Oregon Health Plan benefit packages

• What is the OHP Plus benefit package?
• What is the OHP Standard benefit package?
• Who might be eligible for medical assistance under the OHP Standard benefit package?
• What is the OHP with Limited Drug benefit package?
• Who might be eligible for assistance under the OHP with Limited Drug benefit package?

Q. What is the OHP Plus benefit package?

A. The OHP Plus benefit package is a full set of services generally provided to children and adults who are eligible for traditional Medicaid programs or the Children's Health Insurance Program (CHIP). The OHP Plus benefit package does not have premiums. Some adults have small copayments for some outpatient services and prescription drugs.

Q. What is the OHP Standard benefit package?

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Q. Who might be eligible for medical assistance under the OHP Standard benefit package?

A. When a person applies for medical assistance, his or her worker will evaluate that person's eligibility for the traditional Medicaid programs or the Children's Health Insurance Program, which provide the full OHP Plus benefit package. If he or she is not eligible for any of those programs, the worker may evaluate the person's eligibility for a program that provides a limited OHP benefit package. To be evaluated for OHP Standard, the program must be open to new applicants.

If the program is open to new applicants, the person may be eligible if the person is:

• An adult (19 years or older)
• Not getting Medicare
• An Oregon resident
• A U.S. citizen or a non-citizen who meets the immigration status requirement
• Currently without major health insurance coverage and has been without coverage for six months. The six-month waiting period is waived in some cases.
• Under the income limit set at the federal poverty level
• Under the resource limit set at $2,000
• Paid up on OHP premiums billed in the past  

Q. What is the OHP with Limited Drug benefit package?

A. OHP with Limited Drug offers the same benefits as OHP Plus except it does not cover prescription drugs that Medicare Part D pays for. The OHP with Limited Drug benefit package does not have premiums. Some adults have small copayments for some outpatient services and prescription drugs.

Q. Who might be eligible for the OHP with Limited Drug benefit package?

A. This package is for people who are eligible for both Medicaid and Medicare Part D (a national prescription drug plan).

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***This page was updated Sept. 2006