How SoonerCare and Medicare Advantage work together
- The plan pays first for Medicare-covered care, using its network and rules.
- SoonerCare pays after the plan. OHCA's rule OAC 317:30-3-25 says SoonerCare pays Medicare deductibles, coinsurance and copays under Part C, as it does under Parts A and B, using the state plan's payment method.
- SoonerCare can still pay your Part B premium through OHCA's Part B buy-in. See does SoonerCare pay Medicare premiums.
- Your SoonerCare stays with OHCA. OAC 317:55-3-1 excludes dual-eligible members from SoonerSelect, so you don't pick a SoonerSelect plan as well.
Medicare Advantage plans may offer extra benefits Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
Your options in Oklahoma for 2027
| Option | Who it fits |
|---|---|
| Original Medicare plus a Part D plan | People who want any doctor that takes Medicare; SoonerCare pays cost sharing if you qualify |
| Regular Medicare Advantage plan | People whose doctors are in the plan's network; CMS lists 50 in Oklahoma for 2027 |
| Dual eligible special needs plan (D-SNP) | People with Medicare and SoonerCare or a Medicare Savings Program; part of the 27 special needs plans CMS lists for 2027 |
In seven western counties (Beaver, Cimarron, Ellis, Harmon, Harper, Roger Mills and Texas), special needs plans are the only Medicare Advantage plans for 2027. If your plan is ending, see plans ending in 2027.
Before you join
- Know your SoonerCare level. Full SoonerCare, QMB Plus, SLMB or QI-1 affects which D-SNPs you can join and what SoonerCare pays.
- Check networks. Make sure your doctors, hospital and pharmacy are in the plan's network, and that providers for SoonerCare-only services take SoonerCare.
- Check your drugs. Look each one up on the plan's drug list. Extra Help lowers your costs.
- Enroll at the right time. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
You can see plans for your ZIP code, or request a call from a licensed insurance agent to compare plans from the companies they work with. Read what a D-SNP is, SoonerCare and Medicare together and the SoonerCare and Medicare guide.
Sources
- OHCA — OAC 317:30-3-25, Crossovers (deductibles, coinsurance, and copays)
- OHCA — OAC 317:55-3-1, SoonerSelect excluded populations
- OHCA — OAC 317:35-1-2, Definitions (Part B buy-in)
- Medicare.gov — Special Needs Plans (SNP)
- Medicare.gov — Special Enrollment Periods
- CMS — Qualified Medicare Beneficiary Program
- CMS — CY2027 Medicare Advantage and Part D Landscape file (November 2026)
More questions in this guide
- Can I have SoonerCare and Medicare at the same time?
- Does Medicare or SoonerCare pay for a nursing home in Oklahoma?
- Does SoonerCare pay my Medicare premiums?
- What is a D-SNP in Oklahoma?
- What is the ADvantage waiver in Oklahoma?
Part of the guide: SoonerCare and Medicare: a guide for Oklahoma dual eligibles · All questions
Frequently asked questions
Should I choose a D-SNP or a regular Medicare Advantage plan?
It depends on your doctors, drugs and SoonerCare level. A D-SNP is built for people with both Medicare and Medicaid and must coordinate with SoonerCare under its contract with OHCA. A regular plan may fit if your doctors are in its network. Compare both before you choose.
Can I switch plans more than once a year?
Sometimes. Medicare.gov says people with Medicaid or Extra Help can change drug coverage once a month, including leaving a Medicare Advantage plan for Original Medicare plus a drug plan. People with full Medicaid can also join an integrated D-SNP once a month if one is available.
Do I need a Medigap policy too?
No. Medigap doesn't work with Medicare Advantage, and SoonerCare already helps with Medicare cost sharing if you qualify for QMB Plus or full SoonerCare.
Can a provider in my plan bill me?
If you have QMB Plus, CMS says Medicare providers, including those in Medicare Advantage plans, may not bill you for Medicare cost sharing. Show both your plan card and your SoonerCare card at each visit.
Medicare in your Oklahoma county
Plans, local agents and help, county by county: Oklahoma · Tulsa · Cleveland · Canadian · Comanche · Rogers · Wagoner · Payne · Pottawatomie · Creek · Muskogee · Garfield · Grady · Washington · Logan · Bryan · Le Flore · Carter · Cherokee · McClain · All 77 counties →
