Is OHP Medicare or Medicaid? Coverage, Eligibility, and Dual Enrollment

The Oregon Health Plan is Medicaid, not Medicare. OHP is the name Oregon gives its Medicaid program, a joint state and federal program that covers medical care based on financial need. Medicare is a separate federal program tied to age or disability rather than income. Some Oregonians qualify for both at the same time, but the two programs are distinct in who runs them, who they cover, and how you enroll.

How OHP and Medicare Differ

OHP was created by the Oregon legislature under Oregon Revised Statutes Chapter 414 to provide access to affordable health care for lower-income residents.¹ The state and federal government share the cost, and Oregon administers the program through the Oregon Health Authority and the Department of Human Services.² Because it is Medicaid, eligibility depends primarily on your household income.

Medicare is different. It is a federal program run by the Centers for Medicare and Medicaid Services, and you enroll through the Social Security Administration.³ Medicare covers people 65 and older, people who have received Social Security disability benefits for 24 months, and people with end-stage renal disease or ALS.⁴ Your income does not determine whether you qualify.

So if you are trying to figure out which program you need, the shortcut is this: apply for OHP if your household income is low; apply for Medicare if you are 65 or older or have a qualifying disability. If both apply to you, you can have both.

What OHP Covers

OHP members pay no monthly premiums, no deductibles, and no copays for covered services.⁵ Covered benefits include:⁶

Doctor visits, specialist visits, hospital stays, and emergency care
Mental health and substance use treatment
Preventive and restorative dental care
Prescription medications
Eye exams and corrective lenses
Prenatal care, labor and delivery, and postpartum care
Screenings, lab work, and immunizations
Telehealth visits
Transportation assistance to medical appointments

Some members also qualify for additional benefits tied to health-related social needs, such as housing and nutrition support.⁶

When you are approved, you are placed in a coverage category. Most members receive OHP Plus, the comprehensive benefit package for children and for adults ages 19 through 64 who meet income rules. Adults who also have Medicare receive OHP with Limited Drug, which keeps full OHP Plus medical, dental, and behavioral health coverage but coordinates prescription benefits with Medicare Part D.⁷

Who Qualifies for OHP

Income

OHP eligibility is measured against the Federal Poverty Level. For most adults ages 19 to 64, you qualify if household income is at or below 138 percent of the FPL.⁸ In 2026, that comes out to roughly $1,835 per month for a single person.9 The limit goes up with household size.

Children and pregnant individuals qualify at higher income levels. Children ages 1 through 18 can qualify at income up to 305 percent of the FPL, though those between 139 and 305 percent cannot already have other health coverage. Children under age 1 qualify up to 190 percent of the FPL without restrictions, and up to 305 percent if they lack other coverage. Pregnant individuals also have higher thresholds than the standard adult limit.¹⁰ Income limits are updated each year, so check the current chart before you apply.

Residency and Immigration Status

You must live in Oregon. Immigration or citizenship status has not affected eligibility for full OHP benefits since July 1, 2023. Oregon’s Healthier Oregon program, established by House Bill 3352, extended full coverage to all residents who meet income and other criteria, regardless of immigration status.¹¹ Before that change, many residents without qualifying immigration status could only receive emergency Medicaid.

Older Adults and People With Disabilities

If you are 65 or older or have a disability, you qualify through a different pathway that adds an asset test to the income test. Resource limits for this group are $2,000 for a single person and $3,000 for a married couple. Applications that require a disability determination can take longer to process than the standard 45-day window because the state has to verify the disability.

When You Qualify for Both OHP and Medicare

Being on Medicare does not shut you out of OHP. Some Oregonians, especially those 65 or older or those with disabilities, meet both programs’ rules and enroll in both. When that happens, Medicare typically pays first for covered services and OHP fills in remaining gaps. OHP can also cover things Medicare does not, such as dental care and certain behavioral health services.

Oregon also participates in Medicare Savings Programs, which use Medicaid funds to help pay Medicare premiums and out-of-pocket costs. In 2026, the programs and income limits for a single person are:¹²

Qualified Medicare Beneficiary (QMB): monthly income up to $1,350 and resources up to $9,950. Covers Part A and Part B premiums, deductibles, coinsurance, and copays. Providers cannot bill you for any covered costs.
Specified Low-Income Medicare Beneficiary (SLMB): monthly income up to $1,616 and resources up to $9,950. Covers Part B premiums.
Qualifying Individual (QI): monthly income up to $1,816 and resources up to $9,950. Covers Part B premiums. Only available if you do not qualify for other Medicaid coverage.
Qualified Disabled and Working Individual (QDWI): monthly income up to $5,405 and resources up to $4,000. Covers Part A premiums only.

All four programs also provide Extra Help with prescription drug costs, capping your copay at no more than $12.65 per covered drug in 2026. Married couples have higher income limits. You apply through the regular OHP application; there is no separate form.¹²

How to Apply for OHP

Before you start, gather the following for each household member seeking coverage:

Social Security number, if the person has one or can obtain one
Date of birth
Tax filing status and dependent information
Employer name, gross pay before taxes, and pay frequency
Self-employment income, listed as gross before business expenses
Other income such as Social Security, unemployment, or rental income
Details about any existing health coverage

Report income as gross, the amount before taxes or deductions. The state evaluates your current monthly earnings, not just annual totals.¹³ If you are asked to submit proof of income or other documents, coverage does not start until those documents arrive.

You can submit an application three ways:

Online at ONE.Oregon.gov¹⁴
On paper, downloaded from the Oregon Health Authority website and mailed or delivered to a local Department of Human Services office⁷
By phone, with a state representative entering the information for you

The state typically processes applications within 45 calendar days. Disability-based applications can take longer. If you have not heard anything after 45 days, contact the office where you applied.⁷

Once approved, you are enrolled in a Coordinated Care Organization within three business days. A CCO is a local health plan that connects you with doctors, dentists, and counselors in your area.¹⁵ You can pick a CCO on your application or later through your ONE.Oregon.gov dashboard; if you do not choose one, the Oregon Health Authority assigns one, except for American Indian and Alaska Native members.¹⁶

1
Oregon State Legislature. Oregon Revised Statutes Chapter 414 – Medical Assistance
2
Oregon Health Authority. Oregon Health Plan (Oregon Medicaid)
3
Social Security Administration. Manage Your Medicare Benefits
4
Medicare. Get Started With Medicare
5
Oregon Health Authority. OHP Summary of Benefits and Coverage
6
Oregon Health Authority. Oregon Health Plan (OHP) Benefits
7
Oregon Health Authority. Apply for the Oregon Health Plan (OHP)
8
Oregon Health Authority. Apply for the Oregon Health Plan (OHP)>
9
U.S. Department of Health and Human Services. 2026 Poverty Guidelines
10
Oregon Health Authority. 2026 Income Guide for MAGI Oregon Health Plan (OHP) Programs
11
Oregon Health Authority. Healthier Oregon – Oregon Health Plan
12
Medicare. Medicare Savings Programs
13
Oregon Health Authority. OHP 9043b ONE Application Guide
14
ONE Home Page. About Medical, Food, Cash or Child Care Assistance
15
Oregon Health Authority. Coordinated Care Organization (CCO) Plans
16
Oregon Health Authority. Changing Your Coordinated Care Organization (CCO) Enrollment