Is OHP the Same as Medicare? What You Need to Know

OHP and Medicare are different programs run by different agencies

OHP (Oregon Health Plan) is not Medicare. OHP is Oregon's Medicaid program — it covers low-income adults, children, and families. Medicare is a federal program that covers people 65 and older, regardless of income, plus some younger people with disabilities or end-stage renal disease. They are run by different agencies, have different rules, and cover different groups of people.

If you live in Oregon and are 65 or older, you may be enrolled in both programs at the same time. When that happens, Medicare is your primary insurance and OHP acts as a secondary payer. But they remain two separate programs with separate enrollment processes and separate rules about what they cover.

Understanding which program you are in — or whether you are in both — matters because it changes what you pay, which doctors you can see, and how to file claims. This guide explains the differences and what to do if you are unsure which program covers you.

Key Takeaways

• OHP is Oregon's Medicaid program for low-income people; Medicare is a federal program for people 65 and older or with certain disabilities.
• You can be enrolled in both OHP and Medicare at the same time if you are 65 or older and meet OHP's income limits.
• If you have both, Medicare pays first and OHP pays second, which can lower your out-of-pocket costs.
• You enroll in OHP through the Oregon Department of Human Services; you enroll in Medicare through Social Security or Medicare.gov.
• Check your insurance card to see which program or programs you are currently covered by.

Who OHP covers and who Medicare covers

OHP covers Oregon residents with household income below a certain level. The income limit changes each year and depends on your household size. OHP also covers people who are pregnant, disabled, blind, or over 65, even if their income is slightly higher. You must be a U.S. citizen or may have access to immigrant to enroll.

Medicare covers people 65 and older, people under 65 with end-stage renal disease (kidney failure), and people under 65 who have received Social Security Disability Insurance (SSDI) for at least 24 months. Income does not matter for Medicare — you can be wealthy and still may have access to at 65.

The overlap happens when someone is 65 or older and also has low enough income to may have access to for OHP. In that case, you can hold both cards and use both programs.

How OHP and Medicare work together when you have both

If you are enrolled in both programs, Medicare is always your primary insurance. This means Medicare processes your claim first. If Medicare does not cover the full cost, OHP may pay some or all of what Medicare did not cover, depending on what the service is and what OHP's rules allow.

This arrangement can save you money. For example, if you see a doctor and Medicare covers 80 percent of the cost, you would normally owe 20 percent. But if you also have OHP, OHP may pay part or all of that 20 percent, depending on the service. You should always show both cards when you receive care.

However, having both programs does not mean everything is free. You may still have copays, coinsurance, or deductibles. The exact amount depends on the specific service and what both programs cover.

How to check which program or programs you are in

The easiest way to know which program covers you is to look at your insurance card or cards. Your Medicare card will say "MEDICARE" at the top and will have your Medicare number. Your OHP card will say "Oregon Health Plan" and will have your OHP member ID number.

If you have only one card, you are in only one program. If you have two cards, you are in both. If you are not sure whether you have a card or cannot find it, you can call the program directly. For Medicare, call 1-800-MEDICARE (1-800-633-4227). For OHP, call the Oregon Department of Human Services at 1-800-699-9075.

You can also check your status online. For Medicare, go to Medicare.gov and sign in to your account. For OHP, go to the Oregon Department of Human Services website and use the online portal to check your case status.

How to enroll in OHP if you do not have it

To enroll in OHP, you contact the Oregon Department of Human Services. You can explore online through the Oregon Health Plan website, by phone at 1-800-699-9075, or in person at your local DHS office. You will need to provide proof of income, proof of citizenship or immigration status, and proof of Oregon residency.

The process process usually takes 30 to 45 days. During that time, you may be able to receive emergency coverage for urgent medical needs. If you are 65 or older and already have Medicare, you can still explore for OHP — having Medicare does not disqualify you.

If your income is above the OHP limit but you are 65 or older, you may be able to enroll in a Medicare Savings Program instead. These programs help pay your Medicare premiums and cost-sharing. Ask the Oregon Department of Human Services about this option when you call.

What happens if you turn 65 while you have OHP

When you turn 65, you become may be able to access for Medicare. You do not automatically lose OHP — you can keep both if your income is still low enough. However, you must enroll in Medicare Part A and Part B to avoid penalties later.

You should enroll in Medicare during the three months before your 65th birthday, the month you turn 65, or the three months after. If you miss this window and do not have other may have access to coverage, you may have to pay a late enrollment penalty for the rest of your life.

To enroll in Medicare, go to Medicare.gov, call Social Security at 1-800-772-1213, or visit your local Social Security office. Tell them you want to enroll in Medicare Part A and Part B. At the same time, you can ask about help paying your Medicare costs through Oregon's Medicare Savings Program.

Questions to ask your doctor or insurance company

If you are unsure whether a service is covered, ask your doctor's office or the facility where you are receiving care. Tell them which insurance you have — Medicare, OHP, or both — and ask whether the service is covered and what you will owe. Ask them to check your coverage before you receive the service, not after.

If you receive a bill you do not understand, call the program that should have paid it. If it is a Medicare service, call 1-800-MEDICARE. If it is an OHP service, call the Oregon Department of Human Services. Ask them to explain the bill and tell you whether it was processed correctly.

If you think a service should have been covered and it was not, you have the right to file an appeal. Both Medicare and OHP have formal appeal processes. Ask the program for the appeal form and instructions.

Frequently Asked Questions

Can I have OHP and Medicare at the same time?

Yes, if you are 65 or older and meet OHP's income limits, you can be enrolled in both programs. Medicare will be your primary insurance and OHP will be secondary. Having both can lower your out-of-pocket costs because OHP may help pay what Medicare does not cover.

Do I have to choose between OHP and Medicare?

No. If you may have access to for both, you do not have to choose. You can and should keep both. There is no penalty for having both programs, and having both usually saves you money on medical costs.

What if I am on OHP and turn 65?

When you turn 65, you become may be able to access for Medicare. You should enroll in Medicare Part A and Part B during the enrollment window (three months before, the month of, or three months after your birthday). You can keep OHP at the same time if your income is still low enough. Contact Social Security to enroll in Medicare.

Will OHP pay for things Medicare does not cover?

Sometimes. OHP may cover some services that Medicare does not, or may help pay your Medicare cost-sharing (copays and deductibles). However, OHP has its own coverage rules, so it does not cover everything. Ask your doctor or OHP directly whether a specific service is covered.

How do I know if my doctor takes both OHP and Medicare?

Call your doctor's office and ask whether they accept both OHP and Medicare. Some doctors accept one but not the other. If your doctor does not accept OHP, you may need to find a different provider or ask OHP for a referral to someone who does accept both programs.