Insure oklahoma vs soonercare. Slightly more than half are children.
Insure oklahoma vs soonercare If you have questions about SoonerSelect providers, call your plan for help. Oct 13, 2025 · HOW TO APPLY Businesses may apply for Insure Oklahoma at any time, so get started today. Oklahoma voters expanded Medicaid with a constitutional amendment in 2020 Insure Oklahoma is an innovative program Oklahoma has created to bridge the gap in the health care coverage for low-income working adults. This method is called Modified Adjusted Gross Income (MAGI). Oklahoma City, OK – Dr. What would the EOB say if you could bill the patient for non-covered services? The SoonerCare Choice program promotes the goals of providing accessible, high quality, and cost-effective care to SoonerCare Choice members. Sep 13, 2023 · SoonerCare Pregnancy Benefits Insure Oklahoma members who are below 210% of the federal poverty level (FPL) and become pregnant will move to the SoonerCare pregnancy benefit and receive 12 months of postpartum benefits if the pregnancy is reported in the member application. The Oklahoma Health Care Authority (OHCA) began the renewal process in early March. Apr 1, 2024 · If you add an employee to your staff list through the employer portal and make a mistake keying in the Social Security number, please contact the Insure Oklahoma helpline at 888-365-3742. Nov 17, 2025 · Insure Oklahoma Fast Facts 2025 January - Insure Oklahoma Monthly Summary February - Insure Oklahoma Monthly Summary March - Insure Oklahoma Monthly Summary April - Insure Oklahoma Monthly Summary June - Insure Oklahoma Monthly Summary July - Insure Oklahoma Monthly Summary August - Insure Oklahoma Monthly Summary September - Insure Oklahoma Jan 7, 2025 · SoonerCare (Oklahoma Medicaid) covers many health care services. SoonerCare Traditional provides coverage for members who qualify for Medicaid and are institutionalized, in state or tribal custody or enrolled under a Home and Community-Based Waiver. However, there are limitations that apply to ensure that only medically necessary services are provided. Feb 23, 2024 · Last Modified on Feb 23, 2024Back to Top Apr 9, 2024 · SoonerSelect launched just over a week ago, and the response is mixed. Note: Employer applications take up to 30 days to process, and employees must wait to apply until after the employer is approved. a Overall SoonerCare enrollees increased by 4. SoonerCare (Oklahoma Medicaid) is a health coverage program jointly funded by the federal and state government. SoonerPlan SoonerPlan is Oklahoma’s family planning program for women and men who are not enrolled in regular SoonerCare services. Help jails and prisons capture additional SoonerCare funding for hospitalizations and surgeries as allowed under federal Medicaid law. This will allow you to follow the step by step guide on How to Apply presentation and the actual application at the same time. When a household member is between ages 19 and 22, applying for Insure Oklahoma and enrolled in an accredited Oklahoma college, you must select their college from the drop-down menu. With Soonercare, you can pay your hospital bills, but not all. Whether you're a child, parent, pregnant woman, or adult, this guide will help you understand if you qualify for SoonerCare coverage and how to apply. S. (up to 210% FPL) Oct 13, 2025 · Insure Oklahoma will notify you when you have been approved and how much you can expect to pay for your health premium after Insure Oklahoma’s and your employer’s contributions. You can also apply over the phone by calling 1-800-318-2596 or seek in-person assistance at an Oklahoma DHS Human Services Center. INSURE OKLAHOMA INDIVIDUAL PLAN - Oklahoma’s own health care coverage plan for those under 100%* of federal poverty level. SoonerPlan: A limited package of family planning benefits. The agency balances this fiscal responsibility with two, equally important goals: Aug 15, 2025 · What information do I need to apply online? In addition to your employer’s Insure Oklahoma ID number and your EEN, you will need income, employer and personal information for everyone in your household. The state Purpose Insure Oklahoma is a health premium assistance program Oklahoma has created to bridge the gap in health coverage for low-income working adults. Here When It Counts Perspectives on the Affordable Care Act, SoonerCare and Insure Oklahoma Buffy Heater, MPH Director of Planning & Development Aug 15, 2025 · The employer first enrolls with Insure Oklahoma, then after the employer group is approved, the employees can apply with Insure Oklahoma. All covered benefits must be medically necessary. All applications are subject to review for accuracy. A listing of the waivers of federal law or regulation that are necessary to establish and maintain Oklahoma’s SoonerCare Choice and Insure Oklahoma programs