If you are enrolled on both Medicare and Medicaid (Dual Eligible beneficiary), remember that Medicare serves as your primary insurance and Medicaid or Oregon Health Plan becomes your secondary insurance. Medicare covers 80% of medical bills and Medicaid / OHP covers the deductibles and 20% co-insurance or whatever Original Medicare won’t cover.
Is Medicare the same as Oregon Health Plan (Medicaid)?
Health Plans in Oregon has been helping Medicare beneficiaries in Oregon for over a decade and we’ve found that most people are confused on what Medicare is in relation to Oregon Health Plan (Medicaid) or are they one and the same? If you’re under 65 and do not have Medicare, then you may qualify for Oregon Health Plan alone.
Who qualifies for health insurance in Oregon?
Oregonians may also qualify based on age and disability status. Coverage through the Oregon Health Plan includes doctor visits, hospital care, mental health services, dental, and some vision care.
What is Oregon Health Plan (OHP)?
Medicaid better known as Oregon Health Plan (OHP) in the state of Oregon, is a joint venture funded by Federal and State governments that pays for medical costs for certain individuals and families with low income and limited resources.
How do providers verify eligibility for OHP?
Providers can use multiple systems to verify OHP eligibility. Clients should present their Oregon Health ID (formerly Medical Care ID) at each health care visit so that providers can check eligibility using the Client ID Number printed on the card. Questions?
Does Oregon have something similar to Medi Cal?
The Oregon Health Plan (OHP) is Oregon's Medicaid program. There are several health care programs available for low-income Oregonians through OHP.
How do I get free health insurance in Oregon?
OHP is Oregon's Medicaid program. It provides free coverage for people in Oregon who meet eligibility criteria. Coverage includes doctor visits, hospital care, mental health services, dental, and some vision care.
What is a supplemental insurance for patients with Medicare as their primary insurance?
A Medigap policy is health insurance sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover.
Can you have OHP and Medicare at the same time?
OHP and Medicare can work together if Medicare is your primary source of health coverage. Let's say you qualify and meet the OHP's low-income requirements. In that case, OHP can cover services that Medicare doesn't, such as dental care, some prescriptions, and rides to health care appointments.
What is the maximum income to qualify for Oregon Health Plan?
OHP is available to adults who earn up to 133 percent of the Federal Poverty Level. For a single person, income should be less than $1,507/month or household income of $3,076 for a family of four. OHP is available to kids and teens whose family earns up to 300 percent of the Federal Poverty Level.
Who is eligible for Oregon Health Plan?
Who is covered: Adults (age 19-64) in households that earn up to: $1,468 a month for a single person. $3,013 for a family of four.
Who is the largest Medicare Supplement provider?
UnitedHealthcareAARP's Medicare Supplement Insurance plans are insured exclusively by UnitedHealthcare, which is the largest provider of Medicare Supplement Insurance. AARP/UnitedHealthcare Medigap plans have low complaint rates when compared to most competitors.
What is the difference between Medicare Advantage and supplemental?
Medicare Advantage and Medicare Supplement are different types of Medicare coverage. You cannot have both at the same time. Medicare Advantage bundles Part A and B often with Part D and other types of coverage. Medicare Supplement is additional coverage you can buy if you have Original Medicare Part A and B.
Can you have private insurance and Medicare?
It is possible to have both private insurance and Medicare at the same time. When you have both, a process called “coordination of benefits” determines which insurance provider pays first. This provider is called the primary payer.
How do I qualify for dual Medicare and Medicaid?
Persons who are eligible for both Medicare and Medicaid are called “dual eligibles”, or sometimes, Medicare-Medicaid enrollees. To be considered dually eligible, persons must be enrolled in Medicare Part A (hospital insurance), and / or Medicare Part B (medical insurance).
Can seniors get OHP in Oregon?
The Oregon Health Plan (OHP) provides health care coverage for low-income Oregonians from all walks of life. This includes working families, children, pregnant women, single adults, seniors and more.
What is OHP Plus in Oregon?
The main benefit packages are: OHP Plus (BMH): For people eligible for Medicaid or the Children's Health Insurance Program (CHIP). OHP with Limited Drug (BMD, BMM): For people who are eligible for both Medicaid and Medicare Part D.
Does Oregon help with my Medicare premiums?
Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In...
Who's eligible for Medicaid for the aged, blind and disabled in Oregon?
Medicare covers many services, but Original Medicare can leave enrollees with significant cost sharing obligations, and doesn’t cover important ser...
Where can Medicare beneficiaries get help in Oregon?
Oregon’s State Health Insurance Benefit Advisors (SHBA) Free volunteer Medicare counseling is available through Oregon’s State Health Insurance Ben...
Where can I apply for Medicaid in Oregon?
In Oregon, Medicaid is overseen by the Oregon Health Authority (OHA). You can apply for Medicaid ABD or an MSP using this website. An Area Agency o...
