Medicare

Jim Killackey, Staff Writer

Published: October 3, 2008

Oklahoma retirees — depending upon age, income and eligibility — can be assisted by a pair of long-standing government health-care programs: Medicare and Medicaid.

* Some 550,000 Oklahomans age 65 and older are enrolled in the federally-funded Medicare.

* About 601,000 low-income residents are in the SoonerCare or Medicaid program, which is supported by a combination of federal and state funds.

* For Medicare information go to www.medicare.gov or call (800) 633-4227, or (877) 486-2048 if callers have hearing difficulties.

What is Medicare?

Medicare is health insurance for people 65 or older, those under age 65 with certain disabilities and any age with permanent kidney failure requiring dialysis or a kidney transplant.

Medicare has these key components:

* Medicare Part A, or hospital insurance, helps cover in-patient care. Part A also helps cover skilled-nursing centers, hospice and home-health care under certain conditions.

* Medicare Part B, or medical insurance, helps cover medically-necessary services like doctors’ care and out-patient care. Part B also helps cover some services to maintain health and to keep certain illnesses from getting worse.

* Medicare Part C, or Medicare Advantage Plans, are another way to obtain Medicare benefits. They combine Part A and Part B. Medicare Advantage plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services.

* Medicare Part D is Medicare Prescription Drug coverage. This coverage may help lower prescription drug costs and help protect against higher costs in the future.

Covered individuals also can choose a Medigap or Medicare Supplement Insurance policy to help fill any gaps in Part A and Part B coverage. Medicare officials advise people to ask their doctor which preventive services — like screenings, shots, and tests — a covered individual should get.

What is Medicaid?

Medicaid or SoonerCare coverage under the Oklahoma Health Care Authority depends on household-income guidelines. For the best information, use www.okhca.org or call the SoonerCare Helpline at 1-800-987-7767.Annually, SoonerCare pays for about 70 percent of the nursing home bed days in the state. The Oklahoma Health Care Authority, which operates the SoonerCare program, launched initiatives within the last year to provide Oklahomans with more tools to plan their long-term future.

The Oklahoma Long-Term Care Partnership tries to encourage adults to plan for their future health care needs. The program lets people who buy a qualified long-term care insurance policy that would help pay for nursing home care protect assets equal to the value of the policy instead of spending everything to qualify for SoonerCare. For more information, call 405-522-7402 or go to www.okltcpartnership.org.The Living Choice program offers SoonerCare members the opportunity to move back home or to the community even though they have lived in a nursing home for six months or longer. The program offers long-term services and resources such as accessible housing to make the transition back to the community. The program is an effort to increase consumers’ choice and control over their own care. For more information, call (405) -522-7300.

The health care authority also developed an on-line tool for consumers who are researching nursing homes. The Focus on Excellence program is a voluntary incentive program for nursing homes that participate in the SoonerCare program. The pay-for-performance system enables the state to set quality measurements that financially reward better performance of nursing homes. The program uses performance ratings based on 10 quality measurements. The information from facilities is updated every 90 days. The Web site is http://oknursinghomeratings.com.

Jim Killackey: 475-3690, JKillackey@oklahoman.com

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