Medicare and SoonerCare compared
| Question | Medicare (Part A) | SoonerCare |
|---|---|---|
| Type of care | Short-term skilled nursing or rehab | Long-term nursing facility care, including custodial care |
| How long | Up to 100 days per benefit period | As long as you stay eligible |
| What you need | A three-day inpatient hospital stay and daily skilled care | Nursing facility level of care and OKDHS financial eligibility |
| Cost to you | Days 21–100: $217 a day (2026) | Most of your income, minus a personal needs allowance |
What Medicare covers
Medicare.gov says Part A covers skilled nursing facility care when you have a qualifying inpatient hospital stay, your doctor orders daily skilled care such as therapy or nursing, and the facility is Medicare-certified. Time spent "under observation" in the hospital doesn't count toward the three days. Medicare doesn't cover long-term or custodial care, such as help bathing, dressing or eating. A Medicare Advantage plan must cover the same skilled nursing care but can set its own rules and costs.
How SoonerCare pays for long-term care
- Medical need. You must need nursing facility level of care.
- Income. OKDHS Appendix C-1, Schedule VIII.B sets the income standard at 300 percent of the SSI federal benefit rate.
- Resources. Schedule VIII.D sets the resource limit and a home equity limit for long-term care. OKDHS says one vehicle is exempt.
- Transfers. OKDHS asks for records of any assets given away or sold in the past 60 months.
- Married couples. Appendix C-1, Schedule XI sets amounts a spouse living at home can keep.
How to apply in Oklahoma
- Call OKDHS. Reach the Virtual Eligibility Center at (405) 522-5050, or visit an Oklahoma Human Services Center.
- Send proof. Provide Medicare cards and proof of income and assets for you and your spouse. OKDHS accepts uploads through FastPass at OKDHSLive.org, fax or mail.
- Get the level-of-care decision. OKDHS confirms you need nursing facility care.
- Review estate recovery. Oklahoma can seek repayment from the estates of members 55 and older for nursing facility care, with protections for spouses and certain children. See Oklahoma estate recovery.
Read also the ADvantage waiver, SoonerCare and Medicare together and the SoonerCare and Medicare guide. For questions about how a Medicare plan covers skilled nursing, you can request a call from a licensed insurance agent.
Sources
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Long-term care
- Oklahoma Human Services — Long-Term Care
- OKDHS — Appendix C-1 (7/1/2026), Schedules VIII and XI
- OHCA — OAC 317:35-19-4, Medicaid recovery (nursing facility services)
- OHCA — OAC 317:30-3-25, Crossovers (deductibles, coinsurance, and copays)
More questions in this guide
- Can I have SoonerCare and Medicare at the same time?
- Can I have SoonerCare and a Medicare Advantage plan?
- 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
What do I pay for Medicare skilled nursing care?
In 2026, Medicare pays the full cost for days 1 to 20. For days 21 to 100 you pay up to $217 a day, and after day 100 you pay all costs. If you have QMB Plus or full SoonerCare, SoonerCare can pay that Medicare coinsurance.
Can I keep any of my income in a SoonerCare nursing home?
Yes. OKDHS Appendix C-1 sets a monthly maintenance standard you keep for personal needs. Most of the rest of your income goes toward the cost of your care, and SoonerCare pays the remainder.
What if my income is over the SoonerCare limit?
Appendix C-1 refers to a Medicaid Income Pension Trust, a trust that can hold income over the limit so you can still qualify. Its rules are technical, so talk with OKDHS or an Oklahoma elder law attorney first.
Is there an alternative to a nursing home?
Yes. The ADvantage waiver pays for care at home, in adult day health or in assisted living for people who need nursing home level care, though slots are limited and there can be a waiting list.
Medicare in your Oklahoma county
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