Soonercare
Do you have questions about SoonerCare? We can help!
If you are like many Oklahoma residents and are looking for information about SoonerCare, also known as Oklahoma Medicaid, you are in the right place! Here at Derby Insurance Solutions, we are able to assist you with finding the right solutions when it comes to getting the best Tulsa Soonercare health coverage possible for your situation. We are available to answer your questions concerning SoonerCare, whether you want to learn about whether you might qualify, how the program works, or where you can sign up.
You can call our office at 918-451-9783 to get the most up-to-date information about SoonerCare guidelines. We know how confusing the process can be for many people, and that is why we are here to help at Derby Insurance Solutions. We make the entire process easy!
What is SoonerCare?
SoonerCare, also referred to as Oklahoma Medicaid, is a healthcare coverage program for Oklahoma residents that is funded by both the federal and state government. SoonerCare helps pay some or all medical expenses for many Oklahoma residents who can’t afford them. SoonerCare is administered by the Oklahoma Health Care Authority (OHCA), which is responsible for overseeing the program and determining who is eligible.
Who qualifies for SoonerCare?
There are several stipulations that must be met in order to qualify for Tulsa Soonercare. First, you must be a resident of Oklahoma; second, you must be a US citizen or qualified alien (most immigrants who arrive in the US after August 22, 1996, are barred from participating in the program for five years); third, you must meet specific financial income and resource guidelines, particularly in certain categories. Also, if you qualify for federal healthcare coverage and tax subsidy credit or discount through the Marketplace, in most cases you would not be eligible to participate in SoonerCare.
On June 30, 2020, the Oklahoma Medicaid Expansion Initiative, State Question 802, passed by a majority vote to expand Medicaid eligibility to adults ages 19-64 living in the state of Oklahoma whose income is 138% of the federal poverty level (FPL) or lower. This means that there is no longer a “gap” in income qualification between those who qualify for SoonerCare and those who qualify for Marketplace coverage.
As a result, the vast majority of Oklahomans, regardless of age, now have access to healthcare coverage. Adult Oklahomans under age 65 may qualify for Tulsa Soonercare if their tax household’s Modified Adjusted Gross Income (MAGI) is below 138% of the Federal Poverty Level.
In addition to these citizenship and income requirements, to qualify for SoonerCare you must meet certain categorical requirements and there are other eligibility requirements and benefit packages available. In general, the following groups of individuals might qualify for Tulsa Soonercare services:
- Adults with children under 19.
- Children under 19.
- Pregnant women.
- Women under 65 in need of breast or cervical cancer treatment.
- Adults, age 19-64, who are not eligible for Medicare.
- Individuals age 65 and older.
- Individuals who are blind or who have disabilities.
- Men and women who are 19 and older with family planning needs.
- Individuals who were previously enrolled in Medicaid and who aged out of foster care (at 18 years old) in another state, on or after January 1, 2023.
What are the SoonerCare income guidelines?
This is the most commonly asked question we receive about SoonerCare here at Derby Insurance Solutions.
Adult Oklahomans under age 65 may qualify for SoonerCare if their tax household’s Modified Adjusted Gross Income (MAGI) is below 138% of the Federal Poverty Level (FPL). Any children under age 19 whose tax household’s Modified Adjusted Gross Income (MAGI) is below approximately 214% of the Federal Poverty Level (FPL) may also qualify for Tulsa Soonercare.
It is important to have the most up-to-date information about SoonerCare income guidelines, as they do change frequently and are revised by the federal government at different times throughout the year.
The Federal Poverty Level (FPL) information that is posted online, even on some government sponsored websites, is often not accurate or the most up-to-date numbers. At Derby Insurance Solutions, we have access to the most current data, so feel free to call our office at 918-451-9783 and we can help!
What health services are covered?
Covered health care services through SoonerCare may include doctor visits, hospitalization, dental and vision, and prescriptions.
What does SoonerCare cost?
There is no cost for SoonerCare coverage for those who meet the income guidelines. However, co-pays may apply to some services.
When can I sign up for Soonercare?
Tulsa Soonercare is open and available for enrollment year-round. This is particularly important if your circumstances should change, such as a job loss or income change, the birth of a new baby, marriage, change in tax household / family size, loss of qualified coverage through work, as well as a number of other scenarios. As always, if you are unsure about how your current circumstances might affect your healthcare eligibility, we are happy to answer your questions.
How can I get signed up for Soonercare?
We recommend that you give us a call at 918-451-9783 so we can check your income against the most current guidelines. If you do qualify for SoonerCare, you can apply through the OHCA website or at your local DHS office.
Why am I losing SoonerCare?
Recently, many people in Oklahoma are asking this question, as they may have received a letter in the mail indicating that their SoonerCare coverage will end sometime in 2023.
The Federal public health emergency due to Covid, which was first declared in March 2020, required states to provide continuous coverage for Medicaid recipients to keep them insured during the pandemic, even if their eligibility had changed. This meant that many Oklahomans kept their SoonerCare coverage even though their income was higher than the specified income limitations for the program.
However, in December 2022, Congress passed a federal regulation that ended the public health emergency that waived renewal requirements. As a result, the Oklahoma Health Care Authority announced for the first time in three years that up to 300,000 Oklahomans could potentially be disenrolled from the program. Those that should still qualify for SoonerCare based on their income will need to complete the renewal process.
For those who are losing SoonerCare coverage, there will be a Special Enrollment Period (SEP) for the Affordable Care Act’s Federal Marketplace beginning on March 31, 2023. If you have learned that you or your children will be losing SoonerCare, or believe that you could be affected, please call us ASAP at 918-451-9783 and a Derby Insurance Solutions agent can help you find the best qualified coverage available in Oklahoma!