Plan FAQ

Your Member ID shows your benefits, which may include physical, dental and mental health care and substance use treatment.

When you visit your provider or the pharmacy, bring both your Health Share Member ID card and a photo ID. If you also have Medicare coverage, please bring your Medicare ID card, too.

Contact Health Share to replace a lost or stolen Member ID card.

You can also do this by logging into the MyCareOregon mobile app, tapping “View my Member ID card” and selecting “Mail Member ID card”.

If you don't have your Health Share ID card yet, contact Health Share Customer Service. They can tell you your member ID number. You can give this ID number to the provider. 

To change your PCP, contact CareOregon Customer Service.

You can also do it on the MyCareOregon mobile app by going to “Provider contacts” on the home screen and selecting “Request a new provider.”

Members can change their PCP one time per year.

If you think you need to see a specialist, make an appointment with your primary care provider (PCP) first. Your PCP will decide which services and tests you may need, and they will refer you to a specialist or other provider if needed. View your Health Share Member Handbook for more information about seeing a specialist.

To see if a specific medication is covered, you can check the CareOregon OHP Formulary, or contact Customer Service.

If your medication isn’t covered, there are different steps you can take:

• Contact CareOregon Customer Service to ask for an emergency supply
• Ask the provider who prescribes it about medication alternatives that may be covered, or prior authorizations
• File an appeal if you disagree with the denial

If you become pregnant, tell OHA’s Oregon Eligibility (ONE Customer Service) right away. We will make sure you do not lose health coverage before your baby is born and will sign you up for more vision and dental services. These benefits continue for 12 months after the pregnancy ends.

You also need to talk to ONE Customer Service again if a pregnancy ends.

Learn more about your benefits on our Pregnancy and family support page.

Sometimes, you need special medical equipment to help you get and stay healthy. This is known as durable medical equipment (DME). It’s “durable” because it doesn’t get used up like other kinds of supplies. This equipment is fully covered by CareOregon.

To get started, talk to your provider. Medical equipment must be approved by a physical, dental or mental health provider. They will write you a prescription for equipment.

If you have questions about where or how to get equipment, contact our Customer Service for help.

If any of your personal information—such as your home address—has changed, report the change within 10 days to the Oregon Health Plan.

No. We will never charge you for any covered Medicaid/OHP service. If a health care provider sends you a bill, don’t pay it. Instead, contact our Customer Service right away.

For a list of covered services, please see your Member Handbook.

No. Our members are not charged copayments or fees when they see their primary care provider (PCP) or other providers in our network. Quý vị có thể phải trả các khoản đồng thanh toán tại nhà thuốc đối với một số loại thuốc theo đơn cho sức khỏe tinh thần do tiểu bang chi trả. If a medical office asks you for a copayment, ask the staff to call Customer Service. Khi quý vị đặt lịch hẹn khám, hãy cho phòng khám biết quý vị có bảo hiểm tại CareOregon.

You probably don’t owe anything for covered services while you are a CareOregon member. Contact our Customer Service right away to find out.

To approve sharing your data with a third party, you must provide written consent to CareOregon by downloading and filling out the CareOregon Authorization for Disclosure of Protected Health Information (PHI) Form.

You must fill out everything marked with a star (*) for the form to be valid. Once you have filled it out, you can fax or mail it back using the instructions at the bottom of the form.

Read more about Privacy and third party apps.

To request your claim records, download and complete a Member Request for Records Form.

Once you have filled it out, you can fax or mail it back using the instructions at the bottom of the form.

To authorize a representative for your CareOregon coverage, you must download, fill out and sign the CareOregon Appointment of Representative Form. You will need to provide information about yourself and the person you are choosing as your representative, who must also sign the form. Once you have filled it out, you can fax or mail it back using the instructions at the bottom of the form.

You can find the HealthShare/CareOregon member handbook on the Health Share website.

The Health Risk Assessment is a survey we send all new members. Your answers help us learn more about you and your needs and how we can best support you!

We will send you a Health Risk Assessment in the mail soon. When you get it, please take a minute to fill it out.  You can also fill out this survey in the MyCareOregon app.

You may receive a follow-up call from our Care Coordination team to share some health resources that can help you.

A wellness visit is a yearly appointment with your primary care provider (PCP) to focus on your overall health and preventing health problems.

It may include reviewing your health history, medications and lifestyle. Your PCP may also want to screen for possible health risks, based on your age and overall health, and give immunizations.

A wellness visit is a chance to check in with your PCP, ask questions and make a personalized plan to manage your health.

To schedule a wellness visit, call the PCP’s office listed on your Health Share/CareOregon Member ID card.

Yes, CareOregon has a mobile app. For members over the age of 18, the MyCareOregon mobile app is available for both Android and Apple smartphones.

