than $5.10 for a generic and $12.65 for a brand-name drug |
If you have both, SoonerCare can pay your Part B premium, and if you qualify as a QMBP, your Medicare deductibles and coinsurance too. See Medicare Savings Programs in Oklahoma and Medicare costs in 2026.
What each one covers
| Service | Medicare | SoonerCare (for people with Medicare) |
|---|---|---|
| Hospital and doctor care | Covered by Part A and Part B (or a Medicare Advantage plan); Medicare pays first | Pays after Medicare, for costs and services SoonerCare covers |
| Prescription drugs | Part D plan or Medicare plan with drug coverage | Only a short list of drugs Medicare excludes; Extra Help is automatic |
| Nursing home care | Skilled nursing only, after a qualifying hospital stay, up to 100 days per benefit period | Long-term nursing home care if you meet income, resource and level-of-care rules |
| Care at home | Part-time home health care if you're homebound and need skilled care; not ongoing personal care | The ADvantage waiver and State Plan Personal Care can pay for personal care, home-delivered meals and more |
| Managed care | You can choose Original Medicare or a Medicare Advantage plan, including a D-SNP | People with Medicare are not enrolled in SoonerSelect or SoonerCare Choice |
When you can have both
| Your SoonerCare program | What SoonerCare adds to Medicare |
|---|---|
| Full SoonerCare (aged, blind or disabled; nursing home; ADvantage) | SoonerCare services after Medicare, long-term care, and help with Medicare premiums and cost sharing |
| QMBP | Part A and Part B premiums, deductibles and coinsurance; providers may not bill you for Medicare cost sharing |
| SLMB or QI-1 | Part B premium only |
| QDWI | Part A premium only, for some working people under 65 with a disability |
Turning 65 with SoonerCare? Your eligibility moves to the aged, blind and disabled rules, which include a resource limit, so answer every OKDHS letter. More on SoonerCare and Medicare and turning 65 in Oklahoma.
How to apply
| Step | Medicare | SoonerCare (65+, blind, disabled or with Medicare) |
|---|---|---|
| Where | Social Security: SSA.gov, 1-800-772-1213, or a local Social Security office. Many people getting Social Security benefits are enrolled automatically | Oklahoma Human Services: OKDHSLive.org, your county Human Services Center, or the Request for Benefits form (PS-1 or 08MP001E) |
| When | Your Initial Enrollment Period: the 7 months around your 65th birthday month | Any time; Medicare Savings Program coverage can start up to 3 months before the month you apply |
| Renewal | No yearly renewal; plans can be changed each fall | Usually every 12 months; answer every renewal letter |
| Help line | 1-800-MEDICARE (1-800-633-4227) | SoonerCare Helpline 1-800-987-7767 |
To compare Medicare plans from the companies they work with, including how a plan works with your SoonerCare, you can request a call from a licensed insurance agent. Benefits Life is not connected with OHCA or OKDHS, which decide SoonerCare eligibility. See also D-SNPs in Oklahoma and Medicare enrollment periods.
Sources
- OKDHS — Appendix C-1 (7/1/2026): which agency determines eligibility for which groups
- OHCA — Where to apply
- OKDHS — SoonerCare (Medicaid): applying, copays and the 5% household limit
- OHCA — SoonerCare FAQs (copays and the monthly cost-sharing limit)
- OHCA — SoonerCare expansion (no premiums for expansion adults)
- OHCA — SoonerCare Supplemental
- OHCA — SoonerSelect choice counseling FAQs (excluded groups)
- OHCA — Medicare Part D (dual eligibles)
- OHCA — OAC 317:35-7-60, Certification for SoonerCare
- Oklahoma Human Services — ADvantage Waiver
- Medicare.gov — Get started with Medicare (who qualifies)
- Medicare.gov — Medicare costs (2026)
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Home health services
Frequently asked questions
What is the main difference between SoonerCare and Medicare?
Medicare is a federal program based on age, disability or kidney failure, not income. SoonerCare is Oklahoma's Medicaid program, based mainly on income and resources and run by the Oklahoma Health Care Authority. Medicare covers hospital, medical and drug costs; SoonerCare can also cover long-term care such as nursing homes and the ADvantage waiver.
Can I have both SoonerCare and Medicare?
Yes. People who have both are called dual eligibles. Medicare pays first, and SoonerCare pays after Medicare for costs and services it covers. Some people get full SoonerCare; others get only help with Medicare premiums and cost sharing through a Medicare Savings Program.
Do I lose SoonerCare when I turn 65 and get Medicare?
Not automatically, but the rules change. Adults 19 to 64 apply for SoonerCare through OHCA, but once you have Medicare or turn 65, your eligibility is reviewed under the aged, blind and disabled rules that Oklahoma Human Services applies, which include a resource test. Answer every renewal letter so you don't lose coverage you still qualify for.
Which pays for a nursing home, SoonerCare or Medicare?
Medicare pays only for short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period. SoonerCare can pay for long-term nursing home care if you meet its income, resource and level-of-care rules.
Who covers prescriptions if I have both?
Medicare Part D. Once you have Medicare, your drugs come from a Part D plan or a Medicare plan with drug coverage, and Extra Help is automatic with SoonerCare. SoonerCare covers only a short list of drugs that Medicare excludes.
Medicare in your Oklahoma county
Plans, local agents and help, county by county: Oklahoma · Tulsa · Cleveland · Canadian · Comanche · Rogers · Wagoner · Payne · Pottawatomie · Creek · Muskogee · Garfield · Grady · Washington · Logan · Bryan · Le Flore · Carter · Cherokee · McClain · All 77 counties →