Quick answers
- Can I have SoonerCare and Medicare?
- Yes. Medicare pays first, and SoonerCare pays after Medicare for costs and services it covers.
- Where do I apply if I have Medicare?
- Through Oklahoma Human Services (OKDHS): online at OKDHSLive.org, at your county Human Services Center, or with the paper Request for Benefits form.
- Does SoonerCare pay my Part B premium?
- It can. Full SoonerCare and the QMBP, SLMB and QI-1 programs pay the Part B premium, so it stops coming out of your Social Security check.
- Who covers my prescriptions?
- Medicare Part D. People with SoonerCare get Extra Help automatically, and SoonerCare covers only a short list of drugs Medicare excludes.
- Am I in SoonerSelect?
- No. OHCA excludes people with both Medicare and Medicaid from SoonerSelect and SoonerCare Choice managed care.
Who is a dual eligible in Oklahoma?
SoonerCare is Oklahoma's Medicaid program, run by the Oklahoma Health Care Authority (OHCA). For people 65 or older, blind or disabled, Oklahoma Human Services (OKDHS) decides eligibility using the income and resource standards in its Appendix C-1. If you have Medicare and also qualify for a SoonerCare program, you are "dual eligible." What SoonerCare does for you depends on the program:
| Type | Oklahoma program | What SoonerCare does |
|---|---|---|
| Full dual | Full SoonerCare, for example SoonerCare for aged, blind or disabled people, nursing home care, or the ADvantage waiver | Pays after Medicare for services SoonerCare covers, including long-term care, and helps with Medicare premiums and cost sharing |
| Partial dual (QMBP) | Qualified Medicare Beneficiary Plus, Oklahoma's name for QMB | Pays Part A and Part B premiums, deductibles and coinsurance |
| Partial dual (SLMB, QI-1) | Specified Low Income Medicare Beneficiary or Qualifying Individual | Pays the Part B premium only |
| QDWI | Qualified Disabled and Working Individual | Pays the Part A premium for some people under 65 who work |
OHCA groups the Medicare cost programs under the name SoonerCare Supplemental. Income limits and how to apply are on Medicare Savings Programs in Oklahoma.
How do SoonerCare and Medicare work together?
Medicare is always your primary coverage. Doctors and hospitals bill Medicare (or your Medicare plan) first, and SoonerCare pays after Medicare for costs and services it covers. A few rules matter in daily life:
- The Part B premium is paid for you. OHCA pays the Part B premium for full SoonerCare members and for QMBP, SLMB and QI-1 members through what its rules call the Part B buy-in. In 2026 that premium is $202.90 a month. It stops coming out of your Social Security check once the buy-in starts, which can take a few months.
- QMBP protects you from Medicare bills. Providers who accept Medicare may not bill a Qualified Medicare Beneficiary for Medicare deductibles, coinsurance or copays. Show your Medicare card and your SoonerCare card at every visit.
- Prescription drugs come from Medicare. See Medicare drug coverage for dual eligibles below.
- Renew on time. OKDHS certifies QMBP, SLMB and QI-1 for 12 months at a time (OAC 317:35-7-60). If SoonerCare stops, so does the help with Medicare costs. Open and answer every letter from OKDHS and OHCA.
Does SoonerSelect or SoonerCare Choice apply to dual eligibles?
No. Oklahoma moved many SoonerCare members into SoonerSelect managed care plans, but OHCA lists dual eligibles, people in a Medicare Savings Program (QMB, SLMB, QDWI and QI), people who qualify on the basis of age, blindness or disability, people with a nursing facility level of care, and people in a 1915(c) waiver such as ADvantage among the groups that stay in their current SoonerCare program. OHCA's rule on SoonerCare Choice, its patient-centered medical home program, also excludes people eligible for both SoonerCare and Medicare (OAC 317:25-7-13).
In practice, your Medicare coverage (Original Medicare or a Medicare plan you choose) is how you get most care, and SoonerCare pays its share directly to providers who accept SoonerCare. If you want one plan that coordinates both, ask about a dual eligible special needs plan (D-SNP).
Medicare drug coverage for dual eligibles
- Part D is your drug coverage. OHCA says that if you are eligible for full SoonerCare, CMS will enroll you in a Medicare prescription drug plan if you don't choose one. You can pick a different plan.
- Extra Help is automatic. Medicare.gov says people with full Medicaid, a Medicare Savings Program or SSI automatically qualify for Extra Help. In 2026 that keeps drug copays to no more than $5.10 for a generic and $12.65 for a brand-name drug, or less for some full duals.
- SoonerCare fills a few gaps. OHCA publishes a short list of drugs SoonerCare covers for dual eligibles, for drug types Medicare Part D doesn't cover. Its pharmacy rules say SoonerCare does not pay for drugs available under Medicare Part B or Part D.
- More chances to change. With Medicaid or Extra Help you can switch standalone Part D plans once a month. See Medicare enrollment periods.
Nursing homes and long-term care
Medicare pays for a skilled nursing facility only after a qualifying hospital stay, for up to 100 days per benefit period, with a daily coinsurance of $217 for days 21 to 100 in 2026. It does not pay for long-term custodial care. That is where SoonerCare comes in for many Oklahomans.
- Income limit. For nursing home care, ICF/IID care and the ADvantage waiver, monthly countable income must be at or below 300 percent of the SSI federal benefit rate (OKDHS Appendix C-1, Schedule VIII.B). People with higher income may qualify by using a Medicaid Income Pension Trust, which OKDHS also caps.
