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Senior Health Plan Oklahoma Dual Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Health Plan Oklahoma Dual Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) in 2026, please refer to our full plan details page.
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) is a HMO D-SNP plan offered by St Francis Health System & St John Health System available for enrollment in 2025 to people living in Select counties in N.E. Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Health Plan Oklahoma Dual Complete (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Senior Health Plan Oklahoma Dual Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.20. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) has an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are covered with no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. For all other prescription tiers, including Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, members pay a 25% coinsurance. This 25% coinsurance rate applies to one-, two-, and three-month supplies filled at standard retail pharmacies or via standard mail order.
Additional Benefits
The Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) offers comprehensive medical coverage featuring no copays for most primary and specialist services, though a 20% coinsurance typically applies to outpatient care, emergency visits, and medical equipment. Inpatient hospital stays and skilled nursing facility care are covered with no copay and no coinsurance, though a deductible applies to inpatient admissions. Additionally, members can access routine preventive care and home health services at no cost. This plan also includes valuable supplemental benefits, such as routine dental care, vision services with a $475 annual eyewear allowance, and hearing aids covered up to $500 every two years, all with no copays. Members also benefit from up to 36 free one-way transportation trips per year to approved health locations and a monthly $180 allowance for over-the-counter items. These extra benefits help reduce out-of-pocket costs for essential daily health needs.
Inpatient Hospital See details
Inpatient hospital services are covered by Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) with no copay and no coinsurance, though a deductible applies. This benefit is partially covered because upgrades and non-Medicare-covered stays are not covered, while acute and psychiatric stays feature unlimited additional days and require prior authorization and referrals.
Outpatient Services See details
Outpatient services are covered by Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) with no copays, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization and referrals are required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Ambulance and Transportation Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers emergency, urgently needed, and worldwide emergency services with a 20% coinsurance and no copay. The coinsurance for emergency services is waived if you are admitted to the hospital within 48 hours of your visit.
Primary Care See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers primary care, specialist, therapy, mental health, telehealth, and opioid treatment services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) provides partial coverage for preventive services with no copay and no coinsurance, though some services require a referral. While annual physicals and health education are covered, several supplemental services are not covered, including fitness benefits, weight management, in-home support, PERS, and nutritional/dietary benefits.
Hearing Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers hearing exams with no copay, though routine exams require a 20% coinsurance. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to a $500 maximum limit every two years, though prescription hearing aids are only partially covered because inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Vision services are partially covered by Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) with no copay and no deductible, featuring a 20% coinsurance for routine eye exams and contact lenses. The plan covers one routine eye exam and up to $475 for eyewear (including frames, lenses, or contacts) annually, though other eye exam services and upgrades are not covered.
Dental Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) dental services are partially covered up to a $1,000 annual limit, featuring no copay and 20% coinsurance for Medicare-covered dental, and no copay and 0% to 50% coinsurance for other dental services. Covered preventive and restorative services like cleanings, exams, and extractions have no copay and no coinsurance, whereas endodontics and removable prosthodontics require 50% coinsurance; however, implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Medicare Part B insulin drugs carry a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these services.
Medical Equipment See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetic devices.
Diagnostic and Radiological Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers diagnostic and radiological services, including lab work, X-rays, and therapeutic radiology, with no copay and a 20% coinsurance. These services require both prior authorization and a referral.
Home Health Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Members must obtain prior authorization and a referral before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. While unlimited basic cardiac rehabilitation is covered, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. The benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, but it does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) partially covers other services with no copay and no coinsurance, offering a meal benefit and up to $180 monthly for over-the-counter items, while acupuncture is not covered. The meal benefit requires prior authorization and a referral, and unused over-the-counter benefits do not roll over to the next month.
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