Cost and Coverage of Medicaid in Oklahoma

How much is Medicaid in Oklahoma when it comes to insurance premiums and co-pays? Moreover, what services are covered by Medicaid in Oklahoma for approved beneficiaries? Oklahoma Medicaid coverage, also known as SoonerCare, caters to a number of health services for eligible residents for little to no cost.

To learn more about Oklahoma Medicaid cost estimates and covered services, read the topics below:

  • How much does Medicaid cost in Oklahoma?

  • Types of Medicaid insurance in Oklahoma

  • What services are covered by Medicaid in Oklahoma?

  • What does Medicaid not cover in Oklahoma?

How Much Does Medicaid Cost in Oklahoma?

OK Medicaid coverage is free for enrollees that meet the income guidelines for various medical services. Some members are exempt from OK Medicaid cost estimates and co-payments like those 21 years of age and younger and pregnant women. How much does Medicaid cost for members that do not meet the income guidelines? Medicaid cost estimates in OK for other members vary, as these members must pay require copayments for certain services.

Depending on types of Medicaid insurance, the enrollee’s eligibility group and sought health care service, copayments can start from zero and can go up to a few hundred dollars. For most basic Medicaid coverage, copayments are less than $30. Keep in mind that the Medicaid cost estimates for copayments amount can change. To know the current Medicaid cost estimates for the service or items you require, consult your primary care provider.

An Oklahoma Medicaid coverage provider cannot deny you services if you cannot afford copayment. However, you will still be responsible for the amount you owe. Most Medicaid coverage providers open accounts for members that cannot make co-payments and bill them later. OK Medicaid coverage excludes some health services and items. For non-covered items and services, members must pay for them out-of-pocket or through third party coverage.

Types of Medicaid Insurance in Oklahoma

What types of Medicaid insurance can you apply for? Oklahoma Medicaid coverage has a number of programs for eligible residents. However, Medicaid cost estimates for each program varies.

Medicaid programs include Indian Health Services, Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Long-Term Care Services, Oklahoma Cares, Pregnancy Services, SoonerCare Choice, SoonerCare Health Management Program, SoonerCare Supplemental, SoonerCare Traditional, SoonerPlan, SoonerRide and the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA).

When approved for OK Medicaid coverage, you have to choose a Primary Care Physician (PCP). The types of Medicaid insurance in Oklahoma you can choose will depend on your PCP. If you do not choose a provider, Medicaid will assign one to you. All Medicaid providers offer primary services, although optional services vary. Compare the optional services of different providers to find the right one for you. You can change providers once a year.

Payment for the various types of Medicaid insurance in OK are on a monthly basis. At the end of 12 months, you have to renew your coverage. During the renewal period, furnish the PCP with any new information that can affect your coverage.

What Services are Covered by Medicaid in Oklahoma?

What services are covered by Medicaid by my PCP and other specialists? OK Medicaid coverage depends on the eligibility group you fit in as well as which medical services are necessary. The different types of Medicaid insurance also affects which health care services are covered. The follow illustrates covered services by insurance type.

  1. Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
    This comprehensive and preventive child health program is available to members younger than 21 years old. The services include hearing, dental and vision checks and treatments. Screening services must include lead toxicity screening, laboratory tests, appropriate immunizations, comprehensive unclothed physical exam and comprehensive health and development history.

  2. Child Health Services
    Under this Medicaid coverage program, various services are covered. The services include pathology and hearing services, occupational and physical therapy services, assistive technology services, private duty nursing, orthodontics, optical and optometric services, hearing aids and inpatient hospital services for children in institutions for mental diseases.

  3. ersonal Care Services P
    Medicaid services offered here include assistance with personal hygiene, meal preparation, light housekeeping, laundry, general errands and exercises.

  4. Durable Medical Supplies and Equipment
    Oklahoma Medicaid coverage will pay for durable medical equipment (DME) prescribed by an in-network medical provider. The equipment must to be necessary, serve a medical purpose and withstand repeated use. If it is anticipated that a patient will need equipment for more than 10 months, renting is recommended. A number of DMEs require prior authorization and a Certificate of Medical Necessity. OK Medicaid coverage does not apply for all medical supplies. For example, supplies such as personal comfort items, eating utensils, medicine cups, underpads and diapers are not covered.

  5. Ambulatory Transport
    Oklahoma Medicaid coverage caters to ground and air ambulance services for members with emergencies. Air transport is assessable when other transport methods can endanger a member's health. Transportation to obtain covered medical care is available for arrangement.

Note: Oklahoma Medicaid coverage only applies for services deemed as medically necessary.

What Does Medicaid Not Cover in Oklahoma?

Oklahoma Medicaid coverage does not include all health services. For some services, enrollees must pay for them through third party covers or from their pocket. Examples include:

  • Christian Science nurse or practitioner

  • Cosmetic surgery

  • Any medical service where you refuse to allow release of information required to make a medical decision

  • Experimental treatments, procedures and drugs

  • Infertility services

  • Over-the-counter drugs, except diabetic supplies and contraceptive products and devices

  • Services not considered medically necessary by the PCP or your physician

  • Residential treatment centers

  • Prosthetic devices, including orthotics

  • Hospice and long term care

Find out what is not covered by Medicaid before undergoing any procedure or treatment. The health care provider will inform you whether or not the services or items you need are covered by Medicaid. Do not assume OK Medicaid coverage will apply to all procedures.



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