If You Have OHP and Medicare:
Medicare acts as the member’s main health coverage.
Learn more about what happens if you have both Medicare and OHP.
What is Private Health Insurance?
Some people have both private insurance and OHP. Private insurance is other health insurance, such as plans you buy on your own or get from your job. Private insurance is also called “third-party resource" (TPR) or “third-party liability" (TPL).
Your OHP coverage letter will list it. If you do not see it there, tell your worker and your coordinated care organization (CCO). Also tell them if your private insurance coverage ends or changes.
Your insurance company will manage your health care. You will not be enrolled in a coordinated care organization for OHP.
Your providers should bill private insurance first.
- Ask your insurance company which providers you can see.
- Tell your providers that you now have OHP as your secondary insurance. Show your Oregon Health ID card.
Call your insurance company for a list of their providers. Then call the providers and ask if they take OHP. You can also call your current health care providers and ask them if they take OHP.
If your pharmacy accepts your insurance, but not OHP, tell your insurance company. Ask the company to tell you which pharmacies also bill OHP. Under state law, they must work with pharmacies that can also bill OHP. This is to make sure OHP helps pay for your covered prescriptions.
OHP may be able to do this. Take all your health coverage ID cards to your health care appointments:
- Your Oregon Health ID,
- CCO member ID,
- Private health insurance card, and
- Any other cards, such as your Medicare ID.
Show these cards when you check in.
Report Changes within 30 Days
You must report when you get or lose health coverage, such as private insurance, within 30 days of the change. To report coverage changes, please go to
www.ReportTPL.org.
Need Help Paying Your Insurance Premium?
If you have to pay for your private insurance, that is called paying a “premium." The Oregon Health Insurance Premium Payment (HIPP) program may be able to help pay for the premium. To learn more and apply for premium help,
visit the HIPP program page.