How to get SoonerCare or low-cost care in Oklahoma

How SoonerCare began for adults

SoonerCare is the name of Medicaid in Oklahoma. Medicaid is a public program that pays your doctor bills when your income is low. A state agency called the Oklahoma Health Care Authority, or OHCA, runs it.

Oklahoma voters passed State Question 802 on June 30, 2020. That vote opened Medicaid to adults ages 19 to 64 whose pay is at or below the limit. KFF, a health policy research group, lists July 1, 2021 as the date the expansion took effect.

The limit is 138 percent of the federal poverty level. OHCA describes it as 133 percent with a 5 percent allowance added. The government sets the federal poverty level each year as a dollar amount to measure poverty. OHCA keeps a page with the dollar limit for each size of household. Our Medicaid eligibility guide covers other groups, like kids and pregnant people.

Where and how do you apply?

You can apply at any time of the year, and OHCA lists four ways to begin.

• Apply online at the MySoonerCare.org website.
• Call the SoonerCare Helpline at 800-987-7767 and apply by phone.
• Fill out a paper form in English or Spanish and mail it to the address printed on it.
• Visit one of the partner sites of the agency, where staff help people in person.

You can find the papers to gather in our guide to how to apply for Medicaid. After you are approved, OHCA says to check that your doctor is contracted with SoonerCare or with your plan. A doctor outside your plan can send you a bill that Medicaid will not pay.

Finding a doctor and a ride

The agency has an online directory of doctors that you can search by name, specialty, city and plan. It does not promise you an appointment, because some offices have age limits or are not taking new SoonerCare patients. Call first and ask if the office sees SoonerCare members. Then write down the date and the name of the person you spoke with. The helpline can also help you pick a primary care provider.

American Indian members may pick an Indian Health Service, tribal or urban Indian clinic as their primary care provider. Those clinics can see you even if you did not sign up with them.

SoonerRide covers rides to medical visits that are not emergencies, and its number is 877-404-4500. Our Medicaid transportation guide shows how the rides work.

The work rule starts January 1, 2027

OHCA says the work rule starts on January 1, 2027. It applies to expansion adults ages 19 to 64 who are not exempt. In any month, you meet the rule if you do at least one of the following.

• You earn at least $580 in the month.
• You work at least 80 hours.
• You do at least 80 hours of community service or a work program.
• You attend school at least half-time.
• You combine work, service, a work program and school to reach 80 hours.

Seasonal workers can use the average they earned over the past six months. Many groups are exempt, and OHCA keeps the full list. People on Medicare, people 65 or older and pregnant or postpartum women are on it. So are parents or caretakers of children 13 years old and younger. American Indian and Alaska Native members are exempt as well. So are people with a serious or complex medical condition, a substance use disorder or a disabling mental disorder.

OHCA has a short quiz on its Work Requirements page. It gives you an estimate and does not save your answers. If OHCA needs more details, it will mail a letter that says what to send and when. Our Medicaid work requirement guide has more detail.

If your income is above the limit

For 2027 coverage, the Oklahoma Insurance Department says people still shop for private plans on HealthCare.gov. The department is taking over some jobs from the federal government, such as help programs and a hotline. It plans to launch a fully state-run exchange for the 2028 open enrollment period. HealthCare.gov shows open enrollment as November 1 to January 15.

A tax credit lowers what you pay each month for a plan, and it comes from the government. The extra credit money added during the pandemic stopped after 2025. For 2026 and 2027, people who earn more than 400 percent of the poverty level, or four times that yearly amount, do not get a tax credit. If you lose job-based coverage, ask HealthCare.gov about a special sign-up window.

Low-cost clinics and doctor checks

The Oklahoma Primary Care Association works with the state's health centers. Fees at these centers depend on how much you earn and how big your family is. HRSA, the federal Health Resources and Services Administration, has a free Find a Health Center tool. Call ahead and ask what you will pay before your first visit.

You can check a doctor's license with the Oklahoma Board of Medical Licensure and Supervision. Its Find a Doctor search works by name, specialty, county or license number.

Some doctors charge one flat monthly fee for primary care, which is called direct primary care. Our directory lists cash-pay doctors. You can ask any office what the fee covers.

In an emergency such as chest pain or trouble breathing, call 911 or go to the nearest emergency room. The hospital has to examine you and get your condition stable under federal law, whether or not you can pay. See our guide to hospital financial assistance for help with the bill afterward.