Soonercare is a health insurance program for people with low incomes and limited resources in Oklahoma. It is a form of Medicaid that is funded by both the federal and state governments. Soonercare provides various health care services to eligible individuals, including doctor’s visits, hospital stays, prescription drugs, and mental health services. It also covers long-term care services, such as nursing home care and home health care, for people who meet certain eligibility requirements. The program is administered by the Oklahoma Health Care Authority.
Medicaid Coverage and Eligibility
Medicaid is a state and federal program that provides health insurance to people with low incomes and limited resources. Different states have different rules for who is eligible for Medicaid. In Oklahoma, the program is called SoonerCare.
- Who is eligible for SoonerCare?
To be eligible for SoonerCare, you must meet certain income and resource limits. You must also be a citizen or legal resident of the United States, and you must live in Oklahoma. There are some exceptions to these rules, such as for children and pregnant women.
- What does SoonerCare cover?
SoonerCare covers a wide range of health care services, including:
- Doctor visits
- Hospital care
- Prescription drugs
- Mental health care
- Substance abuse treatment
- Dental care
- Vision care
- Hearing aids
SoonerCare also covers long-term care services, such as nursing home care and home health care.
Comparison of Medicaid and Medicare
| Feature | Medicaid | Medicare |
|---|---|---|
| Who is eligible? | People with low incomes and limited resources | People aged 65 and older, people with certain disabilities, and people with end-stage renal disease |
| What does it cover? | A wide range of health care services, including doctor visits, hospital care, prescription drugs, mental health care, substance abuse treatment, dental care, vision care, hearing aids, and long-term care services | Hospital care, medical care, and prescription drugs |
| How do I apply? | Contact your state Medicaid office | Contact the Social Security Administration |
Medicare Coverage and Eligibility
Medicare is a federal health insurance program for people aged 65 and older, as well as people with certain disabilities or conditions. It provides coverage for a wide range of medical services, including hospital care, doctor’s visits, and prescription drugs.
Medicare Parts
- Medicare Part A (Hospital Insurance):
- Covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care.
- Most people are eligible for premium-free Part A.
- Medicare Part B (Medical Insurance):
- Covers doctor’s visits, outpatient hospital care, durable medical equipment, and certain other medical services.
- There is a monthly premium for Part B.
- Medicare Part C (Medicare Advantage):
- Medicare Advantage plans are offered by private insurance companies and provide all the benefits of Part A and Part B, as well as additional benefits, such as vision, dental, and hearing coverage.
- Medicare Advantage plans typically have a monthly premium.
- Medicare Part D (Prescription Drug Coverage):
- Part D plans are offered by private insurance companies and provide coverage for prescription drugs.
- There is a monthly premium for Part D plans.
Medicare Eligibility
- Age: Most people are eligible for Medicare at age 65.
- Disability: People with certain disabilities, such as end-stage renal disease or Lou Gehrig’s disease, may be eligible for Medicare before age 65.
- Work History: People who have worked and paid Medicare taxes for at least 10 years may be eligible for premium-free Part A.
To learn more about Medicare coverage and eligibility, visit the Medicare website or contact your local Social Security office.
| Part A Premium | Part B Premium | |
|---|---|---|
| Individuals | $0 | $164.90 |
| Couples | $0 | $329.80 |
Similarities and Differences between Medicaid and Medicare
Medicaid and Medicare are two government-sponsored health insurance programs that provide coverage to different populations of people.
Similarities
- Both Medicaid and Medicare are funded by the federal government and administered by individual states.
- Both programs offer a range of benefits, including coverage for doctor visits, hospital stays, prescription drugs, and preventive care.
Differences
- Eligibility
- Medicaid is for low-income individuals and families, including children, pregnant women, and people with disabilities.
- Medicare is for people aged 65 and older, as well as people with certain disabilities and end-stage renal disease (ESRD).
- Cost
- Medicaid is free or low-cost for eligible individuals and families.
- Medicare has premiums, deductibles, and copayments that vary depending on the type of coverage.
- Benefits
- Medicaid offers a wider range of benefits than Medicare, including coverage for long-term care and home- and community-based services.
- Medicare primarily covers hospital stays, doctor visits, and certain preventive services.
- Managed Care
- Medicaid increasingly uses managed care plans to deliver services.
- Medicare also offers managed care plans, but beneficiaries can also choose traditional fee-for-service coverage.
| Characteristic | Medicaid | Medicare |
|---|---|---|
| Eligibility | Low-income individuals and families, including children, pregnant women, and people with disabilities | People aged 65 and older, as well as people with certain disabilities and end-stage renal disease (ESRD) |
| Cost | Free or low-cost for eligible individuals and families | Has premiums, deductibles, and copayments that vary depending on the type of coverage |
| Benefits | Wider range of benefits, including coverage for long-term care and home- and community-based services | Primarily covers hospital stays, doctor visits, and certain preventive services |
| Managed Care | Increasingly uses managed care plans to deliver services | Offers managed care plans, but beneficiaries can also choose traditional fee-for-service coverage |
Soonercare: Medicaid or Medicare?
Soonercare is Oklahoma’s Medicaid program. It is a health insurance program for people with low incomes and limited resources. Medicare is a federal health insurance program for people aged 65 and older, people with disabilities, and people with end-stage renal disease (ESRD). Soonercare is not the same as Medicare, although both programs provide health insurance coverage to different groups of people.
Soonercare Eligibility and Enrollment
To be eligible for Soonercare, you must meet certain income and resource requirements. The income limits for Soonercare are based on the federal poverty level (FPL). The resource limits are based on the value of your assets, such as your bank accounts, stocks, and bonds.
To enroll in Soonercare, you can apply online or through the mail. You can also apply in person at your local Soonercare office. The Soonercare application process can take up to 45 days, so it is important to apply as soon as possible.
Soonercare Eligibility Requirements
- Be a resident of Oklahoma
- Be a U.S. citizen or a qualified non-citizen
- Meet the income and resource limits
- Be pregnant, a child under 19 years old, a parent or caretaker of a child under 19 years old, an adult aged 19 to 64 years old who is disabled or blind, or an individual aged 65 years old or older
Soonercare Income Limits
| Household Size | Monthly Income Limit |
|---|---|
| 1 | $1,563 |
| 2 | $2,113 |
| 3 | $2,663 |
| 4 | $3,213 |
| 5 | $3,763 |
| 6 | $4,313 |
| 7 | $4,863 |
| 8 | $5,413 |
For each additional person in the household, add $650 to the monthly income limit.
Soonercare Resource Limits
- $2,000 for individuals
- $3,000 for couples
- $10,000 for families with children
Resources that are not counted include your home, one vehicle, and personal belongings.
And there you have it, folks! Soonercare is Medicaid, not Medicare. Hopefully, this article cleared up any confusion you might have had. If you have any more questions, feel free to reach out to your friendly neighborhood Soonercare representative. And don’t forget to swing by again soon for more informative and engaging content. Stay healthy, stay safe, and keep those questions coming!