Quick answers
- Can I have Medicare and OHP at the same time?
- Yes. If your income and resources qualify, you can have OHP and Medicare together. Medicare pays first and OHP pays second.
- Does OHP pay my Medicare premiums?
- It can. If you qualify for a Medicare Savings Program, Oregon pays your Part B premium, and the QMB program also covers Medicare deductibles and coinsurance. ODHS decides who qualifies.
- Who pays for my prescriptions if I have OHP and Medicare?
- Medicare Part D. Most members have OHP with Limited Drug, which doesn't cover drugs Part D covers, so you need a Part D plan or a Medicare Advantage plan with drug coverage.
- Do I keep my CCO when I get Medicare?
- Yes. OHA says your CCO doesn't change when you get Medicare. You can change or leave the CCO you use for medical care at any time, but you still use a CCO for dental and mental health care.
- How do I apply for OHP if I have Medicare?
- 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.
The Oregon Health Plan (OHP) is Oregon's Medicaid program, run by the Oregon Health Authority (OHA). The Oregon Department of Human Services (ODHS) decides who is eligible. People who have Medicare and also qualify for OHP are often called dual eligibles. Having both can sharply lower what you pay and adds services Medicare doesn't cover.
Who qualifies for OHP alongside Medicare
For people 65 and older and people on Medicare because of a disability, OHP and the related Medicare Savings Programs are based on income and, for some programs, resources:
- Medicare Savings Programs use income limits tied to the federal poverty level (FPL): up to 100% of FPL for QMB, up to 120% for SLMB (Oregon calls it SMB) and up to 135% for QI (Oregon calls it SMF). ODHS says there are no asset limits for these programs in Oregon. See Medicare Savings Programs in Oregon for this year's dollar limits.
- Full OHP benefits for older adults and people with disabilities have their own income and resource rules (Oregon's program name is OSIPM).
- Medicaid long-term care (nursing facility, in-home and community-based care) also looks at how much help you need with daily activities, and giving away assets can affect eligibility.
ODHS decides eligibility. If you aren't sure, apply: one application covers OHP and the Medicare Savings Programs.
Levels of dual eligibility
What OHP pays depends on which program you qualify for. Oregon's own names are in parentheses.
| Program | What it pays |
|---|---|
| Full OHP with Medicare (OHP with Limited Drug) | OHP Plus benefits except drugs Medicare Part D covers; can help with Medicare premiums, deductibles and coinsurance |
| QMB (Qualified Medicare Beneficiary) | Part A and Part B premiums, deductibles, coinsurance and copays |
| SLMB (Oregon: SMB) | Part B premium |
| QI (Oregon: SMF) | Part B premium; yearly funding is capped |
| QDWI (Qualified Disabled Working Individual) | Part A premium for some working people with disabilities |
Some QMB members don't qualify for full OHP. OHA gives them an Oregon Health ID only so the state can pay their Medicare cost sharing.
How OHP pays alongside Medicare
Medicare is your primary insurance, so claims go to Medicare first. OHP pays second for Medicare-covered services and covers OHP services Medicare doesn't.
- QMB members owe nothing for Part A or Part B copays, deductibles or coinsurance. Federal law bars Medicare providers from billing QMB members for those amounts. If a provider bills you, show your Medicare and Oregon Health ID cards, and call 1-800-MEDICARE (1-800-633-4227) if the bill isn't fixed.
- Prescriptions: OHP with Limited Drug doesn't cover drugs Medicare Part D covers, and OHP doesn't pay Part D premiums, deductibles or copays. People with full OHP automatically qualify for Extra Help, which lowers Part D costs. OHP pays only for certain drugs Part D excludes, such as some over-the-counter drugs.
- Providers: a doctor can accept Medicare without taking new OHP patients. Ask about both when you make an appointment.
Services OHP adds beyond Medicare
OHA gives rides to appointments and dental care as examples of things OHP covers that Medicare doesn't. Your OHP benefits also include mental health care through your CCO. Separately, Oregon's Medicaid program can pay for long-term services and supports, such as in-home caregivers, adult foster homes, assisted living, residential care and ongoing nursing facility care, for people who qualify through ODHS Aging and People with Disabilities. Medicare doesn't pay for this kind of long-term custodial care.
Your CCO's member handbook lists exactly what is covered and how to schedule rides.
