Is Oregon Health Plan Medicaid


Oregon Health Plan Covered Drugs

Oregon Medicaid Eligibility on the Provider Web Portal, updated May 15, 2014

Medicaid 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 OHPs ride service brokerages.

Youll 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!.

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    Oregon Health Plan Customer Service

    If you are a currently enrolled member or potential member with OHP questions, you can contact OHP Customer Service for help, or visit the OHP website.

    You can reach OHP Customer Service by calling .

    OHP Customer Service can help you:

    • Update your address or phone number
    • Replace a lost OHP Card
    • Check the status of your application
    • Change plans

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    How Do I Qualify For Medicare And Oregon Health Plan

    Health Plans in Oregon has been helping Medicare beneficiaries in Oregon for over a decade and weve found that most people are confused on what Medicare is in relation to Oregon Health Plan or are they one and the same?

    If youre under 65 and do not have Medicare, then you may qualify for Oregon Health Plan alone. Medicare is only for Oregonians that are over 65 years old, disabled for at least 24 months by Social Security and have end stage renal disease. In Oregon, Medicare insurance is your primary insurance. Medicare generally covers about 80% of the medical bill and 20% of that would be paid by the beneficiary.

    Medicaid or better called Oregon Health Plan becomes the secondary insurance. Generally, Medicaid covers the 20% or whatever Original Medicare wont cover. In Oregon, to qualify for Medicaid your income should be on certain limits.

    How Do I Enroll In Medicaid In Oregon

    Oregon Health Plan (Oregon Medicaid)

    If you are under 65 and dont have Medicare:

    • The best way to enroll in Oregon Health Plan is online at or One Oregon.
    • You can also contact by phone to enroll at 1-800-318-2596.
    • Residents with certain special-eligibility status can enroll through
    • You can also get in-person assistance with an application by contacting a community partner. This link will help you find assistance in your area.
    • Those who are currently enrolled Oregon Health Plan and Healthy Kids need to renew their benefits annually. They will receive a notice from the state when its time to do this, and the Oregon Health Plan website has renewal forms and full renewal applications available for existing members.

    If you are 65 or older or have Medicare:

    • You can apply for Medicaid or a Medicare Savings Program using One Oregon.
    • You can also receive free assistance with applying through an Area Agency on Aging or a Department of Human Services Office for Aging and People with Disabilities.

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    How To Apply For Ohp Plus

    You can apply for OHP Plus at any Oregon Department of Human Services office in the state, by calling 800-359-9517, or by completing the online application at . The DHS must make a decision about your application within 45 days, or within 90 days when you are applying on the basis of a disability.

    If you are denied OHP, you have the right to request a hearing. The best way to do that is to complete the hearing request form at and turn it in to a DHS office in person, where you can get a date-stamped copy as your receipt.

    If You Don’t Qualify For Ohp Plus

    Oregon runs another health insurance program, called OHP Standard, for low-income adults who don’t fit into any of the categories to qualify for OHP Plus . OHP Standard only opens for new applicants when the state provides additional funding for the program. There is a lottery to apply for OHP Standard to reserve a spot, complete the application for OHP Standard.

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    What’s Oregon Health Plan

    • Health Plans In Oregon will help you find affordable health insurance plans based on your needs and budget weve been doing this since 2006. Furthermore, we will help you apply for any financial assistance you may qualify for through the Health Insurance Marketplace to help reduce your health insurance monthly costs.

    The Affordable Care Act was introduced in 2014 to provide affordable health insurance to everyone. Oregon is one of a select number of states that expanded their Medicaid under the Affordable Care Act. More than 380,000 more Oregonians qualified for the OHP that year. It has since allowed more Oregonians to have access to affordable health insurance when needed, bringing peace of mind and financial security to individuals and families in Oregon.

    The Oregon Health Plan improves access to health care by combining public and private insurance plans and a prioritized list of services. More than 500,000 Oregonians now have health-care coverage, thanks to the OHP.