under the approved section 1115 Medicaid demonstration. d A Q SoonerCare (no PCP) vs SoonerChoice (PCP required) Contact Provider Services to inform them of the issue. Apr 23, 2022 · Image: What is Insure Oklahoma? Insure Oklahoma is a health insurance program administered by the Oklahoma Health Care Authority (OHCA). Feb 29, 2024 · Oklahoma’s managed Medicaid program is called SoonerSelect, and it begins April 1. For help, see Frequently Asked Questions, talk to your employer or call Insure Oklahoma at 1-888-365-3742. With Soonercare, you can have your own medical home and your own doctor who can help you with many different things. citizens or qualified immigrants Oklahoma residents Applicants not enrolled in SoonerCare or Insure Oklahoma Applicants within the income standard (133 percent of Federal Poverty Level) Applicants with or without other insurance Women who have completed their pregnancy-related SoonerCare coverage. (MPR) to conduct a comprehensive evaluation of the SoonerCare 1115 waiver program. SoonerCare (Medicaid) members enrolled in Pr For all practical purposes, it means that NO CHILD in Oklahoma should be without access to health care. To learn about the basic benefits and services that SoonerSelect health plans offer, visit SoonerCare Benefits (oklahoma. Report your findings directly to the provider who made this referral. It provides eligible low-income families with access to private health insurance through premium assistance and enrollment in either the SoonerCare Medicaid or Insure Oklahoma employer-sponsored plans. This report summarizes the results of that evaluation Be sure to follow the rules for the plan you are enrolled in. Eligibility is based on your total family income and household size. Apr 18, 2024 · Oklahoma’s new SoonerSelect program kicked off April 1. May 28, 2025 · More than 1 million people get their health care coverage through Oklahoma's Medicaid program SoonerCare, which is about one out of every four Oklahomans. The Oklahoma Health Care Authority has the primary duty of executing SoonerCare, the Oklahoma version of Medicaid. in the appropriate field on the provider’s claim. In Medicaid1 and subsidized health is Oklahoma or programs. Recommended audience: providers and staff who are new to SoonerCare. Your employer deducts your 15% share from your paycheck, and combines those shares with the employer’s to pay the insurance company. SoonerCare (Medicaid) members enrolled in Prog This paper underscores the importance of Medicaid, known as SoonerCare in Oklahoma, in caring for the state’s young, old, and medically needy. org a There were 797,556 unduplicated members enrolled in either SoonerCare (Oklahoma Medicaid) or Insure Oklahoma during SFY2008 (July 2007 through June 2008). For immediate assistance with claim research or resolution of other Oklahoma SoonerCare issues, contact the OHCA Call Center at 405-522-6205 or 800-522-0114. The new expansion population will show “Expansion Healthy Adult Program”. If you have questions about SoonerCare providers, call the SoonerCare helpline at 800-987-7767. SOONERCARE MATHEMATICA’S APPROACH TO THE EVALUATION In order to broaden understanding about SoonerCare’s role as a health insurance provider and economic force in Oklahoma, and to glean lessons for the future, OHCA contracted with Mathematica Policy Research, Inc. Note: Insure Oklahoma Individual Plan and SoonerPlan members that qualify for expansion have been reprocessed by OHCA into adult SoonerCare. Last Modified on Oct 13, 2025. SoonerCare (Medicaid) members enrolled in Home & Community-Based Services (HCBS) Waivers - 28,857 Unless stated otherwise, CHILD is defined as an individual under the age of 21. During the subsequent 15 years, OHCA substantially modified The Insure Oklahoma is a program to assist qualifying small business owners, employees & their spouses (Employer-Sponsored Insurance- ESI) with health insurance premiums and some individual Oklahomans (Individual Plan-IP) with limited health coverage. In addition to the citizenship and income guidelines, an applicant must meet categorical requirements. SoonerCare offers varying health benefit packages, and each has a different name. FormsLast Modified on The SoonerCare Choice and Insure Oklahoma programs enrolled 557,063 individuals as of December 2014, providing health coverage to approximately 14 percent of the total Oklahoma population1. The Oklahoma Health Care Authority administers the SoonerCare (Oklahoma Medicaid) and Insure Oklahoma programs. Employees choose whether to participate. Stay competitive by attracting and keeping quality employees who need health benefits. 5 percent and the number served increased 3. Coverage, copays and limitations Nov 14, 2025 · With Insure Oklahoma, employers pick the health plan that fits their needs. Any applications that were denied within the last 90 days were reprocessed for expansion. Mar 14, 2023 · SoonerCare to Restart Renewal Process Due to federal regulation passed in December 2022, SoonerCare/Insure Oklahoma will soon restart the renewal process for members as the continuous coverage requirements originally set up by the Public Health Emergency ends. Apr 22, 2023 · Oklahoma Medicaid resources Here are some resources where you can learn more about Medicaid in Oklahoma and upcoming changes related to the end of the public health emergency: Oklahoma Medicaid office: The Oklahoma Health Care Authority oversees and administers the state’s Medicaid program, which is called SoonerCare. Employers and agents will be receiving emails that About SoonerCare (Oklahoma Medicaid) members in Oklahoma are served by the Oklahoma Health Care Authority (OKHCA), which is a government agency. Supplemental: A SoonerCare plan that provides medical benefits to supplement those services covered by Medicare (sometimes called “crossover”). www. The Individual Plan (IP) allows people who can’t access the benefits through their employer About Us The Oklahoma Health Care Authority (OHCA) administers Oklahoma's Medicaid program, commonly known as SoonerCare. OHCA’s charter was to implement a state-wide managed care model that would control costs and improve care for Medicaid enroll-ees. This is not insurance but health care provided through Oklahoma Health Care Authority. SoonerCare Fee Schedules The schedules listed below are the SoonerCare (Oklahoma Medicaid) maximum allowable fees which are in effect as of the date of the report. This program helps pay some or all medical bills for many people who can't afford them. SoonerCare (Medicaid) members enrolled in Home & Community-Based Services (HCBS) Waivers - 30,125 Unless stated otherwise, CHILD is defined as an individual under the age of 21. Oct 13, 2025 · Insure Oklahoma's Employer Sponsored Insurance plan helps employers provide their eligible employees with affordable health care. 6. One moment, pleasePlease wait while your request is being verified SoonerCare members will continue to arrange for and receive non-emergency transportation (NEMT) services through OHCA. Starting Thursday, most Oklahomans participating in SoonerCare, the state’s Medicaid program, will be asked to enroll in a health The Insure Oklahoma Employer Sponsored Insurance is a program Oklahoma created to bridge the gap in health care coverage for low to moderate income working adults. Employees who already have SoonerCare accounts may update their applications to Nov 17, 2025 · The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Health Guides Soozie SoonerCare (a scissor-tailed flycatcher) and Rascal (an Oklahoma raccoon) host a page with neat things for parents, too, including downloads for both a tooth brushing chart and a Tooth Fairy Certificate. Coordinate with jails and prisons to help former inmates apply for SoonerCare coverage upon release, helping them get access to important behavioral health services immediately, thus reducing the risk of recidivism. eligibility income-based (MAGI). Eligibility Soonercare is a choice program offered by the Oklahoma Department of Health to help you take care of your health. Follow the steps below to apply. Oklahoma's Medicaid program, known as SoonerCare, covers various groups, including low-income pregnant women, children, the elderly, and individuals with disabilities. The agency balances this fiscal responsibility with two, equally important goals: SoonerCare (Oklahoma Medicaid) is a health coverage program jointly that helps pay some or all medical bills for many people who can't afford them. WHAT IS SOONERCARE? WHAT IS SOONERCARE? SoonerCare is the brand name given to Oklahoma’s Medicaid Program that covers medical expenses for certain groups of people who have limited income and resources. Coverage of above benefits is dependent upon meeting requirements provided in accordance with various state and federal regulations. Insure Oklahoma/Oklahoma Employer/Employee Partnership for Insurance Coverage Individuals Plan (“IO IP”): A comprehensive SoonerCare package that requires members to share in the cost through premiums and co-payments. The Oklahoma Health Care Authority (OHCA) is the state agency that administers the program and determines financial eligibility for the program. Slightly more than half are children. gov). Step 4: Minimize this screen Step 5: You will now have two screens open at the same time. Aug 19, 2025 · SoonerCare Traditional is a comprehensive medical benefit plan that purchases benefits for members as they receive a service. 