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Oregon Health Plan Benefits

The Oregon Health Plan provides Oregonians access to coordinated health care. It covers services such as regular check-ups, prescriptions, mental health care, addiction treatment and dental care.

Benefits Covered under OHP Plus, OHP with Limited Drug and CAWEM Plus

To see what OHP covers, view the benefit chart below or the OHP benefit chart. OHP benefits are covered according to your benefit package and the Prioritized List of Health Services.

  • To find out if a specific service is covered, please ask your provider or coordinated care organization (CCO).
  • More information about your coverage and your CCO was in your OHP welcome letter.

Benefits Chart

Chemical dependency care  
Dental

Basic services including cleaning, fluoride varnish, fillings and extractions

Urgent or immediate treatment

Dentures

Stainless steel crowns for molars (back teeth)

Other crowns for pregnant women and children under age 21.

Sealants, root canals on back teeth for children under age 21.

Hearing Hearing aids and hearing aid exams
Home health Private duty nursing
Hospice care End-of-life care. Not covered for CAWEM Plus clients.
Hospital care

Emergency treatment

Inpatient and outpatient care

Immunizations and vaccines Such as the flu shot or measles-mumps-rubella (MMR) vaccine
Labor and delivery for pregnancy  
Laboratory tests and X-rays
Medical care from a physician, nurse practitioner or physician assistant Such as a routine check-up or a general appointment
Medical equipment and supplies Such as diabetes testing strips or crutches
Medical transportation Such as an ambulance or non-emergency transportation to an appointment
Mental health care Such as therapy or medical treatment
Physical, occupational and speech therapy  
Prescription drugs OHP with Limited Drug only includes drugs that are not covered by Medicare Part D
Vision

Medical services

Services to correct vision for pregnant women and children under age 21

Glasses are covered for pregnant adults and adults who have a qualifying medical condition such as aphakia or keratoconus, or after cataract surgery.

Other Benefit Packages

CAWEM

Covers emergency medical, emergency dental and emergency transport services.

Qualified Medicare Beneficiary (QMB)

Only covers Medicare premiums and copayments (except for Medicare Part D) and deductibles.

OHP Frequently Asked Questions

How do I apply for OHP benefits?

Visit the OHP How to Apply page to find out more about the application process and where to find an application.

What do I need to know if I’m new to OHP?

View the Getting Started with the Oregon Health Plan guide or visit the New to OHP page to find more information about getting started with OHP.

How do I find out if a specific service is covered under OHP?

Ask your provider or coordinated care organization (CCO) if a specific service is covered. You can also call OHP Client Services at 1-800-273-0557 for more information.

Don’t see your question here?

Read more OHP Client Questions and Answers.

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