"Dual eligible" means you qualify for both Medicare (federal) and Oregon Medicaid, which includes the Oregon Health Plan (OHP) and the Medicare Savings Programs. Together, the two can sharply lower your out-of-pocket costs and add services Medicare doesn't cover.
Who qualifies as dual eligible in Oregon
Two things must be true: you have Medicare (Part A, Part B or both), and you qualify for some level of Oregon Medicaid based on your income and, for some programs, resources.
- Medicare Savings Programs have income limits tied to the federal poverty level and, in Oregon, no asset limit. ODHS ended the resource limits for QMB, SMB and SMF on January 1, 2016.
- Full OHP for older adults and people with disabilities has its own income and resource rules.
- Medicaid long-term care adds a test of how much help you need, and giving away assets can delay eligibility.
ODHS decides eligibility using one application. See Oregon Health Plan and Medicare for more.
Levels of dual eligibility
"Dual eligible" covers several programs. The one you qualify for decides how much of your Medicare costs Oregon pays. Oregon's names are in parentheses.
| Level | What Oregon pays | Income limit (share of federal poverty level) |
|---|---|---|
| Full OHP (OHP with Limited Drug) | Medicare cost sharing plus OHP services Medicare doesn't cover | Set by Oregon's OSIPM rules |
| QMB | Part A and Part B premiums, deductibles, coinsurance and copays | Up to 100% |
| SLMB (SMB) | Part B premium ($202.90 a month in 2026) | Up to 120% |
| QI (SMF) | Part B premium; enrollment capped each year | 120% to 135% |
| QDWI | Part A premium for working people with disabilities who lost premium-free Part A | Up to 200% |
ODHS updates the dollar limits each March. See Medicare Savings Programs in Oregon for this year's amounts. ODHS notes that most working Oregonians with disabilities use the Employed Persons with Disabilities program instead of QDWI.
How Medicare and OHP pay together
Medicare is your primary insurance: claims go to Medicare first, as for anyone with Medicare. Oregon Medicaid is secondary.
- QMB members owe no Part A or Part B deductibles, coinsurance or copays, and federal law bars Medicare providers from billing them for those amounts. If you get a bill, show your Medicare and Oregon Health ID cards to the provider and call 1-800-MEDICARE (1-800-633-4227) if it isn't fixed.
- SMB and SMF members get help only with the Part B premium. They still owe Medicare deductibles and coinsurance.
- Full OHP members also get OHP services Medicare doesn't cover. Their prescriptions come through Medicare Part D, and they automatically qualify for Extra Help with Part D costs.
Medigap and dual eligibility. If you have QMB or full OHP, Medicaid already covers your Medicare cost sharing, so a Medigap policy usually duplicates what you have. Federal law generally bars companies from selling you a Medigap policy if you have full Medicaid, with limited exceptions; ask before you buy.
Extra services OHP adds
OHA gives rides to appointments and dental care as examples of things OHP covers that Medicare doesn't. OHP members also get mental health care through their CCO. For people who qualify, Oregon's Medicaid program can pay for long-term services and supports, such as in-home caregiver hours, adult foster homes, assisted living, residential care and nursing facility care, which Medicare doesn't cover. What is covered for you depends on your OHP benefit; your CCO's member handbook has the details.
D-SNPs: Medicare plans that work with OHP
A dual eligible special needs plan (D-SNP) is a Medicare Advantage plan only for people who have both Medicare and Medicaid. OHA describes D-SNPs as Medicare Advantage plans that work closely with your OHP benefits and says they are available in many areas of Oregon. For 2027, CMS data show 26 special needs plans of all types in Oregon; which ones you can join depends on your county and your Medicaid level. See Medicare by county.
D-SNPs are optional. Many dual eligibles keep Original Medicare with OHP as secondary. Your OHP benefits continue either way.
| Approach | What to know |
|---|---|
| Original Medicare + OHP | Any provider that accepts Medicare; no Medicare network. You also need a Part D plan for prescriptions. You show two cards and coordinate care yourself. |
| D-SNP + OHP | One Medicare plan for hospital, medical and drug coverage, coordinated with OHP. Uses the plan's network. You must keep your Medicaid eligibility to stay enrolled. |
Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
Changing plans: people with Medicaid or Extra Help have special enrollment periods outside the fall Open Enrollment Period. Since 2025, they can switch once a month to Original Medicare with a standalone Part D plan, and full-benefit dual eligibles can join an integrated D-SNP once a month where one is offered. Confirm your options with 1-800-MEDICARE before you switch. To compare D-SNPs from the companies they work with, you can request a call from a licensed insurance agent, or compare plans for your ZIP code at PlanMatch.
