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CommunityCare of Oklahoma is the result of two hospitals coming together to create a health insurance option for their patients. In 1993 Saint Francis Hospital and St. John’s Medical Center created CommunityCare HMO in response to new federal health care reform recommendations. A year later they added the option of PPO plans as well.
CommunityCare moved into the Medicare market in 1996 with the addition of their Senior Health Plan Medicare Advantage plans. They also offer stand-alone Medicare Part D plans. Although they previously also provided Medicare Supplement insurance, there is no mention of these plans on the company website at the time of this review. They appear to have discontinued the Medicare Supplement option.
The company’s headquarters is located in Tulsa, Oklahoma, and while the cover all of Oklahoma, coverage varies when it comes to Medicare options. Medicare Advantage is not available in all counties, while Part D coverage is.
CommunityCare Medicare Plans
There are two categories of Medicare plans from CommunityCare: Medicare Advantage and Prescription Drug only.
CommunityCare has four different Medicare Advantage options in their Senior Health Category. All of the plans are HMOs, which means there is no out of network coverage available.
Three of the plans include prescription drug coverage, while the fourth is a medical-only option. All of the plans include dental, vision, and hearing coverage although copays and coverage vary.
The Silver plan is the basic, medical-only option and is a zero premium (beyond the regular Medicare Part A & B premiums) plan. Copays are $15 for primary care visits and $35 for specialist visits. There is a hospital copay of $200 per day for the first seven days.
Silver Plus is also a $0 premium plan, but this option includes prescription drug coverage. Copays are $20 for primary care visits and 20% for specialist visits. The hospital copay is higher at $270 a day for the first seven days, and this plan has a higher out of pocket maximum. Prescription drugs are covered starting at a $5 copay with no deductible.
The Platinum Plan has copays of $20 for primary care visits and $50 for specialists. The hospital copay is $250 per day for the first seven days. Prescription drugs have no deductible and start at a $0 copay for Tier 1 drugs.
Platinum Plus has lower copays at $10 for primary care, $30 for specialists, and $150 a day for the first seven days in hospital. The prescription drug benefits on this plan are the same as the Platinum plan.
Part D Prescription Drug Plan
Community Care has one option for Part D Prescription Drug coverage. The plan has a $415 deductible, but this does not apply to Tier 1 drugs, which have a $0 copay at in-network pharmacies. Tier 2 has a $6 copay, and the remaining tiers are covered with a coinsurance amount. Tier 3 has a 10% coinsurance while the Tiers 4 and 5 have a 25% coinsurance.
As mentioned, there are two $0 premium plans offered by CommunityCare – the two Silver plans. You will still have to pay your regular Medicare premiums. The Platinum Plans have an additional monthly cost at $42 for Platinum and $112 for Platinum Plus.
The prescription drug plan has a monthly premium of $28 per month.
Although we are unable to compare these rates on a national level since they are an Oklahoma-only company, they do appear to be very reasonable based on what we have seen in other parts of the country for this type of coverage.
Like all health insurance companies, CommunityCare handles their claims internally and directly with providers. Being an HMO, they deal only with their specific network of providers, which should mean expedited claims.
There is no claim information on the website, but it may be available in the member login area that requires an account.
Ratings and Consumer Reviews
CommunityCare has an A+ rating with the Better Business Bureau (BBB). They are not accredited and have no complaints on file in the past three years. There is one review on the BBB site, providing a two-star rating.
Medicare rates CommunityCare’s Advantage plans at 3.5 stars overall. They received 4 stars for health plan services in and 3.5 stars for prescription drug plan services. These ratings place CommunityCare slightly above average.
We found very little in terms of consumer opinion of this health plan company, which generally represents a favorable opinion of an insurance company. A lack of reviews usually means a good reputation, as people are more likely to write a review when dissatisfied than when they are happy.
The Bottom Line
CommunityCare has some good Medicare options available at reasonable prices, and the company has a good reputation. If you do not mind the limited network of an HMO and live in this company’s coverage area, they are a good pick for Medicare Advantage or Part D coverage.
For a list of companies that we recommend, visit our Best Insurance Companies page.