Oregon Health Plan
A Comprehensive Guide
Oregon Health Plan provides FREE health care coverage for thousands of low-income Oregonians from all walks of life, including working families, children, pregnant women, single adults, and seniors.
OHP was one of the first Medicaid expansion programs in the country and has been providing comprehensive healthcare services to the people of Oregon for over 25 years. In this guide, we’ll go over everything you need to know about the Oregon Health Plan, including its eligibility requirements, covered services, and how to enroll.
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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 (OHP) 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.
Who qualifies for Medicaid or Oregon Health Plan (OHP)?
Oregon Health Plan (OHP) is Oregon’s 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 (DMAP).
In order to be eligible for the Oregon Health Plan, you must be a resident of the state of Oregon and meet certain income requirements. The program is designed to serve people who are unable to afford health insurance on their own and do not have access to employer-sponsored insurance.
Oregon Health Plan Goals
Better Health, Better Care and Lower Costs
- Increase access to health care for low-income Oregonians
- Improve the health of Oregonians by improving the quality of care and access to preventive services
- Contain the cost of health care
When can I enroll on 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 didn’t get approved, don’t 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
How to qualify for Oregon Health Plan or Affordable Health Insurance?
To qualify for OHP, individuals and families must meet income and residency requirements. Oregonians may also qualify based on age, health care resources and disability status.
For Adults (age 19-64)
OHP is available to adults who earn up to 133 percent of the Federal Poverty Level. For a single person, income should be less than $1,507/month or household income of $3,076 for a family of four.
Children (age 0-18)
OHP is available to kids and teens whose family earns up to 300 percent of the Federal Poverty Level. That’s about $4,578/mo for a family of two or $6,938/mo for a family of four.
What are the 2022 Oregon Health Plan income limits to apply for Medicaid or Oregon Health Plan?
See below for income limits:
HOWEVER: If your gross household income is higher than the income limits above, Health Plans In Oregon is here to help you apply for affordable health plans through the Health Insurance Marketplace and see if you can qualify for financial assistance to help pay for your health plan premium.
Not only that, but….
In January 2018, Oregon Health Authority started a program called OHP Now Covers Me! This program provides FREE health care to children and teens under 19 (including pregnant teens) REGARDLESS of immigration status.
Health Plans In Oregon will help you find affordable health insurance plans based on your needs and budget– we’ve 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.
Here are several health care programs available for low-income Oregonians through the Oregon Health Plan (OHP):
- 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 (CAWEM) – 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.
What are the Benefits of Oregon Health Plan?
Oregonians can get coordinated health care through the Oregon Health Plan. Regular check-ups, medicines, mental health care, addiction treatment, and dental care are all covered.
OHP Plus, OHP with Limited Drug, and CAWEM Plus Covered Benefits
View the benefits chart below to learn what OHP covers.
Other Benefits:
CAWEM
Emergency medical, dental, and transportation services are all covered.
Medicare Beneficiary Who Is Eligible (QMB)
Only covers Medicare premiums, copayments, and deductibles
(excluding for Medicare Part D).
How much will I have to pay for the Oregon Health Plan?
The cost of the Oregon Health Plan is based on your income and household size. Most people who enroll in the program will not have to pay any monthly premiums, but there may be co-payments for some services.
Want to know if you still can apply for Oregon Health Plan?
The answer! Yes, you can apply now! You read it right! Oregon Health Plan enrollment is always open. You can apply for Oregon Health Plan at any time of the year.
How to sign up for Oregon Health Plan?
You have several options:
- Apply Online – Go to ONE.Oregon.gov 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 partner – Project Access Now, to apply or renew call (503) 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 it’s 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.
How can I check my OHP coverage status?
You can call the OHP customer service department at 1-800-699-9075 and check if your OHP is still active. If you have Healthshare of Oregon, you can call them at: (503) 416-8090 or email them at: info@healthshareoregon.org
More Info on Applying for Oregon Health Plan
If you think you may qualify for the OHP, you should visit OregonHealthCare.gov. Answer a few screening questions to find out what application works best for you. For some people, it may be best to fill out Oregon’s state-based, online PDF or paper application. It’s 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 you’ve 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 don’t 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
Frequently Asked Questions
Which Oregon Health Plan am I enrolled on?
If you live in Clackamas, Multnomah, or Washington counties, you’ll most likely be enrolled in Health Share. Your card looks like this. See below:
How often do I need to renew my OHP?
Every year. OHP enrollment department sends you a renewal application before your coverage expire. Make sure to review your information and fill out any changes on your income, household size or any other available coverage. You need to return this in as soon as you can or go to any community partner that can help you process your renewal.
What if I no longer qualify for OHP?
There are other healthcare plan options you can look. You can apply for affordable health insurance through the Health Insurance Marketplace and get some financial assistance. Check if your employer offers coverage to its employees. Click here to check all other affordable health insurance plan options in Oregon.
Can I change my OHP Plan?
Yes. If you’re on open card OHP plan you can sign up for a CCO plan such as Healthshare.
What is Oregon Health Plan open card?
It means that you have the state administer your health plan and you’re not on a CCO or Healthshare. You can go to any provider that accepts Open card Oregon Health Plan. Open card looks like this below:
What is CCO?
Coordinated Care Organization takes care of your OHP medical, dental and mental health services. You can call Healthshare at 503-416-8090 and request to have all these services through one OHP plan. Everything and everyone will work together to give you the possible best healthcare.
What are the Healthshare Medical Plans in Oregon?
- Careoregon-800-224-4840
- Kaiser Permanente-800-813-2000
- Providence Health Plan-800-898-8174
- Tuality HealthAlliance- 866-575-8104
What are the Healthshare Dental Plans in Oregon?
- Advantage Dental- 866-268-9631
- Careoregon Dental- 888-440-9912
- Kaiser Permanente- 800-813-2000
- ODS-800-342-0526
- Willamette Dental- 855-433-6825
Does Oregon Health Plan Offer free rides?
Yes. You can call Ride to Care at- 855-321-4899 to book your appointment. They provide easy and safe trips to your healthcare appointments.
Which OHP benefit package goes to whom?
The following are the primary benefit packages:
Children, pregnant women, retirees, and people with disabilities eligible for Medicaid or the Children’s Health Insurance Program (CHIP) are eligible for OHP Plus (BMH).
For people qualified for both Medicaid and Medicare Part D normally may get OHP with Limited Drug Coverage (BMD, BMM)
What are the different OHP benefit packages?
The benefits covered for each OHP benefit package are listed below:
- OHP with Limited Drug: BMD and BMM
- OHP Plus: BMH
- OHP Plus Supplemental: BMP
- CAWEM Plus: CWX (OHP Plus benefits for CAWEM-eligible pregnant women)
*CAWEM (Citizen-Waived Medical) is for emergency only coverage.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
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