Oregon Health Plan (OHP) Benefits

What Does OHP Cover?

The summary of benefits and coverage gives an overview of all the types of care OHP covers.

In general, OHP covers health care services only when they are in your benefit package and are:

• Supplied in the United States by providers who accept the Oregon Health ID card and
• Medically necessary. This means the service is important to keep you healthy or help you get better.
  

For adults, OHP covers services according to your benefit package and the Prioritized List of Health Services. (For children under age 21, the Prioritized List does not determine benefit coverage.)

• Do you want to know if OHP covers a specific service? If so, please ask your provider or coordinated care organization (CCO). Learn more about working with your CCO and finding OHP providers.
  
• Do you want to know if OHP covers treatment for a specific health condition? Use the Searchable Prioritized List to find Guideline Notes about the health condition.
  

Learn about Your Benefits

To know what benefits you have, view your OHP coverage letter. It lists your benefit package.

Don't have your OHP coverage letter? Look in your dashboard at ONE.Oregon.gov (under "Current Benefits").

Learn more about your benefits in your OHP member handbook.

If you are in a CCO, you may be able to receive flexible services. These are items or services that are not regular OHP benefits, but can help you stay healthy or become healthier.

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

To learn what OHP covers, click each type of care for more details. You can also view the summary of OHP benefits and coverage.

Behavioral health care   Care coordination   Dental careDiagnostic and preventive care   Emergency care and urgent care   EPSDT (care from birth to age 21)   Eye and vision care   Gender-affirming care   Medical care   Pregnancy care   Prescriptions   Telehealth   Travel help   Limited or not covered services  

Some OHP members may also qualify for health-related social needs benefits. These benefits are for members facing certain life changes. Learn more about these benefits:

Housing benefits   Nutrition benefits  

OHP Dental

OHP Dental covers dental-only benefits for eligible Oregon Veterans and Compact of Free Association (COFA) citizens. Learn more about OHP's dental-only programs.

Qualified Medicare Beneficiary (QMB)

QMB does not cover health care. It only covers Medicare premiums and copayments (except for Medicare Part D) and deductibles.

Frequently Asked Questions