- Resources. Countable resources must be within the Schedule VIII.D limits, and home equity has a cap for people approved for long-term care.
- Married couples. When one spouse is in a nursing home or on the ADvantage waiver, Schedule XI sets how much income and resources the spouse at home can keep.
- Level of care. You also need a medical review showing you need a nursing facility level of care.
- You keep a small allowance. Most of your income goes toward the cost of care, but OKDHS lets a nursing home resident keep a monthly maintenance amount for personal needs.
When OKDHS certifies you for long-term care, you are also eligible for other SoonerCare services, and OKDHS checks separately whether you qualify as a QMBP or SLMB without another application (OAC 317:35-15-1). If you'd rather get care at home, see the ADvantage waiver, which is a SoonerCare program, not a Medicare Advantage plan.
Tip: OKDHS publishes the current dollar amounts for all of these limits in Appendix C-1 (revised July 1, 2026). Ask your OKDHS worker which schedule applies to you.
How do I apply for SoonerCare if I have Medicare?
OHCA handles online applications on mySoonerCare.org for children, parents, pregnant women and adults 19 to 64 without Medicare. If you are 65 or older, blind or disabled, need help with Medicare costs, or need nursing home or waiver care, OHCA sends you to Oklahoma Human Services:
- Choose how to apply. Apply online at OKDHSLive.org, visit your county OKDHS Human Services Center, or download the Request for Benefits form (search OKDHS forms for PS-1 or 08MP001E) and send it to your local office.
- Gather your papers. Have your Medicare card, Social Security number, and proof of income and resources, such as your Social Security benefit letter, pension statements and bank statements.
- Answer OKDHS promptly. An OKDHS worker may ask for more information. For nursing home or ADvantage care, a nurse will also assess your level of care.
- Watch for your decision and renewal. Keep every letter. Renew on time so your Medicare premium help doesn't stop.
Questions about an existing SoonerCare case go to the SoonerCare Helpline at 1-800-987-7767. OKDHS's main line is (405) 522-5050.
Choosing your Medicare coverage
SoonerCare doesn't choose your Medicare plan for you. You can keep Original Medicare with a Part D plan, or join a Medicare Advantage plan, including a D-SNP, if one serves your county. For 2027, CMS data show 27 special needs plans in Oklahoma, which includes D-SNPs and other kinds. To compare Medicare plans from the companies they work with, and check 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; those agencies decide SoonerCare eligibility. See also SoonerCare vs. Medicare and helping a parent with Medicare.
Sources
- OHCA — SoonerCare Supplemental (QMB, SLMB, QI-1)
- OHCA — Where to apply (groups that apply with Oklahoma Human Services)
- OHCA — SoonerSelect choice counseling FAQs (excluded groups)
- OHCA — OAC 317:25-7-13, SoonerCare Choice enrollment ineligibility
- OHCA — Medicare Part D (dual eligibles)
- OHCA — OAC 317:35-1-2, definitions (QMBP, Part A and Part B buy-in)
- OHCA — OAC 317:35-7-60, certification for SoonerCare
- OHCA — OAC 317:35-15-1, long-term care and QMBP/SLMB
- OKDHS — Appendix C-1, Maximum Income, Resource, and Payment Standards (7/1/2026)
- OKDHS — SoonerCare (Medicaid)
- Medicare.gov — Help with drug costs (Extra Help)
- CMS — Qualified Medicare Beneficiary program (billing protections)
- Medicare.gov — Skilled nursing facility care
Every question in this guide
Frequently asked questions
Can I have SoonerCare and Medicare at the same time in Oklahoma?
Yes. Medicare is your main coverage and pays first. SoonerCare pays after Medicare for costs and services it covers. Depending on the program you qualify for, SoonerCare may pay only your Medicare premiums or may also cover services such as nursing home care and ADvantage waiver services at home.
Where do I apply for SoonerCare if I'm 65 or have Medicare?
OHCA sends people who are 65 or older, blind or disabled, people who need help with Medicare costs, and people needing nursing home or waiver care to Oklahoma Human Services (OKDHS). Apply online at OKDHSLive.org, at your county OKDHS Human Services Center, or with the Request for Benefits form (PS-1, also listed as 08MP001E). The SoonerCare Helpline is 1-800-987-7767.
Will I be moved into SoonerSelect if I have Medicare?
No. OHCA says dual eligibles, people in a Medicare Savings Program, people who qualify on the basis of age, blindness or disability, people with a nursing facility level of care and people in a 1915(c) waiver stay in their current SoonerCare program instead of SoonerSelect. OHCA's rules also exclude dual eligibles from SoonerCare Choice.
Does SoonerCare cover my prescription drugs if I have Medicare?
Mostly no. Once you have Medicare, your drugs come from a Medicare Part D plan or a Medicare plan with drug coverage. OHCA says CMS enrolls full SoonerCare members in a Medicare drug plan, and everyone with SoonerCare or a Medicare Savings Program gets Extra Help automatically. SoonerCare covers only a short list of drugs for dual eligibles that it publishes.
Does SoonerCare pay for a nursing home if I have Medicare?
It can. Medicare covers only short skilled nursing facility stays after a qualifying hospital stay, not long-term custodial care. SoonerCare long-term care has its own income limit, 300 percent of the SSI federal benefit rate, plus resource limits and a medical level-of-care review. OKDHS publishes the current amounts in Appendix C-1, Schedule VIII.
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