How Medicare and SoonerCare work together
| Cost | Who pays |
|---|---|
| Hospital and doctor care Medicare covers | Medicare first; SoonerCare pays the remaining deductibles, coinsurance and copays |
| Part B premium ($202.90 a month in 2026) | OHCA, through the Part B buy-in |
| Prescription drugs | Medicare Part D, with Extra Help |
| Long-term care Medicare doesn't cover, such as nursing home stays or ADvantage services | SoonerCare, if you qualify medically and financially |
OHCA's rule OAC 317:30-3-25 says SoonerCare pays Medicare deductibles, coinsurance and copays under Part A, Part B and Part C (Medicare Advantage).
Full SoonerCare or help with Medicare costs only
There are two levels of help. With full SoonerCare (for example QMB Plus, or SoonerCare based on age, blindness or disability), SoonerCare also covers some services Medicare doesn't. With SLMB or QI-1, SoonerCare pays only your Part B premium. OHCA calls these Medicare cost programs SoonerCare Supplemental. See does SoonerCare pay Medicare premiums.
How to get both
- Get Medicare. Sign up through Social Security, as OHCA explains. Most people become eligible at 65 or after 24 months of Social Security disability benefits.
- Apply for SoonerCare with OKDHS. Call the OKDHS Virtual Eligibility Center at (405) 522-5050, visit a Human Services Center, or apply online at OKDHSLive.org. OKDHS checks income and resources against Appendix C-1.
- Keep both cards. Show your Medicare card (or your Medicare plan card) and your SoonerCare card at every visit.
- Renew on time. OHCA's rules review eligibility every 12 months for QMB Plus, SLMB and QI-1.
Your Medicare plan choices
You can keep Original Medicare or join a Medicare Advantage plan, including a dual eligible special needs plan (D-SNP). Read can I have SoonerCare and a Medicare Advantage plan and what a D-SNP is. For long-term care, see who pays for nursing homes. The full guide is SoonerCare and Medicare. To compare plans from the companies they work with, you can request a call from a licensed insurance agent.
Sources
- Oklahoma Health Care Authority — About SoonerCare (What about Medicare?)
- Oklahoma Health Care Authority — SoonerCare Supplemental
- OHCA — OAC 317:30-3-25, Crossovers (deductibles, coinsurance, and copays)
- OHCA — OAC 317:55-3-1, SoonerSelect mandatory, voluntary and excluded populations
- OHCA — OAC 317:35-1-2, Definitions (Part B buy-in)
- OKDHS — Appendix C-1 (7/1/2026)
- Oklahoma Human Services — Long-Term Care (Virtual Eligibility Center)
- Medicare.gov — Which insurance pays first
- Medicare.gov — Help with drug costs (Extra Help)
More questions in this guide
- Can I have SoonerCare and a Medicare Advantage plan?
- 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
Who pays first, Medicare or SoonerCare?
Medicare. Medicare.gov says Medicaid pays after Medicare and other insurance. In Oklahoma, OHCA's crossover rule has SoonerCare pay the Medicare deductibles, coinsurance and copays that are left, using the state plan's payment method.
Will I be moved into a SoonerSelect plan?
No. OHCA's rule OAC 317:55-3-1 excludes dual-eligible members, Medicare Savings Program members, and people whose SoonerCare is based on age, blindness or disability from SoonerSelect. Your SoonerCare stays with OHCA directly.
Where do I get my prescriptions?
Through Medicare Part D. People with full SoonerCare get Extra Help automatically, which lowers Part D costs, and Medicare.gov says they can change drug coverage once a month.
What happens to my SoonerCare when I turn 65?
OKDHS Appendix C-1 explains that OHCA's online enrollment covers adults 19 to 64 who don't qualify for Medicare, while OKDHS decides SoonerCare for people who are aged, blind or disabled. Once you have Medicare, OKDHS reviews whether you qualify under those rules or for a Medicare Savings Program.
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 →
