Who qualifies for both
- Medicare is the federal program for people 65 and older and for younger people with a qualifying disability, ALS or end-stage renal disease. Income doesn't matter.
- OHP is Oregon's Medicaid program. It depends on income and, for some groups, resources. The Oregon Department of Human Services (ODHS) decides eligibility.
Help comes in levels:
- Full OHP with Medicare. The Oregon Health Authority (OHA) says most OHP members with Medicare have "OHP with Limited Drug": the same benefits as OHP Plus, except drugs Part D covers.
- Qualified Medicare Beneficiary (QMB). Pays Part A and Part B premiums, deductibles and coinsurance.
- SLMB and QI (Oregon calls them SMB and SMF). Pay the Part B premium.
Oregon has no asset limit for these Medicare Savings Programs. See Medicare Savings Programs in Oregon.
How Medicare and OHP work together
Medicare is your primary coverage, so claims go to Medicare first. OHP then pays what it covers. If you have QMB, you don't owe Part A or Part B copays, deductibles or coinsurance, and providers can't bill you for them.
With full OHP you keep OHP benefits Medicare doesn't cover, such as rides to appointments (non-emergency medical transportation) and dental care. OHA says your CCO doesn't change when Medicare starts, and that you don't have to get your medical care through your CCO. See coordinated care organizations.
Prescription drugs
OHP doesn't cover drugs Part D covers, so you need Part D coverage. OHA says OHP doesn't pay Part D premiums, deductibles or copays. Because you have OHP or a Medicare Savings Program, you automatically get Extra Help, which lowers those costs.
Dual special needs plans
A dual eligible special needs plan (D-SNP) is a Medicare Advantage plan for people with both Medicare and Medicaid. OHA says D-SNPs work closely with OHP and are available in many areas of Oregon. Availability depends on your county: see Medicare by Oregon county and dual eligibility in Oregon.
How to apply
- Apply online. Use ONE at one.oregon.gov; one application covers OHP and the Medicare Savings Programs.
- Or apply by phone or mail. Call the ONE Customer Service Center at 1-800-699-9075 (TTY 711), or call ODHS Aging and People with Disabilities at 1-855-673-2372.
- Watch for your notice. ODHS says it tells you within 45 days whether you're approved.
For questions about your OHP card or CCO, call OHP Client Services at 1-800-273-0557 (TTY 711). To review your Medicare plan choices with OHP in mind, you can request a call from a licensed insurance agent.
Related questions
Does OHP pay my Medicare premiums?
What the state pays, and when.
Do I keep my CCO when I get Medicare?
What changes and what doesn't.
What is a dual special needs plan?
D-SNPs and OHP.
Sources
- Oregon Health Authority — OHP and Medicare
- Oregon Department of Human Services — Medicare Savings Programs
- Oregon Health Authority — Contact OHP
- Medicare.gov — Help with drug costs (Extra Help)
- CMS — Qualified Medicare Beneficiary program
More questions in this guide
- 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?
Part of the guide: Oregon Health Plan and Medicare: combined coverage · All questions
Frequently asked questions
Does having OHP change my Medicare benefits?
No. Your Medicare benefits stay the same and Medicare stays your primary coverage. OHP adds help with Medicare costs and, if you qualify for full OHP, services Medicare doesn't cover.
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 will not change.
Does OHP pay for my prescriptions if I have Medicare?
Mostly no. Medicare Part D covers your drugs. OHP covers only certain drugs Part D excludes, and it doesn't pay Part D premiums or copays. With OHP you automatically get Extra Help, which lowers Part D costs.
What if I lose OHP?
Losing OHP gives you a Medicare special enrollment period to change your Medicare Advantage or Part D coverage. Call 1-800-MEDICARE (1-800-633-4227) to confirm your dates.
Medicare in your Oregon county
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