Medicare
- Federal program, run by the Centers for Medicare & Medicaid Services (CMS). The rules are the same in every state.
- Not based on income. You qualify by age (65), disability, ALS or end-stage renal disease.
- You share costs: the Part B premium ($202.90 a month standard in 2026), deductibles and coinsurance.
- Covers hospital care (Part A), doctor and outpatient care (Part B) and, through private plans, prescription drugs (Part D). It doesn't cover long-term custodial care, and Original Medicare doesn't cover routine dental, eye exams for glasses or hearing aids.
CMS counts 973,880 people with Medicare in Oregon (July 2026).
Medicaid (OHP in Oregon)
- Federal-state program. Federal rules and funding, run by the Oregon Health Authority (OHA). The Oregon Department of Human Services (ODHS) decides eligibility for people 65 and older and people with disabilities.
- Based on income and, for some groups, resources.
- Covers health care plus services Medicare doesn't, such as dental care and rides to appointments. Most members get care through a coordinated care organization (CCO).
- Medicaid long-term care (in-home care, community-based care and nursing facilities) goes through ODHS Aging and People with Disabilities.
Side by side
| Medicare | OHP (Medicaid) | |
|---|---|---|
| Who runs it | Federal government (CMS) | Oregon (OHA and ODHS), with federal rules |
| Who qualifies | 65+, or certain disabilities | Limited income, any age |
| Income test | No | Yes |
| Long-term care | Short skilled nursing stays only | Yes, if you qualify for Medicaid long-term care |
| Prescription drugs | Part D plans | For people with Medicare, Part D pays instead |
| How you apply | Social Security | ONE (one.oregon.gov) |
Having both
If you have Medicare and OHP, Medicare pays first. OHA says most members with Medicare have "OHP with Limited Drug," which covers OHP Plus benefits except drugs Part D covers, and that your CCO doesn't change when Medicare starts. If your income is low but too high for full OHP, a Medicare Savings Program may still pay your Part B premium; Oregon has no asset limit for these programs. Both OHP and the Medicare Savings Programs give you Extra Help with Part D automatically. More in dual eligibility in Oregon.
To apply for OHP or a Medicare Savings Program, use one.oregon.gov or call 1-800-699-9075 (TTY 711). To sign up for Medicare, contact Social Security at 1-800-772-1213. To compare Medicare plans with OHP in mind, you can request a call from a licensed insurance agent.
Related questions
Can I have Medicare and OHP?
How the two work together.
What happens to my OHP at 65?
What changes when Medicare starts.
How do I qualify for Medicaid long-term care?
ODHS rules for care at home or in a facility.
Sources
- Medicare.gov — Parts of Medicare
- Oregon Health Authority — OHP and Medicare
- Oregon Department of Human Services — Long-term care
- Oregon Department of Human Services — Medicare Savings Programs
- CMS — Medicare Monthly Enrollment
More questions 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 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
Can I have both Medicare and Medicaid in Oregon?
Yes. People with both are called dual eligible. Medicare pays first, and OHP can help pay Medicare premiums, deductibles and coinsurance.
Is OHP the same as the Health Insurance Marketplace?
No. OHP is Oregon's Medicaid program. The Marketplace sells private health insurance, and most people with Medicare don't use it.
Does Medicare or Medicaid pay for a nursing home?
Medicare covers only short skilled nursing facility stays after a qualifying hospital stay. Long-term nursing home care is generally paid by Medicaid long-term care through ODHS, or privately.
Medicare in your Oregon county
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