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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 2025, 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 4 out of 5 stars in 2025.
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 $0.00. 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 $590.00 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 $8850.00 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 a $590 deductible for prescription drugs. After the deductible, you will pay either a coinsurance or no copay depending on the drug tier. For preferred generic drugs, there is no copay when using a standard or mail-order pharmacy. For standard generic drugs, you pay 24% coinsurance, and for preferred brand and non-preferred drugs, you pay 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) offers a range of benefits with varying cost-sharing. Many services, like ambulance, home health, and dental cleaning, have no copay. However, many services, including outpatient, emergency, primary care, vision, dental, and diagnostic services, have a 20% coinsurance. The plan also includes coverage for hearing aids up to $500 every two years, and offers an over-the-counter (OTC) allowance of $240.00 per month. Inpatient hospital, partial hospitalization, and skilled nursing facilities are covered with prior authorization and doctor referrals, and coinsurance may apply.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with prior authorization and a doctor referral required. Additional days for both Acute and Psychiatric inpatient hospital stays are covered. Non-Medicare-covered stays and upgrades for Acute and Psychiatric inpatient hospital are not covered.
Outpatient Services See details
Outpatient services are covered by the Senior Health Plan Oklahoma Dual Complete (HMO D-SNP), including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance. Individual and group sessions for outpatient substance abuse services have a coinsurance between 20% and 20%. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with no copay, but require prior authorization and have a 20% coinsurance for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 36 one-way trips per year via taxi or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a 20% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with a 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as additional preventive services, health education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs, all requiring a doctor referral. This plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services include routine hearing exams with coinsurance of at most 20%, and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are covered up to a maximum of $500 every two years, and OTC hearing aids are covered up to $500 every two years.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, also have a 20% coinsurance with a combined maximum benefit of $475 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered once per year. Upgrades are not covered.
Dental Services See details
The Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) plan covers dental services with a 20% coinsurance for Medicare dental services. Other dental services include oral exams (2 visits per year), dental x-rays (limited to 1 bitewing per 12 months and 1 panoramic image per 36 months), prophylaxis (cleaning) (2 treatments per 12 months), and fluoride treatments (2 treatments per 12 months), all with no copay. Orthodontic services are covered with a $1500 maximum benefit per year. However, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics/medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered with no copay. You may have to pay coinsurance of at most 20% for these services.
Home Health Services See details
Home Health Services are covered by the Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. A doctor referral and prior authorization are required, and the copay information is available in the plan details.
Other Services See details
Other Services include over-the-counter (OTC) items with a maximum benefit of $240.00 per month and meal benefits that require prior authorization and a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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