Chapter 5: Health and Mental Health
Section 1: Medicare
Medicare is the health benefit available to persons receiving Social Security Disability Insurance (SSDI) or Social Security retirement and to some other connected individuals.
Medicare generally covers Durable Medical Equipment (DME) that:
- Can stand repeated use;
- Is primarily and customarily used to serve a medical purpose;
- Is generally not useful to a person in absence of illness or injury; and
- Is appropriate for use in the home.
Medicare typically pays 80% of the Medicare allowable charge for an item or service. The patient may have to pay a deductible and co-payment. A doctor's prescription and in some cases a Certificate of Medical Necessity are required for Medicare payment for medical equipment.
Palmetto Government Benefits Administration handles Durable Medical Equipment (DME) claims for Medicare in this region. Questions on Medicare DME coverage can be directed to 800-213-5452.
Select a state supplier list at this site. The suppliers listed are those who have agreed to accept what Medicare pays and to charge the patient no more than the Medicare allowable charge. The beneficiary still must pay the normal Medicare co-payment for medical equipment, but "participating" suppliers will not charge more than that.
Note: Medicare beneficiaries can also use "non-participating" Durable Medical Equipment (DME) suppliers who have Medicare supplier numbers. These suppliers have not agreed to charge no more than the Medicare allowable charge. For a list of both "participating" and "non-participating" DME suppliers go to the following link: https://www.medicare.gov/what-medicare-covers/part-b/competitive-bidding....
Medicare and You, the Medicare Handbook
Follow this link to Medicare's online resource, https://www.medicare.gov/medicare-and-you/medicare-and-you.html
To report Medicare fraud, call 800-447-8477 or follow this link to the Medicare Fraud webpage, https://www.medicare.gov/forms-help-and-resources/report-fraud-and-abuse....
Durable Medical Equipment (DME) Center
Palmetto Government Benefits Administration handles Durable Medical Equipment (DME) claims for Medicare in this region. Questions on Medicare DME coverage can be directed to 800-213-5452. For more information on Durable Medical Equipment follow this link, https://www.medicare.gov/what-medicare-covers/part-b/durable-medical-equ....
The Dallas Regional Office (Region 6) should be your initial point of contact on any Medicare, Medicaid, or State Child Health Insurance Program (SCHIP). For general inquiries, use the telephone number listed below. For more specific issues, review the Contact List under the Downloads section at the bottom of this page.
CMS - Region 6
1301 Young St., Ste. 714
Dallas, TX 75202
For questions about where to submit a complaint about quality of care received from a kidney dialysis facility.
Full information on Medigap policies available in Oklahoma can be found at http://www.ok.gov/oid/Consumers/Information_for_Seniors/SHIP_Supplemental_Insurance.html
For people with disabilities under the age of 65:
Blue Cross Blue Shield of Oklahoma
1215 S. Boulder
Tulsa, OK 74119
866-303-2583 Toll Free
Christian Fidelity Life Insurance Co
5840 West IH20, Suite 140
Arlington, TX 76017
800-527-6797 Toll Free
Combined Insurance Company of America
Chicago, IL 60640
800-544-5531 Toll Free
Medigap A only
National States Insurance Company
1830 Craig Park Court, Suite 100
St. Louis, MO 63146
800-868-6788 Toll Free
New Era Life Insurance Companies
200 Westlake Park Boulevard
Houston, TX 77079
800-713-4680 Toll Free
Old Surety Life Insurance Co
5235 N. Lincoln Blvd., P.O. Box 54407
Oklahoma City, OK 73154
800-272-5466 Toll Free
Physicians Life Insurance Company
2600 Dodge St.
Omaha, NE 68131
800-228-9100 Toll Free
Help Paying Medicare Out-of-Pocket Expenses
These programs can help low income Medicare beneficiaries:
- Qualified Medicare Beneficiary (QMB): Medicare recipients with very limited income and resources may qualify to have Medicaid pay their Medicare deductibles, premiums and copayments. Presently the income limit for an individual is $851 monthly, but this figure could change. Apply at your local DHS office.
- Specified Low Income Medicare Beneficiary (SLMB): Medicare recipients with income up to $1,021 a month (current) can qualify to have Medicaid pay their Medicare Part B premiums. Apply at local DHS offices.
- Qualifying Individual (QI-1): Pays Medicare Part B premiums for individuals with incomes up to $1,149 monthly (current), and couples to $1,265 monthly (current). Apply at local DHS offices.
- Qualified Disabled and Working Individuals (QDWI) : QDWI pays recipients with incomes up to $1,702 monthly Medicare premiums and your Social Security benefit must have been stopped only because of your earned income.
To qualify for these programs you must also have very limited resources (the things you own and money you have available). Some things are not counted as resources, such as a person's home, car, furniture, some life insurance and burial plots.
Adult Abuse 800-522-3511
Child Abuse 800-522-3511
Child Support Enforcement 800-522-2922
Senior Info-Line 800-211-2116
North and West Oklahoma 800-522-1064
North and East Oklahoma 800-522-1075
Central and South Oklahoma 800-522-1086
Information on where to file a complaint about quality of care received from a doctor, hospital, nursing home, or managed care plan.
Information on hospice programs statewide.
Medicare Part B Carrier for Oklahoma: Information on Medicare Part B coverage, doctor services, outpatient care or other medical services; information on how to recognize Medicare fraud and abuse.
For information on Medicare, Medigap (supplemental insurance) and Medicaid.
The Senior Health Insurance Counseling Program (SHICP) helps inform the public about Medicare and other senior health insurance issues. This division provides accurate and objective counseling, assistance and advocacy relating to Medicare, Medicaid, Medicare Supplements, Medicare+Choice, Long-Term Care and other related health coverage plans for Medicare beneficiaries, their representatives, or persons soon to be eligible for Medicare.