    Apply For Medicaid In Oregon

    Welcome to Jackson Care Connect and the Oregon Health Plan (OHP)

    Online at or by phone at 800-318-2596. If you’re pregnant, a tribal member, a refugee, or have other special eligibility status, you can apply through

    Eligibility: The aged, blind, and disabled. Also, coverage is available if your household income does not exceed 138% of poverty and CHIP is available for children with household incomes up to 300% of poverty.

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    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 or ALS diagnosis. Once youve 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. Its important to consider because if you are enrolled in Medicare and Medicaid, Medicaid will no longer cover your prescriptions youll need a Medicare plan to do that.

    Please Answer A Few Questions To Help Us Determine Your Eligibility

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    Medicaid is a federal program that is managed by each state to provide health insurance for some low-income individuals. The State of Oregon provides Medicaid services through a program that it calls the Oregon Health Plan . Oregon offers different benefit packages and has different income guidelines for different categories of recipients. In general, though, you must be low-income to qualify. The Department of Human Services administers Oregon’s Medicaid program.

    Oregon provides a Medicaid package called OHP Plus to low-income residents who are seniors children under age 19 pregnant, blind, disabled persons and those who qualify to receive Temporary Aid to Needy Families . There is also a Medicaid package called OHP Standard for low-income adults who don’t fit into one of the above categories.

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    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 states 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
    • Hospital services
    • 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
    • Mental health
    • Physical, occupational, and speech therapy
    • Prescription drugs
    • Vision

    When Can I Enroll On Oregon Health Plan

    Oregon Health Plan

    You can enroll anytime throughout the year if you qualify for Oregon Health Plan based on your income. See below for income eligibility. If you applied for OHP but got denied or didnt get approved, dont worry, you may still be able to enroll in an affordable health insurance plan through the Health Insurance Marketplace. Check and shop for affordable health insurance here: ENROLL on Affordable Health Insurance

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    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. Youll get information about which CCO you are in about two weeks after your Medicaid application is approved. Then, youll 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 its important to look at the provided list and decide which doctor you would prefer to receive care from.

    How A Social Security Denial Affects Your Medicaid Eligibility

    If you are approved for OHP Plus on the basis of your disability but Social Security later finds that you are not disabled, you can keep receiving OHP Plus while you appeal your Social Security case. If Social Security finds you are not disabled, you will be disqualified from getting OHP Plus. But only a final decision from the Social Security Appeals Council will end your OHP Plus eligibility.

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    Nonresponse And Selection Bias

    The response rate for the OHP sample is as high or higher than those achieved in other published surveys of Medicaid populations . In contrast, the response rate for the Food Stamp sample is only half as high as that for the OHP sample and two thirds of the 50 percent response rate achieved by many of these other studies. Because data collection and tracing procedures for the OHP and Food Stamp samples were identical, it would seem that the dramatic difference in their response rates can be attributed to the poorer quality of the addresses in the Food Stamp eligibility file. This suggests that nonrespondent Food Stamp recipients were more likely to have moved one or more times compared with those located by survey interviewers.

    Some sociodemographic information was available from state Food Stamp files to evaluate potential nonresponse bias. We found no differences between respondents and nonrespondents with regard to age, gender, or geographic residence. However, nonrespondents were significantly more likely to be Hispanic. Only English-speaking interviewers were available for the survey, which almost certainly made it even more difficult to locate and interview Hispanic sample members.

    So How To Sign Up For Oregon Health Plan

    OHP, Medicaid non-profit FamilyCare Health closing

    You have several options:

    • Apply Online Go to to login or create an account
    • Paper Applications You can download and print an application or have an application mailed to you. Request a paper application by calling OHP Customer Service at 800-699-9075. Paper applications are available in multiple languages.
    • Or Call and OHP Community partnerProject Access Now, to apply or renew call 345-6553.

    A word of caution: If you decide to call in by phone to enroll with the Oregon Health Plan, it may involve a long waiting period, so its highly recommended you either apply online or print the application, fill it out and mail or fax it in. Print the Oregon Health Plan application here.

