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Graduating from SoonerCare

Are you wondering what you should do once you no longer need SoonerCare benefits? HealthCare.gov is a health insurance website to help you navigate the next steps. Below are some frequently asked questions to help you get started.

Other Resources

Healthcare.gov

  • 1-800-318-2596
  • TTY 1-855-889-4325

Available 24 hours a day, 7 days a week (except holidays).

FAQs

Eligibility & Enrollment

Individuals and/or households must qualify for the one of the following to be eligible for health insurance through the Health Insurance Marketplace. 

  • Live in a state within the United States served by the Health Insurance Marketplace they are applying 

  • Be a U.S. citizen, U.S. national, or lawfully present immigrants for the entire time they plan to have coverage; and

  • Not be incarcerated (unless pending disposition of charges) 

You may apply for the Health Insurance Marketplace through:

To find out if you are eligible for Marketplace services, you can call the Marketplace at 800-318-2596 (TTY 855-889-4325). The call center is available 24 hours a day, 7 days a week (except holidays).

  • Online: HealthCare.gov.
  • Phone: Call the Marketplace Call Center at 1-800-318-2596. TTY users can call 1-855-889-4325.

  • In-person: There may be counselors in your area who can help. Visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596 for more information. 

  • En Español: Llame a nuestro centro de ayuda gratis al 1-800-318-2596.

  • Other languages: If you need help in a language other than English, call 1-800-318-2596 and tell the customer service representative the language you need.  

If you still have trouble enrolling, the Health Insurance Marketplace has people in Oklahoma to help you enroll. You can find them at https://localhelp.healthcare.gov.

The Health Insurance Marketplace does allow you to receive subsidies in the exchange even with an income below the poverty level if you’re an immigrant who has been in the U.S. for less than five years and you are not eligible for Medicaid.

You cannot apply if you have Medicare or Medicaid, not legally present in the U.S., incarcerated, or earn less than 100% of the Federal Poverty Level (FPL).

SoonerCare does not have access to the Health Insurance Marketplace letters. Please contact the Marketplace Call Center at 1-800-38-2596. TTY users can call 1-855-889-4325.

A child or other individual a parent, relative, or other person may claim a personal exemption tax deduction. You can learn more by contacting the Health Insurance Marketplace for assistance at 1-800-318-2596 (TTY 1-855-889-4325). They are available 24 hours a day, 7 days a week (except holidays) or online at HealthCare.gov.

Yes, language assistance is available through interpreters, call center support, print and web resources. Help is also available to complete the application. 

  • En Español: Llame a nuestro centro de ayuda gratis al 1-800-318-2596. 

  • Other languages: If you need help in a language other than English, call 1-800-318-2596 and tell the customer service representative the language you need. 

Coverage, typically, starts the first of the month after existing coverage ends. To determine when you may be eligible and start, you may contact the Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325). Callers are available 24 hours a day, 7 days a week (except holidays) or online at HealthCare.gov.

Special enrollment is an option available for anyone in your home that lost SoonerCare benefits or had a change in household circumstances.

The Health Insurance Marketplace may ask you to supply information after you have applied. They may ask for documents to confirm your income information. This happens when the Marketplace can’t immediately verify your information with its trusted data sources.

There are online tools you can use before you apply. 

  • The Savings Estimator Tool (www.healthcare.gov/lower-costs ) provides an estimate of cost savings through the Marketplace or through low-cost or free Medicaid coverage. This estimate is based on your income, household size, and state.

You will need to choose which health coverage you want to keep if you are enrolled in both SoonerCare and the Health Insurance Marketplace. This would include any of your household members also enrolled in both the Health Insurance Marketplace and Soonercare.


Income

Yes, if you earn less than 100% of the federal poverty level (FPL) you may not be eligible for the Marketplace. However, you may be eligible for SoonerCare. 

Contact the Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325) to find out if you or your family are eligible. You can call anytime 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov.

The Health Insurance Marketplace application asks you to provide income information that is reportable on your federal income tax return. For more information on income, contact the Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325).  You can call 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov.

You will need to estimate your household income for the year when you fill out a Health Insurance Marketplace application. You will be asked your current monthly income and your yearly income.

For more information on how income is calculated, call Health Insurance Marketplace for assistance at 1-800-318-2596 (TTY 1-855-889-4325). You can call 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov


American Indians/Alaskan Natives

Members of federally recognized tribes and ANCSA (Alaska Native Claims Settlement Act) shareholders can enroll in a Health Insurance Marketplace plan any time. You can change plans up to once a month. For more information contact the Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325).  You can call 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov.

All family members who apply on the same Health Insurance Marketplace application are eligible if one family member on the application is eligible for the Special Enrollment Period.

Example: Bob and his family apply to the Health Insurance Marketplace on a single application. Bob is an enrolled member of the Crow Tribe. His wife Betty is non-Indian. Their children are enrolled members of the Crow Tribe. They are all eligible for a Special Enrollment Period because they all apply on the same Health Insurance Marketplace application. 

Yes, for more information on both AI/ANs and non-AI/ANs family members contact the Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325).  You can call 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov.

Yes, you will need tribal documents. For more information on how to apply, contact the Health Insurance Marketplace at 800-318-2596 (TTY 855-889-4325) or visit HealthCare.gov. The call center is available 24 hours a day, 7 days a week (except holidays).

For more information on the Federally Recognized Tribes, contact the Marketplace at 1-800-318-2596 (TTY 1-855-889-4325).  You can call 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov or go to bia.gov/service/tribal-leaders-directory.


Cost Sharing

To determine if you will have any cost sharing responsibilities, you may call the Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325).  You can call 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov.

Cost Sharing Reduction is a discount that lowers the amount you must pay for deductibles, copayments, and coinsurance.  It is often called “extra savings.” For more information on CSR’s, contact the Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325).  You can call 24 hours a day, 7 days a week (except holidays) or go online to HealthCare.gov.


Coverage & Services

In the Marketplace, dental coverage is available either as part of a comprehensive medical plan, or by itself through a "stand-alone" dental plan. For more information on CSR’s, contact the Health Insurance Marketplace at 800-318-2596 (TTY 855-889-4325) or visit HealthCare.gov. The call center is available 24 hours a day, 7 days a week (except holidays).

Covered benefits and excluded services are defined in the health insurance plan's coverage documents. To get more information on covered and excluded services, contact the Health Insurance Marketplace at 800-318-2596 (TTY 855-889-4325) or visit HealthCare.gov. The call center is available 24 hours a day, 7 days a week (except holidays).

Last Modified on May 13, 2022