SoonerCare is Oklahoma's Medicaid program, not Medicare

SoonerCare is the name Oklahoma uses for its Medicaid program. It is state and federally funded health coverage for people with low income, not a Medicare program. Medicare is a separate federal program for people age 65 and older, regardless of income, and for some younger people with disabilities or end-stage renal disease. If you live in Oklahoma and have been told you might be covered by Medicaid, you would be enrolled in SoonerCare.

The confusion happens because both programs use the word "care" and both are government health insurance. But they work differently, cover different groups of people, and have different rules. Understanding which one you might be covered by matters because the enrollment process, the services covered, and what you pay are not the same.

Key Takeaways

  • SoonerCare is Oklahoma's Medicaid program — it is state and federal health coverage for low-income people, not Medicare.
  • Medicare is a federal program for people age 65 and older or people with certain disabilities, and income does not matter for Medicare.
  • You can be enrolled in both SoonerCare and Medicare at the same time if you meet the age or disability requirements for Medicare and the income requirements for SoonerCare.
  • SoonerCare covers doctor visits, hospital care, prescription drugs, and other services; what is covered depends on which SoonerCare plan you are in.
  • To find out whether you can get SoonerCare, you contact the Oklahoma Health Care Authority directly or use the federal healthcare.gov website.

Who SoonerCare covers and who Medicare covers

SoonerCare covers Oklahoma residents with low income. The income limit depends on your household size and which category you fall into — parent, child, pregnant person, elderly person, or person with a disability. As of 2024, Oklahoma has expanded Medicaid, which means more working-age adults without children can now be covered if their income is at or below 138 percent of the federal poverty level. For a single person, that is roughly $1,900 per month before taxes; for a family of three, roughly $4,000 per month.

Medicare, by contrast, does not look at income at all. You are covered if you are age 65 or older, or if you are under 65 and have been receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) for at least 24 months, or if you have end-stage renal disease or ALS. Age or disability status determines Medicare coverage, not how much money you have.

Some people are covered by both. If you are 65 or older and have low income, you might have both Medicare and SoonerCare. If you are under 65, have a disability that qualifies you for Medicare, and also have low income, you could have both programs. When you have both, Medicare is your primary insurance and SoonerCare fills in gaps.

What each program pays for

SoonerCare covers doctor visits, hospital stays, emergency room care, prescription drugs, mental health services, dental care (for children and some adults), vision care, and other services. The exact list of covered services depends on which SoonerCare plan you are in — there are different plans for children, parents, elderly people, and people with disabilities. Some services may require a copay or have limits on how many times you can use them per year.

Medicare covers hospital care (Part A), doctor visits and outpatient care (Part B), prescription drugs (Part D), and some preventive services. Medicare does not cover dental, vision, or hearing care unless you choose a Medicare Advantage plan that includes those benefits. If you have both Medicare and SoonerCare, SoonerCare often covers the services Medicare does not, like dental and vision.

How to learn about you can get SoonerCare

You can start the process through the Oklahoma Health Care Authority (OHCA), which runs SoonerCare. You can also use the federal healthcare.gov website, which will direct you to Oklahoma's system. You will need to provide information about your household size, income, and citizenship or immigration status. The process usually takes two to four weeks.

If you are already receiving SSI or SSDI, you may be automatically enrolled in SoonerCare without having to apply separately. If you are age 65 or older, you may be able to get SoonerCare to help pay your Medicare premiums and cost-sharing. Contact OHCA directly to ask whether you may have access to for this program, called Medicare Savings Program.

Why the names are confusing

Medicaid is the federal program; each state runs its own version and gives it a different name. Oklahoma chose "SoonerCare." Other states call theirs Medi-Cal (California), MassHealth (Massachusetts), or Badgercare (Wisconsin). They are all Medicaid — the same federal program with the same basic rules — but each state administers it slightly differently.

Medicare is always called Medicare, no matter what state you live in, because it is run entirely by the federal government. The Social Security Administration handles enrollment and the Centers for Medicare and Medicaid Services (CMS) handles the day-to-day operations. There is no state version of Medicare.

What happens if you have both SoonerCare and Medicare

If you have both programs, you will have two insurance cards. When you go to the doctor or hospital, you show both cards. The provider will bill Medicare first, then bill SoonerCare for anything Medicare did not cover. You should not have to pay anything out of pocket for most services, though some plans have small copays.

Having both programs is actually beneficial because it means more services are covered. For example, Medicare does not cover dental work, but SoonerCare does for some groups. If you have both, you can use SoonerCare to cover dental care that Medicare will not pay for. The same is true for vision, hearing aids, and some other services.

Frequently Asked Questions

Can I have SoonerCare and Medicare at the same time?

Yes. If you are 65 or older and have low income, or if you are under 65 with a disability that qualifies you for Medicare and also have low income, you can be enrolled in both. Medicare is your primary insurance, and SoonerCare covers costs Medicare does not pay for.

Do I have to pay a monthly premium for SoonerCare?

Most SoonerCare members do not pay a monthly premium. Some groups, such as working-age adults without children, may have a small premium, but it is usually waived or very low. You may have copays when you use services, but the amount depends on your plan and the type of service.

If I am on Medicare, do I automatically get SoonerCare?

No. You have to meet SoonerCare's income requirements separately. Being on Medicare does not make you automatically may be able to access for SoonerCare. However, if you are 65 or older and on Medicare with low income, you should contact OHCA to see if you may have access to for the Medicare Savings Program, which helps pay your Medicare costs.

What is the difference between SoonerCare and the Marketplace health plans?

SoonerCare is Medicaid, which is free or very low cost for people with low income. Marketplace plans (from healthcare.gov) are private insurance that may have monthly premiums and higher deductibles. If you are low-income, SoonerCare is usually a better choice because it costs less and covers more services.

How do I know if I am on SoonerCare or Medicare?

Look at your insurance card. A SoonerCare card will say "SoonerCare" or "Oklahoma Health Care Authority" on it. A Medicare card will say "Medicare" and have a red, white, and blue design. If you are unsure, call the number on your card and ask which program you are enrolled in.