What is private health insurance in Oregon?
Private health insurance through HealthCare.gov. Individual health plans, also called private health coverage, are available through the Marketplace. People in every county of Oregon can purchase a plan through the Marketplace. All plans sold through the Marketplace include a comprehensive set of essential health benefits and are regulated by ...
Do Alaska Natives have to pay for co-pays?
This means they do not have to pay for deductibles, co-pays, co-insurance, or prescriptions.
Does Oregon Health Plan cover dental?
It provides free coverage for people in Oregon who meet eligibility criteria. Coverage includes doctor visits, hospital care, mental health services, dental, and some vision care. Learn about Oregon Health Plan coverage.
Does Medicare cover ALS?
Some people who are younger than 65 also qualify for Medicare due to disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS). Medicare does not cover everything, and there is cost sharing involved. It is important to consider additional coverage when you are enrolled in Medicare. The Oregon Senior Health Insurance ...
What is an AAA in Oregon?
Medicare beneficiaries in Oregon can visit an Area Agency on Aging (AAA) for assistance applying for services to help with aging or living with a disability , and help planning for long-term care. This website has more information about AAAs in Oregon.
How much can you have in home equity for Medicaid?
In Oregon, HCBS and nursing home care recipients can have no more than $595,000 in home equity.
Does Oregon have Medicaid?
Oregon does not have a Medicaid spend-down, which means that individuals with incomes above the Medicaid eligibility limit do not have a way of qualifying for regular aged, blind and disabled Medicaid benefits. However, applicants whose income is over the limit for LTSS programs can become eligible for nursing home benefits or HCBS by depositing income into a Qualified Income Trust (known as a “Miller Trust”). Income placed in the Miller Trust isn’t considered when determining eligibility.
Does Medicaid cover long term care?
Every state’s Medicaid program covers some community-based long-term care services, which are provided in an enrollee’s home, adult day care center, or another community setting. Medicaid programs that pay for this type of care are called Home and Community Based Services (HCBS) waivers because recipients can continue living in the community.
Is Medicaid LTSS counted as income?
Eligibility rules for Medicaid LTSS programs differ from other Medicaid benefits when only one spouse is applying. Normally with Medicaid benefits, the income of both spouses is counted – regardless of who is applying. However, for Medicaid long-term care benefits, only the applying spouse’s income is counted.
How to apply for Medicare Part A and B?
To apply, contact your local state Aging and People with Disabilities office by calling 1-800-282-8096 (toll-free). TTY users should call 1-800-282-8096 (toll-free). You may also locate local office information.
Do I need the Marketplace for Medicare?
If you have Medicare, you do not need the Marketplace to get health coverage. Below are frequently asked questions about Medicare and the Marketplace.
Is Medicare part of the Marketplace?
No. Medicare is not part of the Marketplace. If you have Medicare, you are covered and do not need to do anything about the Marketplace. The Marketplace will not affect your Medicare choices or benefits.
Eligibility
Applicants can use Oregon Helps to find out if they may be eligible for various forms of assistance, including OHP. They can also visit a qualified hospital to see if they are eligible for immediate and temporary medical assistance' through the Hospital Presumptive Eligibility process.
Questions?
If you have questions not answered on this page, go to the Contact Us page and send your question to the appropriate contact.
How many people in Oregon have health insurance?
Since Oregon implemented the Affordable Care Act (ACA) in 2014, more than 340,000 Oregonians have gained health insurance. Today, 94 percent (3.7 million Oregonians) have coverage. The current uninsured rate is almost two-thirds lower than the 15 percent who were uninsured in 2011 (before Oregon implemented the ACA and expanded Medicaid).
Why are some Oregonians not covered by OHP?
Reasons for lack of OHP coverage: A large portion of the uninsured were eligible for OHP. The top three reasons Oregonians cited for not being covered by OHP were: concerned about high costs of coverage ...
Which ethnicity has the highest rate of uninsured?
Ethnicity: Hispanic Oregonians constituted the racial/ethnic group with the highest rate of uninsurance (15 percent). Asians had the lowest percentage of uninsured (2 percent). Gender: Men had a higher rate of uninsurance (7.3 percent) than women (5 percent).
Does OHP have a deductible?
There are no premiums costs or deductibles for OHP benefits. OHP offers a comprehensive benefit package of medical, behavioral health and oral health care. Children and adults who qualify for coverage under the Oregon Health Plan can apply any time during the year. Oregonians can find coverage at OregonHealthCare.gov .
Benefit Packages
QMB has four benefit packages based on an individual’s income. The income limits listed are for March 2021 through February 2022.
How to apply
To apply for QMB, contact your Oregon Department of Human Services (DHS) or Area Agency on Aging (AAA) local office. The agency will make a decision on your application within 45 days of the date you submit your application.