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Oregon Health Plan – Easy Access to Health Plan Information

For Individual Private Plans

Easy Access to Information

You may qualify for the Oregon Health Plan or one of the several other State of Oregon financial assistance programs for health insurance designed to help meet the health care needs of Oregon residents.

Check to see if you qualify for the Oregon Health Plan first.

Oregon DHS

Oregon Health Plan (OHP/Medicaid) administered by:
Division of Medical Assistance Programs (DMAP)
This is the part of the program that is most often referred to as the Oregon Health Plan by many. The plan is an insurance program for those Oregonians with the lowest incomes.
Contact information
Oregon DHS
Children’s Health Insurance Program (CHIP)
Created and financed primarily by the federal government.
Similar benefits to OHP/Medicaid but designed specifically for children.
Contact information
If you don't, check here to see if you qualify for FHIAP, the next step up.

Family Health Insurance Assistance Program (FHIAP)
This program offers state subsidies to low-income Oregonians who have incomes exceeding the OHP/Medicaid limits. The FHIAP program helps by reimbursing 50% to 95% of the premiums for the purchase of private health insurance plans for those who qualify. An individual or family may enroll in either group or individual health insurance coverage. Currently Open for Children 100% subsidy.
Requirements: Two months of no insurance and one month proof of qualifying income.
Contact information
Check here to see if you qualify for FPEP.

Family Planning Program

Family Planning Expansion Project (FPEP)

The Family Planning Expansion Project (FPEP) is designed to provide people with tools and skills to plan for healthy and planned pregnancies. They work to assure that a full range of family planning, sexual, and reproductive health services are available to those who qualify across the state.

  • You are an Oregon resident, and
  • do not have prescription drug coverage. (Medicare Part D will not disqualify you).

For More Information click here

If you still don't qualify, look for low-cost Individual Health Plans

Small employers may be able to find help through the OPHP program.

Office of Private Health Partnerships (OPHP)
(Formerly Insurance Pool Governing Board Program (IPGB)
Office of Private
Health Partnerships
This agency provides information about health insurance to small employers, designs and markets affordable health insurance plans and administers the Family Health Insurance Assistance Program (FHIAP). It helps both small employers and those who work for them find affordable health insurance solutions. The OPHP has two new, affordable health care plans for small employers who do not already provide a health benefit plan for their employee, employees and spouses, children only or whole families.

Individuals living with HIV or AIDS who need help paying for medical care expenses, check here.

Department of Human Services HIV/AIDS Program Care and Treatment (CAREAssist)
The programs can help qualified Oregon residents buy health insurance premiums and prescription drugs. They can also let HIV-positive Oregonians know about other programs that may assist in paying for medical expenses.

CAREAssist can pay part or all of your medical premiums. Coverage can include, but is not limited to:

For more information on the CAREAssist Program
For help applying for an individual or OMIP policy, call First Choice Health Insurance, Inc. at 1-888-957-5001 or Request information.

Individuals unable to obtain coverage because of health conditions, check here.

Oregon Medical Insurance Pool Program ( OMIP)
Federal Medical Insurance Pool Program ( FMIP)

The Oregon Medical Insurance Pool (OMIP) provides medical insurance coverage for all Oregonians who are unable to obtain medical insurance because of health conditions. OMIP also provides health benefit portability coverage to Oregonians who have exhausted COBRA benefits and have no other portability options available to them. OMIP has four preferred providers medical plans from which enrollees may choose.
Oregon operates a federal high-risk pool (FMIP) in conjunction with its existing state high-risk program. It also serves adults and children who are unable to obtain medical insurance because of health conditions. Contact information
You may be able to qualify for prescription drug assistance.

Oregon Prescription Drug Program (OPDP)
The Oregon Prescription Drug Program (OPDP) offers a prescription drug discount card open to all Oregonians without prescription drug coverage.
You qualify for OPDP if:
  1. You are an Oregon resident, and
2. You do not have prescription drug coverage. (Medicare Part D will not disqualify you).
To download an application, check here: Applications
If you need assistance or help and are enrolled in Medicare.

SHIBA Senior Health Insurance Benefits Assistance

SHIBA is a statewide network of trained volunteers who educate, assist, and serve as advocates for people with Medicare. SHIBA volunteers help people with Medicare understand their rights and options in health insurance, so that they can make informed choices.

Contact information

The OHP/Medicaid program essentially provides health care benefits at little or no cost to the participants. The rules on what is covered and the member costs involved continue to change from time to time due to State of Oregon budget considerations.

FHIAP, on the other hand, does not provide healthcare benefits. Instead, it reimburses, those who qualify, for part of the premium of an individual health insurance policy that the newly qualified FHIAP person is expected to purchase. The premium reimbursement level is 95%, 90%, 70%, or 50% depending on the
qualifying income level.

This presents a challenge in that many new qualifiers have never had to buy an individual health insurance policy before. Most are not aware of what their premium might be, that premiums vary by age, or even what procedure to follow.

The first surprise might be that the premium for a $500 deductible plan is $300 and, if they qualify for the 95% reimbursement level, they would have to pay 5% or $15 a month.

The second surprise is that this $15 doesn't pay for medical care like OHP/Medicaid, but instead only pays the premium. This means that in addition to the $15 monthly premium payment, they may have to pay the first $500 of healthcare costs themselves and then 20% of the balance over $500.

The third surprise is that many don't qualify for an individual health insurance policy due to strict underwriting requirements in the health insurance industry today. This may require that they apply for insurance a second time. This time it would be the Oregon Medical Insurance Pool (OMIP), Oregon's high-risk pool. Here they find out premiums are even higher and they now might have to pay over $20 a month and still have a deductible in front of them.

The fourth surprise is that only medical care is covered by an individual health insurance policy. Other benefits like vision and dental care are not usually covered under individual policies available on the market today.

This information is provided by to help educate potential FHIAP members in advance.

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