Medicare and the Oregon Health Plan (OHP)

When You Go on Medicare, Your OHP Benefits Change or End.

As soon as you know you are or will be on Medicare, ask your local Aging and People with Disabilities or Area Agency on Aging for help. They will help you with this change.

Most OHP members with Medicare have the OHP with Limited Drug benefit. This covers the same benefits as OHP Plus, except for drugs that Medicare Part D covers.
Some members may no longer qualify for OHP. For example, Qualified Medicare Beneficiaries (QMB) will only get an Oregon Health ID card so that the Oregon Health Authority (OHA) can pay for Medicare cost-sharing.
QMB members with OHP have the QMB + OHP with Limited Drug benefit. This means they still have OHP, and OHA pays for Medicare cost-sharing.

Do You Have Medicare and OHP?

Medicare acts as the member’s main health coverage. If you have both Medicare and OHP:

OHP can help pay for things like Medicare premiums, deductibles, and coinsurance.
OHP also covers things Medicare does not, such as rides to appointments and dental care.

OHP and Medicare benefits can work together. Your medical, dental, and mental health benefits can be covered by one plan called a coordinated care organization (CCO). Read the OHP and Medicare brochure to learn more. You do not have to get medical care through your CCO.

If you get Medicare while you have OHP, your CCO will not change.

Your OHP benefits do not include drugs that are covered by Medicare Part D. If you qualify for Medicare Part D but choose not to enroll, you will have to pay for drugs that Medicare Part D would cover if you had it.

Ask your CCO about Medicare Advantage plans.

Medicare Advantage plans work with your CCO to align your OHP and Medicare benefits.
They sometimes cover more benefits than traditional Medicare, such as vision or dental care.
Medicare Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans that work closely with your OHP benefits. D-SNPs are available in many areas of Oregon.

Not in a CCO? Ask your local Oregon Department of Human Services office for help.

These include your Medicare ID, Oregon Health ID, Medicare Advantage ID, CCO/plan ID, Medigap card and Medicare Part D plan card.

If you are a Qualified Medicare Beneficiary (QMB), you are not responsible for Part A or B copays, deductibles or coinsurance charges. You also do not have to pay for any services covered by Medicare Part A or B.

QMB members with OHP coverage have the QMB + OHP with Limited Drug benefit package listed on their coverage letter.
QMB members without OHP coverage have only the Qualified Medicare Beneficiary benefit package.

Medicare Part D has copayments on covered drugs.

OHP does not pay Medicare premiums, deductibles or copayments for Medicare Part D drug plans or services.

The Estate Recovery Program may collect money from your estate when you die. This money will help repay the state for your care.

Frequently Asked Questions

The Oregon Health Plan (OHP) is Oregon's Medicaid program. There are several health care programs available for low-income Oregonians through OHP.

OHP Plus for children ages 0-18 and adults ages 19-64
OHP Plus Supplemental for pregnant adults age 21 or older
OHP with Limited Drug for adults who qualify for both Medicaid and Medicare Part D

Other medical programs available include OHP Dental (dental-only benefits for Oregon Veterans and Compact of Free Association citizens), and Qualified Medicare Beneficiary.

Medicare is health insurance for: