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SoonerCare refers to the Oklahoma Medicaid program, which grants affordable to no-cost healthcare to the state's residents in a low-income bracket. The Oklahoma Health Care Authority runs everything, including the SoonerCare website that allows eligible residents easy access to government-funded programs and benefits. As of June 2023, 1,267,103 Oklahomans were enrolled in the program.
It covers children, adults, and senior residents in Oklahoma who meet specific income, age, and health-related criteria.
What is SoonerCare? It’s Oklahoma’s Medicaid program. The state and federally-funded program offers accessible healthcare to low-income and vulnerable residents.
If you're a resident of Oklahoma, you might have heard of "SoonerCare" in reference to the Oklahoma Medicaid program. So, what is SoonerCare coverage? Could this Oklahoma state program benefit you or your family?
If you need healthcare coverage and fit the eligibility requirements, you should consider joining this program in Oklahoma. It won't cover everything, but the guide below covers everything you need to know about SoonerCare’s coverage. It also touches on how to extend healthcare with supplemental insurance if you find this state-driven Medicaid option isn’t enough to cover all your medical needs. To prevent shouldering the debt of unexpected medical expenses, many Sooners extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
The Oklahoma Health Care Authority is the government agency running the Medicaid program in the state of Oklahoma. The agency collects sensitive data received in regard to applications from state residents. The information pertains to the services, renewals, appeals, provision, and other details that arise with healthcare and processing of medical claims.
Together with the agency, the SoonerCare Oklahoma Medicaid program aims to provide free or low-cost healthcare services for the state’s eligible low-income children, adults, pregnant women, seniors, and people with disabilities. It guarantees basic healthcare coverage, which includes doctor visits, specialist referrals, and long-term care under specific situations.
SoonerCare coverage is free for participants. However, due to cost sharing, adults might have a small copay requirement for some medical services, like a visit with a specialty doctor.
Cost sharing is how much a Medicaid member pays out-of-pocket. In Oklahoma, all copay amounts come from the cost sharing limit for each SoonerCare member in your household until you reach a 5% monthly cost-sharing limit.
Your SoonerCare ID card confirms that you are an official Oklahoma Medicaid member. The card contains a unique medical number that identifies you as a member and links to your coverage on the system. You might not have to show your SoonerCare ID card to secure medical appointments or fill prescriptions, but you will need to provide your medical ID number.
If you're ready to apply for SoonerCare, you can do so in several ways. The first way is to contact your community's OKDHS Human Services Center and complete an application. Families with household members under 18, caregivers of children under 19, and pregnant women can go to the OKDHS Human Services Center or apply online through mysoonercare.org, the official state Medicaid portal.
Are you over 65, blind, or living with a disability? You must apply for SoonerCare by completing form 08MP003E, a Request for Benefits form. Take it to your local OKDHS Human Services Center or mail your application and supporting documents if you can't get to your local DHS office.
For additional assistance by phone, call 1-800-987-7767.
Before applying for SoonerCare, you'll need to provide information to ensure the agency processes your application correctly. Here are the details and documents you'll need to apply for Oklahoma’s Medicaid program:
People in Oklahoma who are legal residents or citizens must meet these basic eligibility requirements to receive the state’s Medicaid benefits:
If you fall into one of those categories, you must also meet income requirements. For instance, a pregnant woman in a three-person household, including the unborn baby, must not exceed a certain annual income to be able to apply. The same would apply to an adult caretaker with one child under 19, and the income cap for people within this group may differ.
Oklahoma is known as the fastest state for processing Medicaid applications, so you should know quickly whether the state deems you eligible for benefits and approves your application. Once you get your approval, you can log into your member portal at mysoonercare.org so that you can view, download, or print your Soonercare ID card. If you apply for benefits for yourself and others in your household, everyone will carry their own card.
If you apply for Oklahoma’s Medicaid coverage at your local Department of Human Services office, you can request a SoonerCare card printout from them. If you need further assistance, call the SoonerCare Helpline at 1-800-987-7767.
As of Spring 2023, SoonerCare membership eligibility renewals became mandatory. The government temporarily paused these renewals due to the COVID-19 pandemic’s complications and administrative burden. Still, anyone in danger of losing their benefits should receive a series of letters with their final date of coverage, the reasons for their ineligibility, and how they could verify their eligibility to resume this coverage in Oklahoma.
Are you still eligible for SoonerCare but have a lost or stolen card? You can request a new one online at mysoonercare.org. After logging in, go to the bottom of the page where it says "I want to..." and click "Get ID Card" underneath the heading. Input your information to order a new card.
As long as you have a valid state ID and your SoonerCare ID card number, you can still receive medical services.
SoonerCare coverage includes many essential medical services. Here, you can explore some of the most common coverages people wonder about before signing up for Oklahoma Medicaid.
With SoonerCare, adults have limited dental care coverage. As a person 21 or older, you could get preventive dental care, like routine dental exams, teeth cleanings, and fluoride treatments. Basic restorative dental services also form part of the coverage, including silver or tooth-colored fillings, full and partial dentures, and tooth extractions.
Children under 21 will receive those same services, as well as crowns and root canals. Though the children's dental care coverage is more comprehensive than adult coverage in Oklahoma, prior authorization for adults may cover periodontal scaling and root planing to treat gum disease.
For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Oklahoma is advisable.
As a SoonerCare member, you would have a prescription drug maximum of six covered drugs a month (no more than two brand-name medications). However, prescribed birth control and some cancer or HIV and AIDS drugs won't count against the prescription limit, so you could possibly get those and other prescriptions simultaneously. Each medication has a copay due.
Medicaid’s members under 21 won't have a copayment or the same limit for medically necessary prescriptions. Still, Oklahoma’s program won't cover all prescription drugs. You can review the list of approved brand-named drugs to see if your Oklahoma Medicaid membership will pay for your medication and check the small list of over-the-counter products as well.
Do you have questions about your SoonerCare prescription drug coverage? Call the Pharmacy Help Desk at 1-800-522-0114 and choose option 4 or (405) 522-6205 and choose option 4.
SoonerCare offers a wide range of healthcare services for Oklahoma residents with special medical or healthcare needs. For example, children will receive coverage for immunizations, hearing aids, and speech, hearing, and language disorder services. Adult coverage also extends to rural health clinic services, services and products to quit tobacco, and organ transplants with prior authorization.
Routine checkups and basic medical treatments are no doubt important. However many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.
Oklahoma’s Medicaid limits out-of-state coverage. Still, if you live near the state's border, you could seek care from a SoonerCare-approved provider across the border as long as they're within 50 miles of the state line. To see a medical care provider further away, you'll need an out-of-state prior authorization.
If you travel out of state and get hurt or sick, SoonerCare may deem you eligible for compensation if your care is medically necessary. However, if you don't have prior authorization for out-of-state care or you go for non-medically necessary services outside of Oklahoma, you risk having to pay all the related expenses for your treatment.
Despite out-of-state restrictions, Oklahoma’s Medicaid does offer some travel coverage in-state through SoonerRide. The extension of the Medicaid program can get you to and from your doctor’s appointments if you don't have a ride. However, since it isn't emergency transportation, you'll have to arrange your ride for a medically necessary appointment at least three business days in advance.
To reserve SoonerRide transportation, call 877-404-4500 or TDD 800-722-0353, Monday through Friday between 7 am and 6 pm. Also, don't forget to write down your confirmation number when you make your reservation.
If you are traveling outside of Florida for leisure,it is always highly recommended to invest in proper travelers insurance.
Oklahoma’s Medicaid does not offer extra benefits to college students. However, you can still apply if you're a full-time student and an Oklahoma resident who meets the eligibility requirements.
Seniors, on the other hand, can receive coverage for nursing facilities and intermediate care facility coverage for people with intellectual or developmental disabilities. Both seniors and vulnerable Oklahomans of any age can also receive extra support at home through the program’s Home and Community-Based Services Waivers, including the following:
Besides children, adults, the elderly, and disabled Oklahoma residents, SoonerCare coverage extends to the following groups:
Native Americans in Oklahoma can receive free healthcare through tribal clinics and hospitals, the Indian Health Service, and urban health facilities. To receive care at these facilities, people must present a Certificate of Degree of Indian Blood card or a tribal enrollment card.
However, that doesn't mean Native Americans eligible for Medicaid shouldn't apply since the program can serve as extended healthcare for Indian Health Services. With a SoonerCare PCP, Native American Oklahomans can get referrals to specialized services, like cardiology and X-rays, which might not be available at tribal clinics.
Active military personnel, veterans, and immediate family members can receive healthcare through TRICARE. With TRICARE, members can access military hospitals and approved civilian healthcare professionals, pharmacies, and other facilities. Still, if you're an active or retired military member who qualifies for Oklahoma Medicaid, you can apply for benefits and use them in addition to TRICARE insurance.
Though Oklahoma Medicaid covers a broad scope of services for eligible Oklahomans, it won't cover anything that isn't medically necessary. Examples of services that the program won't cover include the following:
It is also important to note that Oklahoma medicaid does not provide any assistance towards the cost of burial and funeral services. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.