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    Understanding Health Share And Oregon Health Plan Insurance

    The Oregon Health Plan and Health Share work together with OHSU Health Services on different parts of your healthcare needs. OHP provides insurance. Health Share coordinates your services. OHSU Health Services works with providers to deliver your medical care needs.

    OHSU Health Services is a new system of care, with over 45 locations and thousands of providers across the metro area. With partners OHSU Health Hillsboro Medical Center and Adventist Health in East Portland, OHSU Health Services is ensuring every Portland area neighborhood has access to OHSUs innovations and treatments.

    The Oregon Health Plan is the Medicaid program for the state of Oregon. This program provides healthcare coverage for low-income residents of Oregon.

    How To Enroll In Oregon Medicaid

    Oregon Medicaid is a safety net that acts as symbol of hope. If youre worried about losing health insurance because you had your hours cut or lost a job, you may now be eligible for coverage under Medicaid.

    Eligibility varies by state, so contact Oregon Medicaid office to see if you qualify and to sign up.

    Watch this video to learn how to enroll in Oregon Medicaid:

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    Medicare Costing Savings Programs

    The purpose of Medicare Costing Savings programs is to assist individuals by paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services.

    The Qualified Medicare Beneficiary program pays for Medicare Part B premiums, coinsurance, and deductibles for those eligible and enrolled in Medicare Part A.

    The Specified Low Medicare Beneficiary program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income.

    The Qualified Individual program provides payment of Medicare Part B premiums only for individuals who would be eligible for the SLMB program except for excess income.

    The Qualified Disabled Working Individual program provides payment of Medicare Part A premiums only for individuals meeting income limits.

    Who Qualifies For Medicaid Or Oregon Health Plan

    Oregon Medicaid enrollment increases by over 100,000 since March ...

    Oregon Health Plan is Oregons Medicaid program which provides free health care coverage to low-income individuals and families in Oregon through programs administered by the Division of Medical Assistance Programs .

    Here are several health care programs available for low-income Oregonians through the Oregon Health Plan :

    • OHP Plus for children ages 0-18 and adults ages 19-64
    • OHP Plus Supplemental for pregnant adults age 21 or older
    • OHP with Limited Drug for adults who qualify for both Medicaid and Medicare Part D

    Other medical programs available includes:

    • Citizen Alien Waived Emergent Medical this program covers emergency medical services only. If you are new in Oregon or living in the United States for less than 5 years, you can apply for this program.
    • Qualified Medicare Beneficiary People with Medicare who are in this program are also enrolled in Medicaid and get help in paying Medicare premiums, deductibles and copays.

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    More Info On Applying For Oregon Health Plan

    If you think you may qualify for the OHP, you should visit Answer a few screening questions to find out what application works best for you. For some people, it may be best to fill out Oregons state-based, online PDF or paper application. Its very important to apply immediately because it can take up to 45 days to process your application. OHP may cover you from the day you applied as long as your application gets processed and approved. However, if you do not get approved, and if youve incurred medical bills during the application process, you may be responsible to pay those medical bills.

    If you want to protect yourself in the event of accidents, heart attack or other unforeseen medical maladies while your application is being processed, you can enroll for affordable short term medical insurance. Click here to shop for affordable short term medical insurance- SHOP SHORT TERM MEDICAL

    For those who dont qualify for the OHP based on income, you may still be able to enroll through the Insurance Marketplace, and perhaps qualify for tax credits or financial assistance to help pay for your private health insurance. Click here to shop for affordable health insurance plans in Oregon: Shop for Affordable Health Insurance

    Which Oregon Health Plan am I enrolled on?

    If you live in Clackamas, Multnomah, or Washington counties, youll most likely be enrolled in Health Share. Your card looks like this. See below:

    How often do I need to renew my OHP?

    What is CCO?

    Health Insurance For Low

    The Oregon Medical Assistance Program, also known as Medicaid, is a Federal and State funded program providing medical and health-related services for eligible Oregon residents.

    The Executive Office of Health and Human Services administers the Medicaid program to provide health insurance for low-income families with children, pregnant women, senior citizens, people with disabilities or special needs, and other residents struggling to access affordable healthcare.

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