Understanding Medicaid Coverage & Oregon Health Plan
Access to healthcare should never depend on your income. If you live in Oregon and have a low or moderate income, you might qualify for the Oregon Health Plan (OHP) — Oregon's version of Medicaid. OHP offers free or low-cost health coverage, including medical, dental, and mental health care.
Let’s break down what OHP is, who qualifies, what it covers, and how Neighborhood Health Center (NHC) can help you apply.
What is Medicaid?
Medicaid is public health insurance for people with low income. Medicaid makes sure income doesn't stand between you and essential services like doctor visits, prescriptions, and emergency care. It's funded by both the federal and state governments and is designed to make sure you can get care when you need it, even if you can’t afford private insurance.
Each state runs its own Medicaid program. In Oregon, it’s called the Oregon Health Plan.
What is the Oregon Health Plan (OHP)?
OHP is what we call Medicaid in Oregon. It provides healthcare coverage to people with low to moderate incomes. It’s especially helpful for:
- Children and teens
- Pregnant people
- Adults ages 19–64
- People with disabilities
- Seniors with limited income
Eligibility is based on household income and family size.
Oregon uses Coordinated Care Organizations (CCOs) to deliver services. A CCO is a group of local doctors, dentists, counselors, and other providers who work together to manage your care. That means your providers share information, coordinate services, and put you at the center of your health.
Learn more about your healthcare options in Oregon
What OHP Covers
OHP provides complete healthcare coverage that goes beyond just basic medical care.
When you have OHP, you get access to:
Primary Care
Things like regular check-ups. You can also get preventive care like vaccines, health screenings, and annual physicals.
Dental Care
OHP includes dental coverage. You can get cleanings, fillings, extractions, and other necessary dental treatments.
Mental Health and Addiction Treatment
OHP covers counseling, therapy, and treatment for substance use disorders. Get help for depression, anxiety, trauma, and other mental health concerns without paying out of pocket.
Prescription Medications
Most medications prescribed by your doctor are covered under OHP. This includes both generic and brand-name drugs when medically necessary.
Specialist Care
When your primary care provider refers you to a specialist, OHP covers those visits. This might be cardiologists, orthopedists, dermatologists, or other specialists.
Emergency Services
If you have a medical emergency, OHP covers emergency room visits, ambulance services, and urgent care.
Hospital Care
Both inpatient and outpatient hospital services are covered. This included surgeries, medical procedures, and hospital stays.
Women's Health Services
Family planning services, prenatal care, delivery, and postpartum care are covered.
Vision Care
Some vision services are covered, especially for children and people with certain medical conditions.
Specific services and any limitations may vary. So it's always good to check what's covered. You can also visit OHP's website for the most current information.
Coverage details may vary, so check OHP.Oregon.gov or talk with an enrollment specialist if you have questions.
Related: What You Might Not Know About OHP Benefits
Who Qualifies for OHP?
You might qualify for OHP if your income falls within certain limits. These limits can change, so be sure to check the current numbers on Oregon.gov. Or speak with an enrollment specialist.
Remember, you don't need to be unemployed to qualify for OHP. Many working people have OHP coverage. You might work full-time or part-time and still qualify if your income is below the limit. Some jobs don't offer health insurance, or the employer’s insurance is too expensive. Some people may even qualify for their employer’s insurance and still be on the Oregon Health Plan.
Why Enroll in OHP
Having health insurance through OHP offers:
Cost Benefit
OHP is low-cost or free health insurance in Oregon. Most people don't pay monthly premiums, and there are usually no co-pays for most services. This means having health insurance through OHP offers:
Comprehensive Coverage
Some insurance plans only cover major medical expenses. OHP includes preventive care, dental care, and mental health services. It's designed to keep you healthy, not just treat you when you're sick. It covers care for your mind, body, and smile.
Access to Regular Care
With OHP, you can establish a relationship with a primary care provider. This means consistent care with someone who knows your health history.
No Surprises
When you have OHP, you won't get surprise medical bills you can't afford.
Family Coverage
If you qualify, your whole family can get covered.
