Medicaid Costs and Coverage in Oregon

“How much is Medicaid in Oregon?” is an important question for residents researching the various health programs available throughout the state. Anyone asking, “How much does Medicaid cost an eligible resident in Oregon?” should know that costs can vary based on household information and eligibility submitted during the application process. Medicaid cost estimates for the Oregon Health Plan (OHP), Oregon’s Medicaid expansion program, take into account the income and financial resources of the applicant and his or her entire household in addition to the health statuses of all household members. To estimate how much Medicaid is for a specific Medicaid program in Oregon, applicants should check to make sure the Medicaid treatments and care that they and their families need is covered by the Oregon health assistance program. What services are covered by Medicaid in Oregon? Multiple categories of Medicaid health benefits are available to eligible residents in Oregon, such as annual checkups, emergency services and sometimes even dental services.

What does Medicaid not cover in Oregon? Like all types of Medicaid insurance throughout the United States, some medical services and treatments are guaranteed to be covered for the recipient regardless of what specific option for coverage he or she meets based on Medicaid eligibility requirements. This basic medical coverage is considered the federal minimum standard of care around the country. Interested welfare applicants in Oregon can submit an application for Medicaid coverage and learn more about costs for their specific situation at the Oregon Health Authority who manages the Oregon health network. Continue reading to learn more about what services are covered by Medicaid in Oregon and what type of medical costs applicants can expect.

How much does Medicaid cost in Oregon?

Medicaid costs in Oregon depend on the specific medical service or treatment the applicant needs and whether it is included in his or her OHP Medicaid package. In Oregon, health coverage varies across OHP programs though the copayment fee schedule for benefit recipients in every group is essentially the same. The services covered by Medicaid in each program vary due to the different types of Medicaid insurance available in Oregon. OHP Plus (BMH) Coverage, OHP Plus Supplemental Benefits Package, OHP with Limited Drug (BMD and BMM) Coverage and Citizen Alien Waived Emergent Medical (CAWEM) Medicaid plans are for applicants with different eligibility requirements.

The OHP Plus Medicaid coverage program is the one of the state’s largest health assistance programs, providing Medicaid coverage to children up to 18 years old and adults from 19 to 64 years old who are not eligible for other categories of assistance. Most basic medical services are covered by Medicaid for these benefit recipients, such as wellness checks, behavioral healthcare, dental health, vision health and more. Depending on a benefit claimant’s financial resources, he or she may have to provide a copayment for some health treatments and prescription medications. Oregon citizens with OHP Plus Medicaid coverage are entitled to receive all necessary health treatments, even if they are unable to pay the copayment at the time of service.

The OHP Plus Supplemental Medicaid coverage program provides extensive healthcare services to all pregnant women over the age of 21 living anywhere in the state in addition to the typical services offered adults through the BMH program. This type of Medicaid insurance allows for pregnant women to receive the same comprehensive Medicaid coverage as more traditionally needy groups, like seniors and children. Medicaid cost estimates are also different for the OHP with Limited Drug program caters to adults who are eligible for both Medicaid and Medicare Part D by providing them with additional prescription drug coverage.

Medicaid cost estimates for the CAWEM benefit programs are similar to those in the BMH program but only apply to emergency services. This program allows for Oregon residents who do not have American citizenship or an otherwise eligible immigration status to receive Medicaid coverage. CAWEM Plus care for pregnant women includes the same costs and benefits as the BMH program. Additionally, the state offers Qualified Medicare Beneficiary (QMB) Medicaid Coverage.This Oregon Medicaid coverage plan is geared towards senior citizens who need to supplement their Medicare-associated health benefits. Those completing the application process can see plan requirements based on income, family composition and other eligibility factors.

What services are covered by Medicaid without a copayment for all benefit recipients?

Medicaid cost estimates for some services that are deemed essential health needs never require that a benefit recipient makes a copayment, regardless of which specific Medicaid plan he or she participates in. All types of Medicaid insurance available to Oregon residents provide services for family planning, lab tests, prescription drugs provided through the OHP home delivery service, emergency services and X-rays. Medicaid costs for other services, such a visits to a primary care physician or physical therapy, can have a small copay.

What services are covered by Medicaid in Oregon?

Medicaid coverage in Oregon includes most medical treatments and preventative care services that benefit recipients need. The medical treatments included in Oregon Medicaid coverage are dually determined by the federal government and the Oregon Health Authority which have divided available healthcare into multiple categories of service. The federal government determines mandatory care, while the state can have optional benefits for recipients, in addition to the federal requirements. Healthcare services are covered by Medicaid in Oregon include:

  • Physical health: Doctor visits, wellness checks, emergency care, preventive information and services, lab tests or other workups, treatment for most major diseases and more
  • Behavioral health: Mental health counseling and illness treatment in addition to help with addiction to tobacco, alcohol or drugs
  • Dental health: Preventive care and treatments, dental checkups, x-rays and lab results, tooth removal and more
  • Vision care: Medical care and treatment, glasses for a qualifying condition and exams and glasses for pregnant women and children or adults under the age of 21
  • Prescriptions: Most required medications are completely or partially covered by OHP

OHP plans also offer family planning services, pregnancy and newborn care, hearing services including hearing aids, medical equipment, home healthcare, skilled therapy, inpatient hospital care and much more. To learn more about national Medicaid coverage guidelines, you can download our free Medicaid guide now.

What Does Medicaid Not Cover in Oregon?

What healthcare services does Medicaid not cover in Oregon? As mentioned above, Medicaid coverage for benefit recipients in different OHP groups can varies significantly. All types of Medicaid insurance in Oregon, however, prohibit OHP funding for certain services such as:

  • Treatment for conditions that will go away naturally, such as colds.
  • Surgery or treatments for cosmetic purposes only.
  • Fertility services.
  • Weight-loss programs.

To learn more about Medicaid coverage and potential costs, you can download our national Medicaid guide today.