4 percent from Apr 11, 2025 · Videos you watch may be added to the TV's watch history and influence TV recommendations. May 29, 2025 · Advertiser disclosure Best Health Insurance Plans in Oklahoma 2025 Ambetter and CommunityCare get top marks for health insurance in Oklahoma. The Oklahoma Health Care Authority (OHCA) is the state agency that administers the program. Jan 9, 2024 · Most SoonerCare members will get their health care services covered in a new way in 2024 – through health and dental plans. Please verify coverage or consult with a SoonerCare or Insure Oklahoma helpline representative prior to receiving services. SoonerCare is a health coverage program jointly funded by the United States federal government and the Oklahoma state government. The benefits and coverage outlined may change. OHCA may share this personally identifiable data with its authorized The majority are in SoonerCare Choice, a PCCM program. org Learn who’s eligible to enroll in Oklahoma's Medicaid program, SoonerCare, how to apply, the status of Medicaid expansion and the effects of Medicaid disenrollment. CLASS DESCRIPTION A high-level overview of Oklahoma Medicaid, or SoonerCare, aimed at increasing a provider’s understanding of eligibility requirements, programs and benefits available for members, as well as basic knowledge about getting started as a SoonerCare provider. MAGI is the method required by the Affordable Care Act (ACA) to determine eligibility for income-based Medicaid1 and subsidized health Please verify coverage or consult with a SoonerCare or Insure Oklahoma helpline representative prior to receiving services. Insure Oklahoma members are NOT included in the figures above. Aug 15, 2025 · Insure Oklahoma sends its share of the premium to your employer every month. The SoonerCare Choice program promotes the goals of providing accessible, high quality and cost-effective care to SoonerCare Choice members. EPSDT – A Guide to Keeping Your Kids Healthy/SoonerCare Member Guide - English | Spanish MAGI (Income Fact Sheet) - English | Spanish Referral Guide for SoonerCare Members - English | Spanish Document Verification Guide - English | Spanish SoonerCare Member Handbook - English | Spanish SoonerCare FAQs - English | Spanish SoonerPlan Family Planning Brochure Nov 6, 2025 · nder Individuals then to Programs. This guide provides comprehensive information about Medicaid eligibility in Oklahoma, known as SoonerCare. Adults who were not affected by expansion will still show “Title 19” and those with Choice will still show “SoonerCare Choice”. All the plans listed below meet Insure Oklahoma’s requirements to be qualified benefit plans, so employees can afford to take care of their health. Insure Oklahoma Summary (updated 11/17/2025) – Overall Insure Oklahoma program member monthly statistics. Oct 27, 2016 · What Is SoonerCare? SoonerCare is Oklahoma’s Medicaid program. Aug 5, 2025 · If you need assistance with the online application you can call the SoonerCare helpline at 1-800-987-7767 or visit your local Community Action agency. Applicants who apply for multiple programs, such as Insure Oklahoma and SoonerCare, will see results for each program. The success of the Insure Oklahoma program is evident: It is being held up nationwide as a model of partnership between the government and private entities. Under the Employer-Sponsored Insurance (ESI) option, commercial health insurance premium costs are shared by the state (60%), the employer (25%), and the employee (15%). Bernard Rhone, DDS, will serve Oklahomans on SoonerCare as the new Director of Dental Services with the Oklahoma Health Care Authority. Jun 27, 2025 · SoonerCare representatives can help you pick the plan that best suits your needs. org The covered benefits list provided is not all-inclusive. May 6, 2025 · er Individuals then to Programs. The current demonstration is approved for August 31, 2018 through December 31, 2023. If these income types are listed on your case and you have received an income verification for unearned income, contact the SoonerCare hel With Insure Oklahoma, you can save on health premiums, and: Protect your bottom line by supporting your employees’ health, morale and productivity. Insure Oklahoma Individual Plan and Employer Sponsored Insurance members who qualified for SoonerCar Aug 15, 2025 · The Oklahoma Health Care Authority administers the SoonerCare (Oklahoma Medicaid) and Insure Oklahoma programs. Coverage, copays and limitations are subject to change. CLASS DESCRIPTION A high-level overview of Oklahoma Medicaid, or SoonerCare, aimed at increasing a provider’s understanding of eligibility requirements, programs and benefits available for members, and basic knowledge about getting started as a SoonerCare provider. SoonerCare (Medicaid) members enrolled in Home & Community-Based Services (HCBS) Waivers - 29,723 Unless stated otherwise, CHILD is defined as a individual under the age of 21. Changes to Medicaid under the new federal health care law have sparked a welcome and ongoing dialogue about the