OHP is Medicaid, not Medicare

Oregon Health Plan (OHP) is a Medicaid program run by the state of Oregon. It is not Medicare. The confusion is understandable because both are government health insurance programs, but they work differently and cover different groups of people.

Medicare is a federal program that covers people age 65 and older, regardless of income, plus some younger people with disabilities or end-stage renal disease. Medicaid is a joint federal and state program that covers people with low income. Oregon's version is called OHP, and it is the state's Medicaid program.

If you live in Oregon and have low income, you may be covered by OHP. If you are 65 or older, you may have both Medicare and OHP at the same time — this combination is called "dual coverage." Understanding which program you have, or whether you have both, matters because they cover different services and have different rules.

Key Takeaways

  • OHP is Oregon's Medicaid program for people with low income, while Medicare is a federal program for people 65 and older or with certain disabilities.
  • You can have both OHP and Medicare at the same time if you are 65 or older and meet Oregon's income limits.
  • OHP covers doctor visits, hospital care, prescription drugs, and dental care, depending on which OHP plan you are in.
  • To find out whether you have OHP, Medicare, or both, contact the Oregon Health Authority or your insurance card will show which program covers you.

How OHP and Medicare are different

Medicare and OHP are funded and run by different government bodies. Medicare is run by the federal Centers for Medicare and Medicaid Services (CMS). OHP is run by the Oregon Health Authority, a state agency. This means the rules, covered services, and costs are different for each program.

Medicare has the same rules nationwide. OHP rules are set by Oregon and can differ from Medicaid in other states. For example, Oregon's OHP covers dental care for adults, but not all states' Medicaid programs do. If you move to another state, your OHP coverage will not follow you — you would need to look into that state's Medicaid program instead.

The income limits are also different. Medicare has no income limit — anyone 65 or older can have it. OHP has income limits that change each year based on the federal poverty level. In 2024, the income limit for a single person in Oregon was roughly 138% of the federal poverty level, but this number changes annually. You can contact the Oregon Health Authority to find the current limit.

What OHP covers

OHP covers a broad range of health services. All OHP members receive coverage for doctor visits, hospital stays, emergency care, lab tests, X-rays, and prescription drugs. Mental health services and substance use treatment are also covered. Dental care for adults is included in OHP, which is unusual — many states' Medicaid programs do not cover adult dental.

OHP has different plan types, and what you pay out of pocket depends on which plan you are in and your income level. Some OHP members pay nothing for most services. Others pay small copays — usually a few dollars per visit or prescription. The Oregon Health Authority website lists the exact copays for each plan type.

One important difference from Medicare: OHP does not cover long-term care in a nursing home the way Medicare does. However, OHP does cover some long-term services and supports, including in-home care and assisted living, depending on your needs and income. If you need nursing home care, you would need to explore other options or Medicaid's long-term care coverage rules.

If you are 65 or older and have both OHP and Medicare

Many seniors in Oregon have both programs. You would have Medicare because you are 65 or older, and OHP because your income is low enough to meet Oregon's limits. When you have both, Medicare is your primary insurance and OHP is secondary — Medicare pays first, and OHP may cover costs that Medicare does not.

This combination can be helpful because Medicare does not cover everything. For example, Medicare has a gap in prescription drug coverage called the "donut hole," and OHP may help pay for drugs during that gap. OHP also covers some services Medicare does not, like adult dental care and vision care.

If you are 65 or older and think you might be low-income enough for OHP, contact the Oregon Health Authority to ask about coverage. You do not need to wait until you are already on Medicare — you can be on OHP before you turn 65. When you turn 65, you will be enrolled in Medicare automatically if you are a U.S. citizen or permanent resident, and your OHP coverage will continue if you still meet the income limit.

How to find out which program covers you

The easiest way to know whether you have OHP, Medicare, or both is to look at your insurance card. The card will say "Oregon Health Plan" or "Medicare" on it. If you have both, you will have two cards.

If you do not have a card or are not sure, you can contact the Oregon Health Authority directly. Their customer service line can tell you whether you are enrolled in OHP and what your coverage includes. You can also log into your account on the Oregon Health Authority website if you have one set up.

If you are not currently covered by either program and think you might be low-income enough for OHP, you can contact the Oregon Health Authority to learn about coverage. They can tell you the current income limits and what documents you would need to provide.

What happens if you have OHP and turn 65

When you turn 65, you become may be able to access for Medicare. If you are a U.S. citizen or permanent resident, you will be enrolled in Medicare Part A (hospital insurance) and Part B (medical insurance) automatically three months before your 65th birthday. You do not have to do anything — it happens on its own.

Your OHP coverage will not stop when you turn 65. If you still meet Oregon's income limits, you will keep OHP as your secondary insurance. This is actually beneficial because OHP will help cover costs that Medicare does not pay.

However, you should be aware that Medicare Part B has a monthly premium, and if you do not enroll when you first become may be able to access, you may face a penalty. OHP does not have a monthly premium. When you have both, Medicare is primary and OHP is secondary, so Medicare will be billed first for your care.

Frequently Asked Questions

Can I have OHP if I am already on Medicare?

Yes. If you are 65 or older and your income is low enough to meet Oregon's limits, you can have both OHP and Medicare at the same time. Medicare will be your primary insurance, and OHP will help cover costs Medicare does not pay. Contact the Oregon Health Authority to see if you meet the current income limits.

Does OHP work the same way in other states?

No. OHP is Oregon's Medicaid program and only works in Oregon. If you move to another state, you will need to look into that state's Medicaid program. Each state runs its own Medicaid program with different rules and covered services. You can contact the new state's health authority to learn about coverage there.

What is the income limit for OHP?

OHP's income limit changes each year and is based on the federal poverty level. In 2024, the limit was roughly 138% of the federal poverty level for a single person, but this varies by family size and changes annually. Contact the Oregon Health Authority or visit their website to find the current income limit for your household size.

Does OHP cover dental care?

Yes, OHP covers dental care for adults, which is unusual — many states' Medicaid programs do not. Coverage includes cleanings, exams, fillings, and some other dental work. The exact services covered depend on your OHP plan type. Check your plan documents or call the Oregon Health Authority to see what dental services are included in your specific plan.

What should I do if I am not sure whether I have OHP or Medicare?

Check your insurance card — it will say which program covers you. If you have both, you will have two separate cards. If you do not have a card or cannot find it, call the Oregon Health Authority customer service line. They can tell you which programs you are enrolled in and answer questions about your coverage.