UPDATE: For the year 2020, no significant changes are expected to be made to Medicaid insurance.
Oregon Medicaid coverage, also known as Health Plan (OHP), provides patients with access to coordinated health care. The Medicaid services covered include dental care, treatment of addiction, mental health care, prescriptions and regular check-ups.
What is covered by Medicaid depends on the patient and types of Medicaid insurance for which he or she qualifies. Continue on to review information about Medicaid coverage and costs through the following sections:
- How Much Does Medicaid Cost in Oregon?
- What Services are Covered by Medicaid in Oregon?
- What Does Medicaid Not Cover in Oregon?
- Types of Medicaid Insurance in Oregon
How Much Does Medicaid Cost in Oregon?
Oregon Medicaid cost estimates vary depending on the health service a member needs. OR Medicaid coverage offers mental and dental services under benefit packages. The benefit package that a client qualifies for depends on factors such as his or her health condition and age. How much is Medicaid in Oregon? Check the different benefit packages outlined below:
OHP Plus Benefit Package – This Medicaid coverage caters for chemical dependence, mental health, dental and medical services. Some OHP Plus package clients are required to make co-payments for prescription drugs and outpatient services. Patients may not have to pay a co-payment if enrolled in a managed care plan or Coordinated Care Organization (CCO).
Oregon Medicaid cost estimates differ depending on the services offered. For example, the payment for prescription drugs for each filled prescription ranges from free to $3. Co-payments for outpatient services start at $3. If a beneficiary cannot pay the estimate Medicaid costs, he or she will still receive the health care service or drugs.
Explore Medicaid coverage and costs by downloading our detailed guide.
Some treatments do not require co-payments. These include Medicaid services received from most managed care plans or CCOs, X-rays, durable medical equipment, vaccinations and lab tests, emergency services, prescription drugs ordered through the OHP Home-Delivery Pharmacy Program and family-planning services.
OHP Plus Supplemental Benefit Package – This Medicaid coverage package is for expectant women. Under the package, pregnant women receive the same level of coverage for vision and dental that is offered to children and adults below 21 years.
OHP with Limited Drug Benefit Package – Various Medicaid services are covered in this preventive package option. The only items that are limited in this package are prescription drugs. This package is available to Oregonians eligible for both Medicare Part D and Medicaid.
CAWEM (Citizen Alien-Waived Emergency Medical Assistance) Benefit Package –This Medicaid services package allows health coverage for those that are not U.S. citizens and those who do not have an immigration status to qualify for affordable health care. The program only covers limited emergency services.
CAWEM Plus Benefit Package – Under this OR Medicaid services program, pregnant women eligible for CAWEM benefits also get all Oregon Medicaid benefits except Death with Dignity services, hospice services, therapeutic abortions and sterilizations.
What Services are Covered by Medicaid in Oregon?
Patients who qualify for Medicaid coverage in Oregon have access to a wide variety of medical services. To start, Medicaid services include dental care, like primary services such as extractions, fillings, fluoride varnish and cleanings, immediate or urgent treatment, dentures, stainless steel crowns for the back teeth (molars). Children under 21 years old and pregnant women are provided with crowns and sealant.
Download our informative guide to learn more about Medicaid coverage and costs.
Medical coverage also provides vision services to beneficiaries. Children under 21 years old and pregnant women are covered for eye services to correct vision, and glasses are covered for pregnant women and adults that have a qualifying medical condition
In addition to the above, Medicaid services covered by Oregon include:
- Hearing aids and hearing aid examinations.
- End of life care at a hospice (patients covered for CAWEM Plus will not have Medicaid eligibility for this service).
- Private duty nursing and emergency treatment at the hospital
- Inpatient and outpatient care.
- Vaccines and immunizations (for example, measles-mumps-rubella – MMR vaccines – and flu shots).
- Medical supplies and equipment, like crutches and diabetes testing strips.
- Mental health care such as medical treatment and therapy.
- Medical transportation such as non-emergency transportation to an appointment or an ambulance.
- Medical care from a physician, a physician assistant or a nurse practitioner, including general appointments or routine checkups.
- Physical, occupational and speech therapies.
What Does Medicaid Not Cover in Oregon?
Medicaid coverage in Oregon covers many medical services. However, if you’re wondering, “What is not covered by Medicaid?” there are a number of services in this category.
The state reserves the right to not cover medical care even if treatment may be important. If patients go for treatment for a condition that is not covered, they should be prepared to pay the bill. Medicaid insurance in Oregon does not pay for the following services:
- Weight loss programs
- Services to help with fertility
- Treatments that are generally not effective
- Cosmetic surgeries or treatments
- Treatments for conditions that can be treated using home remedies (such as some skin conditions, calluses, corns, allergies and sprains)
- Treatments for conditions that get better on their own (such as flus or colds)
Types of Medicaid Insurance in Oregon
There are various types of Medicaid insurance in Oregon. These are offered by Coordinated Care Organizations (CCOs). Approved OR Medicaid plan providers include but are not limited to the following:
- AllCare CCO, Inc.
- Cascade Health Alliance, LLC.
- Columbia-Pacific CCO.
- Eastern Oregon CCO.
- FamilyCare, Inc.
- Health Share of Oregon.
- InterCommunity Health Network CCO.
Dental Medicaid services in Oregon are provided by the following Dental Care Organizations (DCOs): Access Dental Plan, LLC., Advantage Dental Services, LLC, Capitol Dental Care, Inc., CareOregon Dental, Family Dental Care, Managed Dental Care of Oregon, Inc. and ODS.