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Oregon Health Plan (Oregon Medicaid Program) Guide

Every state’s Medicaid program is slightly different. The Medicaid plan in Oregon is called “Oregon Health Plan” and covers about 4.1 million people (24% of the Oregon population). Most people who qualify for Medicaid in Oregon will be enrolled in OHP Plus (Oregon Health Plan Plus). Pregnant women over the age of 21 will be enrolled in OHP Plus Supplemental, and anyone who qualifies for Medicare as well will be enrolled in “OHP with Limited Drug.” The three plans are almost identical, except that “OHP with Limited Drug” does not include full prescription benefits, and “OHP Plus Supplemental” adds in vision coverage and extra dental.

Click below to learn more about Oregon Medicaid:

Oregon Health Plan Coverage

All state Medicaid programs are federally required to cover the same basic benefits, but most states take some liberties with the other benefits they offer based on each state’s individual needs. For example, the OHP provides more dental coverage for adults than many other state Medicaid programs. The largest benefits included are:

  • Chemical dependency care
  • Dental
  • Hearing
  • Home health
  • Hospice
  • Hospital services (emergency, inpatient, and outpatient)
  • Immunizations and vaccinations
  • Labor, delivery, and post-partum services
  • Lab tests and x-rays
  • Medical appointments with doctors and nurses
  • Medical equipment/supplies
  • Medical transportation (both emergency and non-emergency when medically necessary)
  • Mental health
  • Physical, occupational, and speech therapy
  • Prescription drugs (except for those who also have Medicare)
  • Vision (only when medically necessary)

Oregon Health Plan Dental and Vision

The OHP provides coverage for cleanings, fluoride varnish, fillings, extractions, dentures, stainless steel molar crowns, and emergency care. Those who are pregnant or under the age of 21 can also receive additional crowns, sealants, and root canals. Similarly, vision services are only covered for kids (under age 21), pregnant adults, and adults with specific medical conditions that require vision treatment.

Oregon Health Plan Covered Drugs

Medicaid (OHP Plus only) members in Oregon can not only receive ambulance rides for medical emergencies but can also receive non-emergency medical transportation when necessary. If you do not have a reliable means of transportation or cannot afford the gas to get you to and from your medical appointments, you may be able to take advantage of OHP’s ride service brokerages.

You’ll need to call the ride service brokerage in your county to schedule a ride. The person on the phone will need to verify your ride service eligibility, verify that your drop-off location is a Medicaid-covered appointment, verify that you do not have another means of transportation to your appointment, and then schedule your ride with a vehicle that makes sense for your medical needs. If you are repeatedly not at your scheduled pick-up location at the correct time, you may lose this benefit, or you may be asked to call to confirm rides before someone comes to pick you up - so it is in your best interest to be on time!.

Have Questions? Ask a Benefits Advisor in Your Area

Oregon Health Plan Providers and CCOs

Most members will be enrolled in a CCO, or Coordinated Care Organization. A CCO is a group of doctors, nurses, dentists, and other specialists in your area who work together to provide quality care to beneficiaries like you. You’ll get information about which CCO you are in about two weeks after your Medicaid application is approved. Then, you’ll receive an ID card and will be asked to select a primary care provider. This will be the main doctor that you turn to for your healthcare needs. If you do not choose one, your CCO will select one for you, so it’s important to look at the provided list and decide which doctor you would prefer to receive care from.

OHP Copays and Costs

There are very few costs associated with Oregon Medicaid. In some cases, you may be asked to pay a $3 copayment for outpatient services and a $1 or $3 copayment for prescriptions. You may be able to alleviate those costs through a prescription drug savings card.

Prescription Discount Card | Medicare Plan Finder

Oregon Health Plan Eligibility

Oregon Health Plan eligibility is mostly based on your household income. The amount of people in your household is taken into consideration. To qualify, you also must be a legal resident of the United States and Oregon state.

Oregon Health Plan Eligibility | Medicare Plan Finder

Oregon Health Plan Application

Unlike Medicare, Oregon Medicaid does not have a specific enrollment period - you can apply for Medicaid during any time of year. You can either download, print, and mail the application, order a paper application at 1-800-699-9075, or go through the application process online. The website one.oregon.gov will allow you to find out what you’re eligible for, apply for benefits, and manage your account. If you go through any major life changes, like getting a new job or getting married, you can update your Medicaid application online as well.

Medicare and Medicaid Together in Oregon

If you are eligible for Medicaid based on the income requirements listed above and you also qualify for Medicare, you can benefit from both programs. You can qualify for Medicare either by turning 65, collecting SSDI for over 24 months, or receiving an ESRD (End-Stage Renal Disease) or ALS diagnosis. Once you’ve established that you are eligible for both programs, you should enroll in a Dual-Eligible Special Needs Plan, or DSNP. DSNPs are types of Medicare Advantage plans specifically designed for those who are benefitting from both programs. It’s important to consider because if you are enrolled in Medicare and Medicaid, Medicaid will no longer cover your prescriptions - you’ll need a Medicare plan to do that.

How to Enroll in DSNP

We have Medicare professionals in 38 states available to answer your questions and help you select and enroll in a DSNP plan. To get started, send us a message or give us a call at 833-438-3676.

Medicare Special Needs Plans | Medicare Plan Finder

Have questions? Ask a Benefits Advisor!