The Oklahoma Health Care Authority (OHCA) Board had authority over cost sharing in Sooner Care. Cost sharing is the portion of payment for services the member pays out of their own pocket. Member copays are deducted from the total cost sharing limit for each member of the household. The cost sharing limit is based upon the members’ family income and is capped at five percent per month. The cost sharing limit is also applied across the members of the household and re-sets at the beginning of each month. Once the household cost sharing limit is reached, the members of the household should not be charged a copay.
Sooner Care (Medicaid covers many health care services. However, there are limitations that apply to ensure that only medically necessary services are provided. Outlined in the links below are the benefits and coverage:
- Comparison Chart of SoonerCare Benefits and Co-pay Amounts | Spanish
- Cost Sharing/Out-of-Pocket Cost Exemptions
The member is responsible for paying all copay amounts. A provider cannot deny services based upon a member’s inability to pay at the time of service. However, if a member’s copay amount is left unpaid, providers can send their account to a collection agency.
For a current list of copay amounts that providers are allowed to charge see the links above or contact the Sooner Care Helpline at 1-800-987-7767. Members may also visit OKHCA and click on the (Individuals Benefits) page.
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