CCOs and dual eligibles
Most OHP members get medical, dental and mental health care through a coordinated care organization (CCO). OHA says your CCO doesn't change when you get Medicare. People with Medicare can change or leave the CCO they use for medical care at any time, but must use a CCO for dental and mental health care. Find the CCOs in your county on OHA's CCO plans page, and read our CCO guide.
Estate recovery in Oregon
Federal law requires states to try to recover some Medicaid costs from a person's estate after death. In general this covers long-term care services (nursing facility care and home and community-based services) and related hospital and drug costs for people who got them at age 55 or older. Oregon's Estate Recovery Program is run by ODHS.
- Medicare Savings Programs: Oregon's rule excludes correctly made payments for Medicare cost sharing on or after January 1, 2010 from estate claims (OAR 461-135-0835).
- Family protections: under federal law, the state can't collect while a surviving spouse is alive, or when there is a surviving child under 21 or a child who is blind or disabled. Hardship waivers are possible.
If estate recovery matters for your family, talk with an elder-law attorney before moving or giving away assets, since transfers can also affect long-term care eligibility.
How to apply
- Apply through ODHS. Use one.oregon.gov, call the ONE Customer Service Center at 1-800-699-9075 (TTY 711), or visit a local ODHS office. One application covers QMB, SMB, SMF, full OHP and Medicaid long-term care.
- Gather documents. Have proof of income (Social Security, pensions, wages), your Medicare card and information about household members.
- Get help with long-term care. ODHS Aging and People with Disabilities, at 1-855-673-2372, connects you to your local office or Area Agency on Aging.
- Watch for your notice. ODHS says it decides Medicare Savings Program applications within 45 days. Once approved, check that your Part B premium stops coming out of your Social Security check, which can take a few months.
Related guides
Oregon Health Plan and Medicare
How OHP works alongside Medicare.
Medicare Savings Programs
QMB, SMB, SMF and QDWI.
Coordinated care organizations
How CCOs deliver OHP.
Sources
- Oregon Health Authority — OHP and Medicare
- Oregon Department of Human Services — Medicare Savings Programs
- ODHS — Transmittal APD-PT-21-041 (MSP resource limits eliminated January 1, 2016) (PDF)
- ODHS — OAR 461-135-0835, Limits on Estate Claims (PDF)
- Oregon Department of Human Services — Estate Recovery Program
- Oregon Health Authority — Coordinated Care Organization (CCO) Plans
- Medicaid.gov — Estate Recovery
- Medicare.gov — Medicare Savings Programs
- CMS — CY2027 Medicare Advantage and Part D Landscape files
Frequently asked questions
What does dual eligible mean in Oregon?
It means you have Medicare and also qualify for Oregon Medicaid, either full Oregon Health Plan benefits or a Medicare Savings Program that pays some Medicare costs. Medicare pays first and Medicaid pays second.
Do I need both a Medicare card and an Oregon Health ID card?
With Original Medicare, yes: show both every time you get care so claims go to the right place. If you join a D-SNP you also get that plan's card, and you keep your Oregon Health ID for OHP services.
Can a doctor bill me if I'm a QMB member?
No. Federal law bars Medicare providers from billing QMB members for Medicare deductibles, coinsurance or copays. A provider can decline to see new OHP patients, but if you are treated, show your Medicare and Oregon Health ID cards and call 1-800-MEDICARE if you are billed.
Will Oregon's estate recovery take money for my Medicare Savings Program?
No, for Medicare cost sharing. Oregon's rule (OAR 461-135-0835) excludes correctly paid Medicare cost sharing paid on or after January 1, 2010 from estate claims. Estate recovery can apply to other Medicaid services, such as long-term care; an elder-law attorney can explain your situation.
How do I apply?
Apply online at one.oregon.gov, call the ONE Customer Service Center at 1-800-699-9075 (TTY 711), or visit a local ODHS office. ODHS says it decides Medicare Savings Program applications within 45 days.
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