Medicaid and the Oregon Health Plan
Section Summary
Navigating health insurance can be incredibly complex. It's important that individuals of all ages are educated on the process of acquiring and utilizing health insurance in Oregon to ensure their health needs are met. This section discusses:
- What is Medicaid and the Oregon Health Plan?
- How can I apply and maintain eligibility for the Oregon Health Plan?
- What is private insurance?
- Common terms in health insurance
Medicaid and the Oregon Health Plan
The most common types of health insurance used by youth and young adults include Medicaid, employer-sponsored health insurance, and private health insurance. Determining which type of health insurance one is eligible for and how one’s insurance plan can be put to use are critical to maintain and enhance the health and well-being of Oregonians.
Medicaid is a federal program that operates across the United States to ensure individuals of all ages who are experiencing financial constraints and struggling with limited resources are provided with free or low-cost health care. In 2024 in the United States, nearly 80 million people were covered by Medicaid. Each state implements its own Medicaid program via state and federal funding.
The Oregon Health Plan (OHP) is Oregon’s Medicaid program that offers free health coverage for people who live in Oregon and meet the program’s eligibility requirements. For instance, OHP may cover services such as dental and hospital care, doctor visits, and mental health support. Luckily, through OHP, a handful of healthcare programs exist to meet the needs of low-income Oregonians.
- OHP Plus addresses the needs of children who are between the ages of 0 to 18 and adults who are between the ages of 19 to 64.
- OHP Plus Supplemental addresses the needs of pregnant adults who are age 21 or older.
Eligibility
In order to qualify for OHP, individuals or families must meet certain residency and income requirements.
- Residency requirements
- Income requirements and income limits (subject to change annually)
Not sure if OHP is the right fit for you? Use this tool to help guide your decision.
Applying for OHP
An individual can apply for OHP at any time since enrollment in the program is always open year round. There are several different routes one can take to apply for OHP which include applying online, in-person, or by the phone.
To apply for OHP online, an individual must first create a ONE account by going to one.oregon.gov and then follow this step-by-step guide to assist them in setting up their account. Following the creation of their account, an individual must go to one.oregon.gov and click “Apply Now”. Refer to this step-by-step guide on how to complete the application.
Alternatively, to apply for OHP in person, individuals can find a local Oregon Department of Human Services (ODHS) office near them or to apply over the phone call ONE Customer Service at 1-800-699-9075.
Recertification & Reporting Changes
Participating in the recertification process and reporting changes to OHP is an important step to ensure individuals still qualify for health care coverage. To ensure that OHP is able to easily contact you, regularly check that personal information is up-to-date (including address, phone number, and email). This step is essential in breaking down barriers to effectively communicate with OHP personnel and preventing a delay in receiving healthcare coverage.
Personal information can be viewed and/or edited online through one’s Oregon Eligibility (ONE) account by following this step-by-step guide (see page 8) or by calling the ONE Customer Service Center at 800-699-9075. Offices are open Monday-Friday from 7:00 a.m. to 6:00 p.m. Individuals can also contact their Coordinated Care Organization (CCO) to update their contact information.
Every two years, OHP sends members a notice regarding whether more information is needed to determine renewal eligibility, a renewal packet is required to be filled out, or one still qualifies or does not qualify for coverage.
These notices are received by members in the mail and/or can be viewed online through one’s Oregon Eligibility (ONE) account; click here to access a step-by-step guide to assist you in setting up an account.
More information about the renewal process can be found here and a step-by-step guide of how to renew your OHP coverage online can be found here.
Alternatively, you can watch the video below to gain further insight into the renewal process.