OREGON HEALTH PLAN BENEFITS
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.
|Chemical dependency care
- Basic services including cleaning, fluoride varnish, fillings and extractions
- Urgent or immediate treatment
- 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 aids and hearing aid exams|
||Private duty nursing|
||End-of-life care. Not covered for CAWEM Plus clients.|
- 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|
||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
||OHP with Limited Drug only includes drugs that are not covered by Medicare Part D|
- 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 & Answers.
HEALTH CARE ACCESS