cost and value of the SoonerCare program. This new program manages Medicaid (SoonerCare) services through three different plans offered by: Humana, Aetna and Oklahoma Complete Health. Feb 1, 2024 · Changes are coming to Oklahoma’s Medicaid program as the state looks to overhaul how it provides health benefits to hundreds of thousands of low-income residents. Who qualifies? U. If you or a loved one is on SoonerCare, learn about the changes. Each employee may apply for Insure Oklahoma online and enter the EEN on the application. SoonerCare Choice Benefits Guide for Adults 21 and Over The covered benefits list provided is not all-inclusive. Some services are for children only. Eligibility, coverage, and application insights for better healthcare decisions. Aug 15, 2025 · Once a business is approved for Insure Oklahoma, each employee listed in the business’s Employer Portal account will be assigned an Employee Eligibility Number (EEN). It provides benefits for members on the Individual Plan who have qualifying incomes at or below 100 percent of the FPL. This new healthcare delivery model is called SoonerSelect. Jun 1, 2024 · The Oklahoma Health Care Authority manages the SoonerCare and Insure Oklahoma programs, ensuring state-purchased health care meets acceptable standards and provides progressive and positive services to citizens. The program changes the way Medicaid is administered through SoonerCare. Hundreds of plans qualify for the program. Insure Oklahoma provides premium assistance to small businesses to help purchase health insurance on the private market for qualified employees and their spouses. When projecting your coverage start date, it’s best to allow time for both application Navigate SoonerCare seamlessly with our Oklahoma Medicaid guide. Pivotal in these discussions is an understanding of SoonerCare’s safety net function Sooners (STBS) Limited Benefits Plan May qualify for SoonerCare services* if their tax household’s Modified Adjusted Gross Income (MAGI) is within the following guidelines. Members and Applicants SoonerCare Applicants What is SoonerCare SoonerCare Benefits Digital Benefits Chart Eligibility Guidelines Citizenship Guidelines Income Guidelines Other Types of Income Where to Apply Before Applying Apply for SoonerCare Step-By-Step Guide How-To Videos Open Application Form How We Determine Income The Oklahoma Health Care Authority uses a specific method to determine the income and household size for someone applying for SoonerCare, Insure Oklahoma or other programs. With the exception of Insure Oklahoma members enrolled in Insure Oklahoma qualified health plan, all SoonerCare beneficiaries select or are assigned to a PCP responsible for furnishing primary care and making medically necessary referrals. This means that instead of the Oklahoma Health Care Authority paying providers directly, it’s paying private companies to coordinate enrollees’ care. Providers may email the SoonerCare coordinator to request training at SoonerCareEducation@okhca. Feb 3, 2025 · In Oklahoma, the program is known as SoonerCare and is administered by the Oklahoma Health Care Authority. ents, workers’ compensation, etc. May 10, 2025 · Medicaid is a state-federal program that provides free or low-cost medical benefits to low-income individuals and families. The Insure Oklahoma is a program to assist qualifying small business owners, employees & their spouses (Employer-Sponsored Insurance- ESI) with health insurance premiums and some individual Oklahomans (Individual Plan-IP) with limited health coverage. The agency balances this fiscal responsibility with two, equally important goals: Assuring that state-purchased health care meets acceptable standards of care; Ensuring that citizens of Oklahoma who rely on state-purchased health care are served in a progressive and positive system. That transition has been decades in the making. Jun 6, 2025 · To apply for Insure Oklahoma, you can visit the Oklahoma Health Care Authority website or the SoonerCare Medicaid website. We do have some stand-alone programs funded by CHIP including Soon-To-Be-Sooners, Insure Oklahoma Employer Sponsored Insurance (ESI) Child and ESI Dental. Demonstration Background The Oklahoma Health Care Authority (OHCA) is the State’s Single State Agency for Medicaid. insureoklahoma. The OHCA operates the SoonerCare Choice and Insure Oklahoma programs under Section 1115(a) demonstration authorities. Mr. You can enroll by logging in to MySoonerCare. The main difference that providers will notice between the two programs will be when checking eligibility for members. *In addition to income, there are different eligibility requirements and benefit packages available. CEO Nico Gomez was named an Oklahoman of the Year by Oklahoma Magazine. Oklahoma Health Care Authority has selected three health plans to provide