CCOs deliver OHP benefits
Most OHP members get their medical, dental and mental health benefits through a coordinated care organization (CCO), a local plan that serves set counties. OHA says your CCO does not change when you get Medicare. People with Medicare can change or leave the CCO they use for medical care at any time, but they must use a CCO for dental and mental health care. American Indian and Alaska Native members can join, change or leave a CCO at any time. To see which CCOs serve your county, use OHA's CCO plans page. More in our CCO guide.
D-SNPs: Medicare Advantage 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. Each CCO must work with one or more Medicare Advantage plans that serve dual eligibles across its service area. You don't have to join a D-SNP: you can keep Original Medicare with OHP, and your OHP benefits continue whichever Medicare option you choose.
For 2027, CMS data show 26 special needs plans in Oregon (D-SNPs and other types), and availability differs by county. See Medicare by county and our dual eligible guide, or compare plans for your ZIP code at PlanMatch. To talk through D-SNPs from the companies they work with, you can request a call from a licensed insurance agent.
How to apply for OHP
- Apply online. Use the ONE application at one.oregon.gov (also at benefits.oregon.gov). It covers OHP, the Medicare Savings Programs, SNAP and other benefits.
- Apply by phone or mail. Call the ONE Customer Service Center at 1-800-699-9075 (TTY 711).
- Apply in person. Visit a local ODHS office; use the ODHS office finder.
- Ask about long-term care. For in-home or nursing facility care, contact ODHS Aging and People with Disabilities through its statewide resource line, 1-855-673-2372, which connects you to your local office or Area Agency on Aging.
ODHS says it decides Medicare Savings Program applications within 45 days. Once you have OHP, OHP Client Services (1-800-273-0557, TTY 711) handles CCO changes, ID cards and handbooks.
If your income or assets change
OHP eligibility is renewed regularly. Report big changes to ODHS, such as a new job, a pension, an inheritance or selling property. Higher income can move you to a different Medicare Savings Program or end your eligibility; lower income may qualify you for more help. Reporting on time protects you from overpayment claims later.
Related guides
Medicare Savings Programs in Oregon
QMB, SMB, SMF and QDWI help with premiums and cost sharing.
Coordinated care organizations
How CCOs work when you have Medicare.
Dual eligible in Oregon
Medicare and OHP together, D-SNPs and estate recovery.
Sources
- Oregon Health Authority — OHP and Medicare
- Oregon Health Authority — Coordinated Care Organization (CCO) Plans
- Oregon Health Authority — Contact OHP
- Oregon Department of Human Services — Medicare Savings Programs
- Oregon Health Authority — Affiliated Medicare Advantage Plan Guidance 2025 (PDF)
- Medicare.gov — Medicare Savings Programs
- CMS — CY2027 Medicare Advantage and Part D Landscape files
Every question in this guide
- Can I have Medicare and the Oregon Health Plan?
- Do I keep my CCO when I get Medicare in Oregon?
- Does OHP pay my Medicare Part B premium?
- How do I qualify for Medicaid long-term care in Oregon?
- What's the difference between Medicare and Medicaid in Oregon?
- What happens to my OHP when I turn 65?
- What is a dual special needs plan (D-SNP) in Oregon?
- What is Oregon Project Independence and who qualifies?
Frequently asked questions
Can I have both Medicare and the Oregon Health Plan?
Yes. People with Medicare whose income and resources fall within Oregon's limits can also have OHP. They are often called dual eligibles. Medicare pays first and OHP pays second.
Does OHP pay for long-term nursing home care that Medicare won't?
Medicare covers only short-term skilled nursing care after a qualifying hospital stay. Oregon's Medicaid program can pay for long-term care in a nursing facility, at home or in community-based care for people who meet the financial and service-need rules, which ODHS Aging and People with Disabilities decides.
How do I apply for OHP if I'm on Medicare in Oregon?
Apply online at one.oregon.gov or benefits.oregon.gov, call the ONE Customer Service Center at 1-800-699-9075 (TTY 711), or visit a local ODHS office. The same application covers OHP and the Medicare Savings Programs.
Will I lose OHP if my income goes up?
Possibly. Report income and household changes when they happen. Higher income can move you to a different Medicare Savings Program or end your eligibility, and unreported changes can lead to overpayments you have to repay.
Medicare in your Oregon county
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