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Other State Programs
Medicaid
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Medicaid is a program administered by each state. In Oregon, the Medicaid program is called the Oregon Health Plan (OHP). OHP is a public health insurance program for certain categories of people with low incomes. Some of those categories are: children, pregnant women and newborns, people with disabilities, and people who need long-term care.
 
Eligibility
There are different eligibility requirements for different programs. Children and pregnant adults, for example, qualify for insurance at higher income levels than non-pregnant adults. Everyone completes the same application. OHP eligibility specialists match the person (or each person in a family) to programs.
 
For example: You are a family of four, two adults and two children. You earn just a bit too much for the adults to qualify, however, your children qualify for insurance because the program for them takes higher incomes and has immediate openings.
 
Program
Most OHP clients have managed care plans. This means they get a list of doctors and services to use. In some areas, there are no managed care plans. In this case, clients receive an "open card." This means they can go to any doctor who takes OHP clients.
 
Different clients have different benefits. For example, OHP Plus and OHP Standard are different benefit packages. Your package determines what medical services are covered. Oregon's budget also is a factor. Because the state doesn't have enough money to pay for everything, it ranks services and covers those that are most effective.
 
Learn more at: http://www.oregon.gov/OHA/healthplan/index.shtml.
 
 

OHP For Seniors
OHP has programs that help people pay some of their Medicare costs as well as programs to pay for nursing homes and other types of residential care. Learn more at: http://www.oregon.gov/DHS/spwpd/hlth_med/healthmed.shtml#medicaid.

Non-citizens
The Citizen Alien-Waived Emergency Medical Assistance (CAWEM) clients are not U.S. citizens and do not qualify for Medicaid based on their immigration status. Coverage is limited to emergency services and childbirth. For details: http://www.dhs.state.or.us/spd/tools/program/cawem.htm.

Medicare
Because Medicare is health insurance, you share the costs of your care.
 
Medicare is the federal health insurance program for:
  • Americans age 65 and older
     
  • People of all ages with certain disabilities
     
  • People with end-stage renal disease (ESRD) - permanent kidney failure requiring dialysis or a kidney transplant.
Original Medicare (Parts A & B) is a fee-for-service plan that is managed by the federal government. It pays for many but not all health care services and supplies.
 
To avoid a late penalty, enroll in Medicare when you first become eligible. If you already have health insurance from an employer or another source, talk to your benefits administrator about whether you should join Medicare while still covered.
 
Medicare has four parts:
  • Hospital insurance (Part A)
  • Medical insurance (Part B)
  • Medical Advantage (Part C)*
  • Prescription Drug Insurance (Part D)
Medicare Parts A and B do not cover all your health care costs. Because of these "gaps" in coverage, you may want to buy additional insurance. Private insurance companies sell Medigap plans (also called Medicare Supplements). Private Medicare Advantage plans combine all Medicare-covered benefits into a single package that may offer more services, such as dental and vision, than a Medigap plan. Typically, you need to live within the plan's service area, and may pay extra to go outside the plans network. Medicare Advantage Plans may be purchased with or without prescription drug coverage (Part D).
 
*What is Part C? Medicare Advantage (Part C) gives you the choice of receiving the benefits of Medicare A and B through a private health plan.
 
Costs
  • Most people don't pay a premium for Part A. There is a monthly premium for Medicare Part B that changes yearly.
     
  • Because Parts A and B don't cover all costs, many people with Medicare buy additional insurance. It might be a Medigap supplement plan or a Medicare Advantage plan. Most plans have a separate monthly premium.
     
  • Prescription drug coverage typically has a separate premium, although it may be part of a Medicare Advantage plan.
     
  • In addition to the monthly premium, you share in other costs of your hospital medical, and/or prescription drug coverage when you use services.
 
Help with Premiums
If you pay a premium for Part A and have a limited income, Medicare Savings Programs may help you pay. You may receive help paying for Part B premiums. To find out if you qualify, contact your local office of Seniors and People with Disabilities Services for an application, at 800-282-8096, or http://www.oregon.gov/DHS/spwpd/offices.shtml.
 
People with limited income and resources may be eligible for extra help paying for prescription drug coverage, as well. To find out if you qualify for extra help, contact Social Security at 800-772-1213 or online at http://www.socialsecurity.gov.
 
If you already have prescription drug coverage from an employer, former employer, or other source, you may be better off keeping that coverage. Contact your benefits administrator to find out how your existing coverage works with Medicare drug coverage before you make a decision.
 
Be sure to consult with your employer before leaving the employer's plan. If you leave your employer coverage and later change your mind, you probably will not be able to return for health or prescription drug coverage.
 
Help with Medicare
Local
 
The Senior Health Insurance Benefits Assistance (SHIBA) program provides free counseling to people with Medicare and those who assist them. Volunteers who are trained in Medicare can help you select a Medicare prescription drug plan; find out if you are receiving all possible benefits; compare supplemental health insurance policies; review a bill; and file an appeal or complaint. This program is part of the Oregon Department of Consumer and Business Services and is funded by a federal grant.
  • Call 800-722-4134. You will be routed to a volunteer in your area.
  • Or visit: www.oregonshiba.org
Federal