Oregon Health Plan and Medicare by Dianne Faligowski

Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with End-Stage Renal Disease (ESRD).

Oregon Health Plan (OHP) is a state-run health insurance program that provides coverage to low-income individuals and families who meet certain eligibility requirements. Both Medicare and OHP offer coverage for a wide range of medical services, including doctor visits, hospital stays, prescription drugs, and preventive care. However, there are some important differences between the two programs. For example, Medicare is only available to people who meet certain age or disability criteria, while OHP is open to any Oregon resident who meets the program’s income guidelines. 

Additionally, OHP offers additional benefits such as vision, dental and long-term care services that are not covered under Medicare. While Medicare is federally funded, OHP is funded by both the state and federal government.

Can I keep my Oregon Health Plan and keep my Medicare?

We receive a lot of calls from Oregonians that are currently enrolled on Oregon Health Plan and wondering what to do with Medicare when they turned 65 or it also pertains to anyone that’s been disabled for over 2 years under Social Security rules. 

The answer?

Unfortunately, you can’t opt out of Medicare once you’re eligible because Medicare will normally becomes your primary insurance and if you’re eligible, you can continually have OHP as your secondary health insurance. There’s a Part B penalty if you opt out. 

Fact is:

OHP members that qualify for Medicare need to be re-determined to see if your income and resources still qualify you for both Oregon Health Plan and Medicare. The eligibility income and asset guidelines are different when you become Medicare eligible. It is very important to go to your local Aging and Disability Service Office (ADS) and ask to speak with an eligibility specialist. You can also call the ADS office via phone or call the Central Processing Center (800-699-9075). You may get turned away, placed on hold with long wait times or given various answers. Another way is by checking online, here’s a link on which local branch you can go to get some help re-determined in person: http://www.oregon.gov/DHS/Offices/Pages/Seniors-disabilities.aspx#multnomah

What you need to tell the eligibility specialist when you head to local ADS branch?

You can say that you’re new to Medicare and turning 65 (say what month you turn 65) and that you want to see if you can keep your Oregon Health Plan and/or qualify for additional benefits. And the eligibility specialist should help you determine if you qualify for OHP PLUS, QMB, SMB or LIS or nothing.

Check this out:

Here are some help or programs you may qualify for:

• Low Income Subsidy (Extra Help) – Helps pay for your part D premium or Medicare Advantage Plan, pays or lower your deductible and co-pays on your prescriptions.
• Specified Medicare Beneficiary (SMB) – the state of Oregon can help pay for your Part B Medicare premium which is $121/month for 2016 or $104/month.
• Qualified Medicare Beneficiary (QMB) – the state of Oregon can help pay for your Part B Medicare premium which is $121/month for 2016 or $104/month. It also helps pay for your deductibles, co-insurance or co-pays that Medicare or Medicare Advantage Plan won’t cover. It usually covers or picks up the rest of the medical bill that Medicare or Medicare Advantage won’t pay.
• OHP Plus – the state of Oregon can help pay for your Part B Medicare premium, $170.10/month in 2022. It also helps pay for your deductibles, co-insurance or co-pays that Medicare won’t cover. It usually covers or picks up the rest of the medical bill that Medicare or Medicare Advantage won’t pay. You may also qualify for dental, mental health, wrap around benefits, transportation and more…

Above all,

Whichever of these programs you may qualify for, it’s very important to go over the many different Medicare plan options available to ensure your medical needs such as your prescriptions or doctors are covered. If you qualify for QMB or OHP Plus, your Original Medicare or Medicare Advantage Plan will be your primary insurance and QMB or OHP Plus becomes your secondary insurance.