Learning about the medical services that SoonerCare covers can shed light on the many areas of healthcare that the program covers for you and your family in Oklahoma. Each category leads into various subcategories with benefit inclusions and exclusions, though. For clarity, let's take a closer look at the most common procedures to explore whether SoonerCare covers what you need:
| Dental | |
|---|---|
| Dental exams and X-Rays | Oklahoma’s program will pay for preventive and diagnostic procedures for children and adults, including routine dental exams and X-ray imaging. X-rays are essential for dental care because they help dentists see dental, oral, and periodontal problems beyond what they can detect with the naked eye. |
| Wisdom teeth | If you have impacted or infected wisdom teeth, SoonerCare will cover the cost of tooth extraction. The service is completely free with no copay. |
| Vision | |
|---|---|
| Eye Exams | SoonerCare benefits include annual eye exams and requested follow-ups for children. Unfortunately, Oklahoma Medicaid only covers eye exams for adults with medical reasons, such as cataracts, dry eye, diabetes, and eye allergies. |
| Glasses | With SoonerCare, children can get a pair of glasses, a frame, and prescribed lenses. Members over 20 cannot get eyeglasses under the program; they must pay out of pocket or use a supplemental insurance policy. |
| Laser Eye Surgery | Medicaid in Oklahoma generally doesn't cover elective laser eye surgeries. However, it may cover specific cases that are medically necessary. |
| Surgery | |
|---|---|
| Rhinoplasty | If you want a nose job to improve your appearance or relieve sleep apnea symptoms, you can't pay for the rhinoplasty surgery with Oklahoma state’s funding. However, Oklahoma’s Medicaid may cover the surgery if it meets clinical criteria, such as chronic nasal obstruction from collapsed internal valves, obstructed nasal breathing, or nasal airway obstruction. |
| Breast Reduction | The OHCA deems breast reduction surgery as cosmetic unless it causes persistent pain for over a year to the back, neck, or shoulders, upper extremity neuropathy, or problems sleeping. Patients must undergo evaluations and meet additional criteria for the surgery to be medically necessary. |
| Hospital | |
|---|---|
| Hospital stays | SoonerCare covers all inpatient hospital stays. In some cases, the OHCA may review inpatient services post-payment. |
| Ambulance transportation | You can be confident that SoonerCare will cover your ambulance ride and ambulatory surgery center services if you experience a medical emergency. |
| Giving birth | With SoonerCare for Pregnant Women, coverage includes prenatal visits, medically necessary specialty appointments, delivery services, ultrasounds, and more. It even provides complete Medicaid benefits for a year postpartum, regardless of life changes. |
All Medicaid members in Oklahoma can receive a basic package of preventive behavioral services. You could schedule screenings for anxiety, depression, and substance abuse, usually without prior authorization.
Commonly covered services include the following:
| Sexual Health | |
|---|---|
| Gynecologist visits | SoonerCare will cover gynecological visits for women. Referrals may be necessary. |
| Erectile Dysfunction | Medications to improve erectile dysfunction are not part of Oklahoma Medicaid's coverage unless the drugs treat a condition other than sexual dysfunction. |
| Birth Control | SoonerPlan is a branch of the Medicaid program that focuses on family planning for men and women who otherwise don't qualify. SoonerPlan will pay for birth control information and products, including IUDs. |
| Fertility Treatment | Though Oklahoma’s Medicaid includes family planning services, it won't pay for fertility treatments and related services. |
| Specialist Services | |
|---|---|
| Dermatology | You can see a SoonerCare-approved dermatologist with your Medicaid membership and a referral from your primary care physician. |
| Physiotherapy | Physical therapy and occupational therapy are part of your Oklahoma Medicaid benefits. |
| Massage Therapy | Most Medicaid programs don't cover massage therapy. Still, the service might be part of your SoonerCare membership if your primary care physician considers the therapy as medically necessary. |
| Podiatry and Foot Care | Children and adults can receive the same podiatric or footcare services. Examples of covered foot care services include medically necessary foot surgeries, X-rays, and outpatient services. Preventive services like corn and wart removal don't have coverage unless they're essential due to a medical diagnosis. |
| Allergy Testing | SoonerCare only covers allergy testing reimbursements if the testing is in a hospital or under the care of a SoonerCare provider. You must have a potentially life-threatening, chronic allergy like asthma that doesn't respond to conservative treatments. |
| Sleep Physician Services and CPAP Machines | As with most specialty services, Oklahoma’s Medicaid coverage depends on medically necessary conditions under specific guidelines. That’s the only way to cover sleep studies that uncover disorders like sleep apnea and CPAP machines to improve nighttime breathing. |
Now that you have a better understanding of the Oklahoma Medicaid coverage, you should know that you can combine these benefits with a private or third-party health insurance policy. It doesn't matter if you choose extended coverage through an employer-based program or if you prefer to purchase an individual plan yourself. As long as you qualify for SoonerCare, you can apply for extended coverage. You can use private insurance providers to fill the gaps in your Oklahoma Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.
With supplemental health insurance and SoonerCare, the state insurance will typically only pay for services after the primary insurance receives the bill. You'll also have to notify the OHCA if you have additional healthcare insurance.
Why might supplemental insurance be necessary with Oklahoma’s Medicaid program? Simply put, you might not be able to receive payments or reimbursements for every medical service you need. Private insurance covers the gaps so that you can enjoy the following benefits:
If you're interested in supplemental health insurance in addition to your SoonerCare membership, Insurdinary can help. The team aims to help clients find reliable insurance for the best healthcare services at the most affordable prices. The process is easy, with several quotes from leading health insurance providers giving you a chance to compare the benefits at a glance.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:
