What If You Lose Your OHP Benefits? | Oregon Health Plan Eligibility

A huge number of Oregonians (approximately 555,000) has been receiving quality health care coverage through the Oregon Health Plan (OHP). It provides health care coverage for low-income Oregonians from all walks of life which includes working families, pregnant women, children, seniors, single adults and more. Individuals and families must meet income and residency requirements to qualify for OHP. Oregonians may also qualify based on age and disability status.

Oregon Health Plan Eligibility

You and your family may qualify for OHP if you live in Oregon, meet OHP’s income limits and other criteria. See chart below for income eligibility:

There are several health care programs available for low-income Oregonians through the Oregon Health Plan, this includes:

  • 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

Renew Oregon Health Plan Coverage

If you have received notice from OHP that you or your family need to renew health plan coverage, you can renew your OHP application by:

  • Calling OHP Customer Service — 1- 800-699-9075
  • Renew through federal healthcare.gov website
  • Public Benefits Hotline — 1-800-520-5292
  • Legal Aid Directory — www.oregonlawhelp.org
  • Governor’s Advocacy Office — 1-800-442-5238

Report Changes to OHP

What To Do When You Don't Qualify For OHP

If any of the information you provided on your Oregon Health Plan application changes, you must report it within 30 days of the change.

  • Online: If you have a ONE account, you can submit your changes online at https://one.oregon.gov/General/ReportAChange
  • Email: You can send a secure email with your changes to OregonHealthPlan.Changes@dhsoha.state.or.us. You must Include your full name, date of birth, Oregon Health ID number, and phone number.
  • Call OHP Customer Service: 1-800-699-9075 (toll-free) from 7 a.m.to 6 pm. Monday to Friday

BUT, what if you have reported a change or have just received Notice of Eligibility from Oregon Health Plan stating that you no longer qualify for it?

Reasons for Oregon Health Plan Denial

Here are some reasons why you will not qualify for Oregon Health Plan Program:

  • You are not an Oregon resident.
  • Your income is over the limit to receive health coverage through the Oregon Health Authority.
  • You have private health insurance. Individuals with private health insurance are not eligible for Children’s Health Insurance Program (CHIP). You do not qualify for Oregon Health Plan/Healthy Kids Program.
  • You have health coverage from another state.
  • You are entitled to or enrolled in Medicare Part A and or Part B benefits.
  • You are over age 65.
  • You are receiving Social Security Income (SSI) and will receive a notice about other Medical Programs you are eligible for.
  • You did not complete the application process.
  • You have requested to withdraw your application.

Health coverage options when you lose Oregon Health Plan

Depending on the reason stated on your Oregon Health Plan Eligibility Notice, you can apply on any of these health plan options:

  • Medicare is for people who are age 65 and older, or have a disability.
  • Citizen-Alien Waived Emergency Medical (CAWEM) covers emergency care for those whose immigration status makes them unable to get OHP.  This program is for immigrants or permanent residents who lived in the US for less than 5 years.
  • CAWEM Plus gives full coverage to pregnant women who qualify for CAWEM.
  • Medicare Savings Programs cover Medicare costs, depending on the specific program. Medicare serves as primary insurance and Oregon Health Plan becomes secondary insurance depending on the level of OHP eligibility. Dual Eligible beneficiaries may receive full Medicaid benefits that cover will their Medicare premiums, cost sharing and deductibles through this program.
  • Health Insurance Marketplace offers private health plans and financial help for people who earn too much for OHP. Click here to check all other affordable health insurance plan options in Oregon.

Let’s see a sample of Oregon Health Plan Notice of Eligibility (see below).

oregon-health-plan-notice-of-eligibility-2019

Common reason why Oregonians receive Oregon Health Plan termination letter is because of income increase. OHP termination letter will specify name of those enrolled in Oregon Health Plan Program who will lose coverage and it will also state end date.

What to do when you receive OHP Notice of Eligibility?

You need to act quick! Why? From your Oregon Health Plan end date, you only have 60 days to enroll on Health Insurance Marketplace to have health coverage for the rest of the year. Enrolling through the Health Insurance Marketplace may qualify you or your family for Premium Tax Credit that will lower the cost of your monthly premium. Click here to see if you qualify for premium tax credit and find affordable health insurance plan options in Oregon.

If you have missed 60-day window or your Special Enrollment Period, you have to wait until the next Open Enrollment Period (Nov 1 to Dec 15) to apply for health insurance coverage.

Have you missed your Special Enrollment Period?

If you missed your 60-day period in enrolling for affordable 2020 health insurance through the Health Insurance Marketplace, you may consider short-term health insurance. Short-term insurance doesn’t cover pre-existing conditions and may have limited benefits compared to Health Insurance Marketplace plans but it may fill gaps in coverage until you can choose a longer term health plan.

Or you may look into supplemental insurance that will provide you with cash benefits to cover unexpected expenses for illness or injury. This may still give you protection than not having health coverage at all.

Get free assistance.

If you don’t qualify or have lost your Oregon Health Plan, give us a call and we’re glad to assist you in finding affordable health insurance.  Give us a call at 503-998-6169Health Plans In Oregon. We’re local, independent and licensed agent who has been helping Oregonians since 2006.

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