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Oregon Health Plan (OHP) Benefits

 COVID-19: OHP covers testing, treatment and vaccines.
Have OHP and need a test for COVID-19? It’s covered. Need to stay in the hospital because of COVID-19? That’s covered, too. Learn more on OHP's COVID-19 page.

OHP is Oregon's Medicaid and Children's Health Insurance Program. It provides Oregonians access to coordinated health care. It covers services such as:

  • Regular check-ups
  • Prescriptions
  • Mental health care
  • Addiction treatment
  • Dental care

OHP covers services according to:

Your OHP welcome letter lists your benefit package and CCO.

OHP Benefits: OHP Plus, OHP with Limited Drug and CWM Plus

To see what OHP covers, view the lists below. Click each type of care for more details. You can also find more details in the OHP Handbook.

Behavioral health in-home services to support independent living:

  • Personal care attendant services to help with or perform activities of daily living
  • Services to maintain, develop or improve skills needed to perform activities of daily living​

Children, youth and family supports ​such as applied behavior analysisintensive in-home behavioral health treatment and family support services

Mental health care ​such as therapy, medication management, residential treatment and peer delivered services

Substance use disorder treatment such as counseling, medication assisted treatment, acupuncture, residential treatment and peer delivered services​

Learn more about behavioral health services in Oregon.

OHP covers all services needed for their health and development, such as:

  • Screening visits and health exams
  • Visits due to illness, injury or other health changes
  • Follow-up care for any health concerns found at a visit or exam 

To learn more, read OHA's fact sheet and web page about these benefits (also known as EPSDT).​

Basic services including cleaning, fluoride varnish, fillings and extractions

Urgent or immediate treatment

Dentures

Stainless steel crowns for molars (back teeth)

Other crowns for children under age 21 and pregnant adults.

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

Learn more about OHP dental benefits.​

Such as ambulance and emergency room services.

OHP covers emergency care for true emergencies. These are sudden illnesses or injuries that need treatment right away. Not being treated right away could cause severe problems or death.

​Screening and treatment for medical conditions (such as cataracts, glaucoma, injury)

For children under age 21 and pregnant adults, services to correct vision (such as exams, glasses and fittings for glasses)

For other adults, glasses are covered only for certain medical conditions. These include aphakia, keratoconus, or after cataract surgery.

 

Home health care:

  • Care provided by a registered nurse or home health aide
  • Physical, occupational or speech-language pathology services

Hospice services (end-of-life care):

  • Home care
  • Inpatient care at a hospital, hospice or nursing facility
  • Respite care to relieve family members or caregivers

​Emergency treatment

Inpatient and outpatient care

Purchase, rental or repair of medical equipment, such as:

  • Canes or crutches
  • CPAP devices
  • Hospital beds
  • Oxygen equipment
  • Standing and positioning aids
  • Walkers
  • Wheelchairs

Medical supplies, such as:

  • Diabetes testing strips
  • Incontinent supplies

Emergency services, such as an ambulance.

Non-emergency travel, such as:

  • Rides to appointments
  • Help with travel costs (mileage, meals and lodging)

 Learn more about non-emergency travel.​


​Medical care from a physician, nurse practitioner or physician assistant, such as a routine check-up or a general appointment

Physical, occupational and speech therapy to improve skills or function for daily living:

  • To restore skills following an illness, injury or disability, or
  • To teach age-appropriate skills (such as therapy for a child who is not walking or talking at the expected age) 
​Vaccines according to recommended immunization schedules, including:
  • Flu or COVID-19 vaccine
  • Childhood vaccines such as Measles, Mumps and Rubella (MMR)

Prenatal, labor, delivery and postpartum care, such as:

  • Doula care​
  • Prenatal checkups
  • Labor and delivery in a hospital, birthing center or at home
  • Newborn nurse home visits
  • Postpartum counseling

Postpartum care lasts 12 months for OHP Plus members, and 60 days for CWM Plus members. Learn more about CWM Plus benefits:


​Such as medications and oral nutritional supplements

OHP with Limited Drug only includes drugs that are not covered by Medicare Part D. These include:

  • Over-the-counter drugs
  • Barbiturates

Learn more about prescription coverage.

Family planning

  • Birth control, including condoms, birth control pills, immediate postpartum IUD and implants
  • Sterilization services, including vasectomies, getting tubes tied

Regular screenings and tests (such as pelvic exams and Pap tests)​

Pregnancy testing

STD screenings 

Abortion

Laboratory tests and x-rays, such as blood screening and mammograms




Gender affirming services, such as hormone therapy, counseling and some surgeries

Hearing aids and hearing exams​​

​Services to help you stop smoking, such as:

  • Nicotine replacement therapy (such as nicotine gum or patch)
  • Tobacco cessation medications (such as Chantix and Zyban)
  • Counseling


Other Benefit Packages

Citizenship Waived Medical (CWM)

Covers emergency medical, emergency dental and emergency transport services; treatment for end-stage renal disease (kidney failure); cancer treatment; behavioral health crisis services; reproductive health services. 

Learn more about CWM benefits:

OHP Dental

Dental-only benefits for eligible Oregon Veterans and Compact of Free Association (COFA) citizens, starting January 1, 2023. Learn more about OHP's new dental-only programs.

Qualified Medicare Beneficiary (QMB)

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

Frequently Asked Questions

​Visit the Apply for OHP page. You can find out more about the application process and where to find an application.​

There are three steps to getting started using your OHP benefits:​
  1. Get to know your coordinated care organization (CCO). Your CCO can help you get the care you need.
  2. Pick a provider.
  3. Make an appointment.
​Visit the New to OHP page. You can find more information about getting started with OHP.

​When you are approved for OHP, you get an approval letter, then a welcome letter. The welcome letter contains your Oregon Health ID card and lists your coordinated care organization (CCO).

If you don't know if you still have OHP, you can view your dashboard at ONE.Oregon.gov (look under "Current Benefits"). 

You can also call OHP Customer Service at 800-699-9075.

OHP may pay for services you get outside Oregon when: 

  • It is a medical emergency or 
  • The service is not readily available in Oregon, and your CCO or OHA approved the service. 

OHP will not cover any health care services you get outside the United States, including Canada and Mexico. 

For all services you get outside Oregon, the provider must accept OHP. If the provider does not accept OHP, you must pay for the services. 

If you need services outside Oregon: 

  • In an emergency, make sure the hospital knows you are an OHP member. Show your CCO ID and your Oregon Health ID card. 
  • If it’s not an emergency, your CCO or OHA must approve the service first. 

​You can report it as a change to OHP. Learn how to report changes to OHP.

Note: If you qualify for OHP Plus benefits but want to enroll in private health insurance coverage, known as a Qualified Health Plan (QHP), at HealthCare.gov:

  • Canceling your OHP does not mean that you no longer qualify for OHP Plus.
  • As long as you qualify for OHP Plus, you will not qualify for financial help to pay for the QHP's monthly premium. You would need to pay full cost.