coordinated, whole-person care for enrollees May 2, 2025 · SoonerCare (Oklahoma Medicaid) covers many health care services. Sep 19, 2025 · Step 3: Open the application by selecting: Apply for Benefits from the Get Started link. Find a plan with the right mix Insure Oklahoma (IO) is a premium assistance program that helps employers and employees bridge the gap in the health care coverage for low-income Oklahomans. Insure Oklahoma members are N T included in the figures above. Employers should distribute the EENs to the employees. . Jun 7, 2022 · The Insure Oklahoma is a program to assist qualifying small business owners, employees & their spouses (Employer-Sponsored Insurance- ESI) with health insurance premiums and some individual Oklahomans (Individual Plan-IP) with limited health coverage. To qualify, these individuals must meet income and other eligibility requirements. Mar 31, 2009 · Insure Oklahoma/O-EPIC is a program under the SoonerCare umbrella managed by the Oklahoma Health Care Authority. Several cuts in the "big beautiful bill" appear to target states like Oklahoma that have chosen to expand Medicaid coverage. We would like to show you a description here but the site won’t allow us. by insurance through Affordable Aug 15, 2025 · All health and dental plans provide the same health care services currently offered by SoonerCare, but some may provide extra services to help improve your health. Dec 9, 2015 · How We Determine Income Modified (ACA) to determine Gross Oklahoma for someone Adjusted Care Authority uses SoonerCare, a specific determine and household exchanges. Jul 8, 2025 · The Insure Oklahoma is a program to assist qualifying small business owners, employees & their spouses (Employer-Sponsored Insurance- ESI) with health insurance premiums and some individual Oklahomans (Individual Plan-IP) with limited health coverage. Other programs include SoonerCare Traditional (Medicaid fee-for-service) and SoonerPlan (a limited benefit family planning program), and Insure Oklahoma (a premium-assistance program for low-income people whose employers offer health insurance). If you qualify, you can choose Aetna Better Health or OHCA’s annual tribal consultation provides an opportunity for tribal community leaders to receive program updates, as well as give input and ask questions about the SoonerCare and Insure Oklahoma programs. To avoid this, cancel and sign in to YouTube on your computer. The benefits available to both programs are very similar. Employers choose an Insure Oklahoma-qualified commercial health insurance plan and decide how much to contribute (at least 25 percent) for employee health premiums. Aug 22, 2025 · In Oklahoma, the Children’s Health Insurance Program (CHIP) and Medicaid operate as a combined program, SoonerCare, under our state plan. Reinvest in your business quickly with monthly premium subsidy payments. SoonerCare Managed Care History and Performance: 1115 Waiver Evaluation In 1993 the Oklahoma Health Care Authority (OHCA) was created by statute and charged with reforming Oklahoma’s Medicaid program. However, there are limitations that apply to ensure only medically necessary services are provided. The Insure Oklahoma Employer Portal offers resources and support for employers in the Insure Oklahoma program. SoonerSelect members must contact the plan they are enrolled in for non-emergency transportation (NEMT) needs. SoonerCare works to improve the health of qualified Oklahomans by ensuring medically necessary benefits and services are available. Usually those Oklahomans are low-income, maybe they’re age blind disabled or something along those lines. The agency is the state-level counterpart to the Federal Centers for Medicare and Medicaid Services. Children's Benefits Guide SoonerCare Traditional & Choice for Children Under 21 The covered benefits list provided is not all-inclusive. Looking for who can give you care? Find a provider. See Before You Apply for a list of required information. Once you apply, the Oklahoma Health Care Authority reviews whether you are eligible for SoonerCare. A high-level overview of Oklahoma Medicaid, or SoonerCare, aimed at increasing a provider’s understanding of eligibility requirements, programs and benefits available for members, as well as basic knowledge about getting started as a SoonerCare provider. You can use your health plan’s benefits and network of doctors to stay healthy. A. Oklahoma Health Care Authority SoonerCare Choice and Insure Oklahoma §1115(a) Demonstration 11-W-00048/6 Application for Extension of the Demonstration, 01/01/18-12/31/18 Submitted to the Centers for Medicare and Medicaid Services HCP Provider Portal > Home HCP Provider Portal Feb 17, 2025 · SoonerCare is a government program that provides no-cost or low-cost health care for millions of Americans. Under the Employer-Sponsored Insurance (ESI) program, premium costs are shared by the state (60 percent), the employer (25 percent) and the employee (15 percent). org or calling the choice counseling line at 800-987-7767. Copays are low as well as monthly fees for coverage, if any for plan details including eligibility, doctors and how to enroll visit: www. In general, the following groups of individuals may qualify for SoonerCare services: Adults with children under 19 Children under 19 and pregnant women Adults, not eligible for Medicare, age 19-64 Individuals 65 and older Individuals who are blind or who have disabilities Women under 65 in Aug 15, 2025 · The Oklahoma Health Care Authority administers the SoonerCare (Oklahoma Medicaid) and Insure Oklahoma programs. Small Group 1-50Mid-Market Group 51 - 150 Small Group 1-50Mid-Market Group 51 - 150 Third Party Liability (updated 11/17/2025) – Monthly enrollment demographics and breakdowns for SoonerCare members with additional insurance through a third party. This program consists of two branches of benefits. Use the NPI number for electroni All payments for services are subject to coverage limitations under the SoonerCare/Insure Oklahoma program and the referral is not a guarantee of payment. Feb 1, 2024 · Members of the Healthcare Authority of Oklahoma say Sooner Select will offer more options than the Oklahoma Medicaid system or Sooner Care. Each state has its own eligibility requirements and insurance plans available under Medicaid. The Oklahoma Health Care Authority (OHCA), which administers SoonerCare, provides government-assisted health insurance coverage to qualifying Oklahomans. Apr 10, 2019 · Oklahoma Health Care AuthorityMembers/Applicants The Insure Oklahoma program was offered this year to businesses with up to 99 employees and made available to full-time college students as a way for them to access health insurance. Gomez was one of only six men and women honored with this designation. Please check Chapter 30 of the OHCA Rules for the most up to date information. Below are your options if you meet the citizenship and income guidelines and are in one of the following categories, you can apply for Soonercare on this website: Children (newborn up to 19 years of age) Pregnant women (women of child bearing age) Low income non-disabled adults with children (under age 19) Individuals seeking family planning services (19 years of age and older) Individuals SoonerCare: All OHCA medical benefit packages including Traditional, Choice, Insure Oklahoma, SoonerPlan, and Supplemental. In addition, the 1115(a) research and demonstration waiver provides the authority for the Insure Oklahoma program, which provides premium assistance to qualifying Oklahomans. Invoices must be dated from the 1st day of the calendar month to the last day of calendar month. IO members choose a primary care provider who is paid a monthly rate for case management. a A total of 771,105 Oklahoma SoonerCare members received services during SFY2008. The benefits and coverage outlined here may change. For example, applicants who indicate they are applying for Insure Oklahoma only may see results for both the Employer-Sponsored Insurance and Individual Plan options. The SoonerCare Choice program was expanded from operating in 61 counties to a statewide managed care system. According to the Kaiser Family Foundation, Medicaid covers approximately 20% of Oklahoma Mar 31, 2025 · An overview of Oklahoma Medicaid / SoonerCare long term care programs benefits and eligibility requirements including nursing home care, assisted living and in-home care. org. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. Adults and children who qualify meet certain state guidelines. cover individuals with qualifying income from 139 – 200% FPL. Oklahoma Health Care Authority WebsiteMedicaid is a state/federal program that pays for medical services for low-income pregnant women, children, individuals who are elderly or have a disability, parents and women with breast or cervical cancer. Apr 1, 2025 · Oklahomans may qualify for SoonerCare Services* if their tax household's Modified Adjusted Gross Income* (MAGI) is within the following guidelines. 5. Jointly funded by the federal and state government. This class will give participants a better understanding of SoonerCare adult expansion with an overview of expansion eligibility requirements and benefits, a discussion on transition to the Choice program, and cost-sharing information. It is important to note that eligibility for Insure Oklahoma is based on income guidelines. org May 2, 2024 · Most of Oklahoma's Medicaid population is transitioning to managed care. listed in this prest tion Q 10. Apr 2, 2024 · Long: SoonerCare is Oklahoma’s Medicaid Program and we serve about one million Oklahomans. lyugsmippsbpiwgbffhcvibipexvzjmgqlabbymuutjgbgttbcyrirnupmztlwwzemommln