Support During Life Changes
Say you lose a job, have a baby, or experience other life changes that affect your income. OHP can provide stability during uncertain times.
How to Apply for the Oregon Health Plan
There are several ways to start the application process:
Apply Online
This is the fastest way to apply. The website is available 24 hours a day. And you can save your application if you need to gather more information. The online system at One.oregon.gov will guide you through each step and let you know what documents you need.
Over the Phone
You can call, and a trained specialist will help you apply for or renew your OHP coverage by helping you complete your application and answer any questions you have.
In-Person Help
Sometimes it helps to have someone sit with you and walk through the application. Many community health centers have trained staff who can help you apply for free.
Here at Neighborhood Health Center (NHC), we have Certified Outreach & Enrollment Coordinators. They can help you apply for or renew your OHP coverage. And it's free of charge. You don't have to be an NHC patient to get this help. It's a service we provide to the whole community.
Find local community partners who can help you apply
Required Information
When you apply, you'll need information about you and your household, income, and any current insurance. This might include pay stubs, tax returns, or other income documents. You may also need an ID or proof of identity if you are not a US citizen. Don't worry if you don't have everything perfect. Enrollment assistors can help you figure out what you need.
When to Apply
You can apply for OHP at any time of the year. Unlike some other insurance, there's no specific enrollment period. If you qualify, your coverage can start the same month you apply.
Staying Enrolled: Renewals
As of 2024, most people need to renew their OHP coverage every two years. Here's how to stay covered:
- Keep your contact info up to date with the state
- Watch your mail for renewal packets
- Return forms quickly to avoid gaps in coverage
Need help? NHC Outreach & Enrollment Coordinators can help you renew.
What Happens if You Miss Renewal
If you miss your renewal deadline, you might lose coverage temporarily. However, you can often get coverage back by completing the renewal process, even if it's late.
What if You Don't Qualify for OHP?
Not everyone will qualify for OHP. If you don’t, there are still options to help you get affordable healthcare:
Sliding Fee Discounts
At NHC, we offer a sliding discount fee based on your income and family size. This maintains affordable healthcare for Oregon. You pay what you can afford. The sliding fee scale ensures that cost doesn't prevent you from getting care.
Other Insurance Options
If you don’t qualify for OHP, NHC's enrollment assistors can still help you explore other options. This includes plans through the Health Insurance Marketplace. You might also qualify for help that makes private insurance more affordable.
Payment Plans
Many healthcare providers, including NHC, offer payment plans. These let you spread the cost of care over time rather than paying it all up front.
How NHC Supports OHP Patients
At Neighborhood Health Center, we're proud to serve many patients who use OHP. We believe everyone deserves quality healthcare, regardless of how they pay for it.
We offer:
- Medical, dental, and behavioral healthcare all in one place (at some locations)
- Enrollment help for new or returning OHP members
- Judgment-free care for all patients, regardless of insurance
Browse all of NHC's services
Breaking Down Stigma Around Public Insurance
Some people feel embarrassed about using Medicaid or other public insurance programs. This stigma is unfortunate and not true. Here are some facts that might help:
- Many OHP recipients are working or in families where someone works. Having OHP doesn't mean you're just taking services. It means you're getting help to stay healthy.
- Preventive healthcare saves money for everyone. When people can get regular check-ups and manage chronic conditions, it prevents expensive emergency room visits and hospital stays.
- Through taxes and other contributions, you've helped fund the safety net that OHP represents. Using it when you need it is part of how the system is supposed to work.
- Access to healthcare shouldn't depend on your ability to pay. Many people use OHP during specific life circumstances. Job loss, pregnancy, when starting a business, or while in school. It's there when you need it. And you can move to other insurance when your situation changes.
OHP is Oregon's commitment to ensuring that everyone has access to healthcare. Whether you're struggling to afford health insurance, between jobs, starting a family, or facing other transitions, OHP/Medicaid can help. It's exactly why it's here. Take the first step today.
If you're uninsured or wondering about your options, NHC is here to help. Apply for OHP today or connect with one of our Outreach & Enrollment Coordinators to learn more.