Oregon Health Plan Made Easy (UPDATED)

Oregon health plan

What’s Oregon Health Plan?

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.

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.

Oregon-health-planWhat does Oregon Health Plan Cover?

Oregon Health Plan pays for most if not all related healthcare costs such as:

  • Physical health: Doctor visits, preventive services to help you stay healthy, tests to find out about your health, treatment for most major diseases, emergency ambulance and 24-hour emergency care,family planning services, and pregnancy and newborn care.
  • Behavioral health: Mental health and counseling, and help with addiction to tobacco, alcohol and drugs. (You do not need a referral from your primary care provider for these services.)
  • Dental health: Cleanings and preventive treatments, dental check-ups and x-rays, fillings, tooth removal, 24-hour emergency care.
  • Prescriptions: OHP with Limited Drug only includes drugs not covered by Medicare Part D.
  • Eye care: Medical care; glasses to treat a qualifying medical condition such as aphakia or keratoconus, or after cataract surgery.
  • Vision care: Exams and glasses (only for pregnant women and children under age 21).
    Other needs: OHP can pay for hearing aids, medical equipment, home health care, skilled therapy, hospital care, and rides to health care appointments.

When Can I Enroll on Oregon Health Plan?

You can enroll anytime throughout the year if you qualify for the 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 despair, 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

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).

OHP 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

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.  

How can I qualify for OHP or affordable health insurance?

You may be eligible to reduce, even eliminate, all your health insurance costs. If you qualify for Oregon Health Plan, there is no cost to you nor your family.  BUT, if your income is over the OHP income limit, you may still be eligible for affordable health insurance thanks to available tax credits or financial assistance.

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 138 percent of the Federal Poverty Level.  For a single person, income should be less than $1,396/month or household income of $2,887 for a family of four.
  • Children (age 0-18)
    OHP is available to kids and teens whose family earns up to 305 percent of the Federal Poverty Level. That’s about $4,184/mo for a family of two or  $6,380/mo for a family of four.

Not only that:

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.

What’s the 2020 Oregon Health Plan income limits to apply for Medicaid or OHP?

ohp-income-limits-2019

If your income is less than the amount listed above, then YOU ARE IN with Oregon Health Plan!

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.

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.

Oregon-health-plan-assistance

So 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 partnerProject 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 atinfo@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

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:

healthshare-medical-card

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:

OHP-open-card

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?

  1. Careoregon-800-224-4840
  2. Kaiser Permanente-800-813-2000
  3. Providence Health Plan-800-898-8174
  4. Tuality HealthAlliance- 866-575-8104

What are the Healthshare Dental Plans in Oregon?

  1. Advantage Dental- 866-268-9631
  2. Careoregon Dental- 888-440-9912
  3. Kaiser Permanente- 800-813-2000
  4. ODS-800-342-0526
  5. 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.

Call us-503-998-6169 if you have any questions on obtaining affordable health insurance through the Health Insurance Marketplace or go over your healthcare options in Oregon. You can also email us at: info@healthplansinoregon.com

Download/Print: 2019 Oregon Health Plan Application

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