Definition. The Oregon Health Plan (OHP) is Oregon's Medicaid program, run by the Oregon Health Authority. People who have both Medicare and OHP are "dual eligible": Medicare pays first, and OHP can help with Medicare premiums, deductibles and coinsurance and with care Medicare doesn't cover.
What it means
OHP covers Oregonians who meet its income and other rules. For people with Medicare, the Oregon Health Authority (OHA) explains:
- Most OHP members with Medicare have OHP with Limited Drug: the same benefits as OHP Plus, except drugs Medicare Part D covers. You need Part D coverage for those drugs; OHP pays only certain drugs Part D excludes.
- OHP doesn't pay Part D plan premiums, deductibles or copays, but people with full OHP get Extra Help automatically, which lowers them.
- Members with QMB have "QMB + OHP with Limited Drug" and pay no Part A or Part B deductibles, coinsurance or copays.
- OHP care is delivered through Coordinated Care Organizations (CCOs) or open card (fee-for-service). If you get Medicare while on OHP, your CCO won't change.
How it works with Medicare plans
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans for people with Medicare and OHP; OHA says they're available in many areas of Oregon and work closely with OHP, and your OHP benefits continue whichever Medicare plan you choose. Find your CCO with OHA's CCO finder. Apply for OHP at ONE Oregon (one.oregon.gov) or 1-800-699-9075.
Sources
- Oregon Health Authority — OHP and Medicare
- Oregon Health Authority — Contact OHP
- Medicare.gov — Help with drug costs (Extra Help)
Frequently asked questions
Can I have both Medicare and OHP?
Yes. If you qualify for both, Medicare is your main coverage and OHP is secondary. Most OHP members with Medicare get the OHP with Limited Drug benefit, which means Medicare Part D covers their prescriptions.
Will my CCO change when I get Medicare?
No. The Oregon Health Authority says that if you get Medicare while you have OHP, your CCO won't change.
Who do I call with OHP questions?
OHP Client Services at 1-800-273-0557 (TTY 711), Monday to Friday, 8 a.m. to 5 p.m. Pacific, for CCO changes, ID cards and handbooks. For eligibility and applications, call the ONE Customer Service Center at 1-800-699-9075.
Medicare in your Oregon county
Plans, local agents and help, county by county: Multnomah · Washington · Clackamas · Lane · Marion · Jackson · Deschutes · Linn · Douglas · Yamhill · Benton · Polk · Josephine · Umatilla · Klamath · Coos · Columbia · Lincoln · Clatsop · Malheur · All 36 counties →