With the MyCareOregon mobile app, you can access the following from your smart phone:

• Digital Member ID card and other benefits information
• Medical prescriptions and refill schedule
• Medical claims history
• Primary care provider contact information
• Dental provider contact information
• CareOregon provider search
• CareOregon Customer Service
  

It’s available in English, Spanish, Vietnamese, Russian, Chinese, Somali, Dari and Arabic.

Visit the MyCareOregon mobile app page to learn more and download the app.

You can view past claims and prior authorizations by registering for the CareOregon member portal or by downloading the MyCareOregon mobile app. You will need to register online or through the app to create an account, using your Member ID number.

If you don’t know who to call, visit our Customer Service page for find the best contact for your needs.

If you believe your health is in serious danger, go to the ER or call 911 right away. Quý vị không cần phải gọi trước cho bác sĩ, nha sĩ hay gói dịch vụ y tế của quý vị. You are covered for urgent and emergent care, and prior authorization is not needed.

Đối với các vấn đề như cảm lạnh thông thường, táo bón, hăm tã, đau lưng hay đau răng, PCP hoặc nha sĩ của quý vị sẽ đảm bảo chăm sóc tốt nhất vì họ là những người hiểu rõ về tiền sử sức khỏe và về chính quý vị. Hãy đảm bảo gọi cho họ trước nhất khi quý vị gặp phải các vấn đề như trên. PCP và nha sĩ sẽ nỗ lực thăm khám cho quý vị càng sớm càng tốt.

If you need to be seen sooner than your provider can see you, go to an urgent care clinic instead of the ER. Làm như vậy thường sẽ nhanh chóng và thuận tiện hơn. You can use our Find a provider tool to search for an urgent care clinic near you.

You can also use the MyCareOregon app to search for urgent care near you.

Nếu quý vị không hài lòng với CareOregon hoặc Health Share of Oregon, dịch vụ y tế hoặc nhà cung cấp, quý vị có thể gửi đơn khiếu nại/phiền trách bất cứ lúc nào, trong mọi trường hợp ngoại trừ việc từ chối cung cấp dịch vụ. Nhà cung cấp hoặc bên đại diện được ủy quyền của quý vị cũng có thể thay mặt quý vị gửi đơn khiếu nại. Chúng tôi sẽ cố gắng cải thiện.

To file a complaint, you can:

• Contact CareOregon Customer Service
• Send a letter of complaint to:
  CareOregon
  Attn: Appeals and Grievances
  315 SW Fifth Ave
  Portland, OR 9720
• Or fill out a complaint and feedback form.

CareOregon và Health Share of Oregon sẽ tiến hành giải quyết đơn khiếu nại/phiền trách của quý vị nhanh chóng tùy theo tình trạng sức khỏe của quý vị yêu cầu. Nếu cần nhiều hơn 5 ngày làm việc, chúng tôi sẽ gửi thư cho quý vị để thông báo lý do. Quý vị sẽ nhận được câu trả lời chính thức trong vòng 30 ngày. Chúng tôi sẽ không thông báo cho bất cứ ai khác về đơn khiếu nại của quý vị trừ phi quý vị yêu cầu.

You can also file a complaint with Oregon Health Authority (OHA) by calling the OHP Client Services unit toll-free at 800-273-0557. You can also call OHA’s Ombudsman at 503-947-2346 or toll-free at 877-642-0450.

Nếu chúng tôi từ chối, ngừng hoặc giảm một dịch vụ y tế mà nhà cung cấp của quý vị đã yêu cầu, chúng tôi sẽ gửi thư Thông báo cách xử lý cho quý vị, trong đó trình bày rõ lý do chúng tôi đưa ra quyết định đó. You have a right to ask to change it through an appeal and a fair hearing. Quý vị phải yêu cầu kháng nghị trong vòng tối đa là 60 ngày kể từ ngày trên thư Thông báo cách xử lý. Quý vị có thể yêu cầu chúng tôi gửi thông báo từ chối trong đó nêu rõ một dịch vụ không được bảo hiểm chi trả nếu:

• Quý vị không nhận được thông báo từ chối bằng văn bản, hoặc;
• Nhà cung cấp của quý vị cho biết rằng quý vị cần phải thanh toán cho một dịch không được bảo hiểm chi trả.

For full instructions on the appeals process, visit the Health Share appeals page.

Provider appeals

Nhà cung cấp có quyền kháng nghị thay mặt cho quý vị khi yêu cầu của bác sĩ của họ bị một gói dịch vụ từ chối. Quý vị phải đồng ý với yêu cầu kháng nghị này bằng văn bản. Instructions for this process can be found in your Member Handbook.

Yes! You can talk to us in person at a Connect to Care event. When you go to a Connect to Care event in the Portland area, we’ll either answer your questions on the spot—in your preferred language—or connect you to someone who can.

Visit our Connect to Care event page.

If you need to contact us sooner, reach out to Customer Service.

We’ve got you covered! To get a ride to your CareOregon/Health Share appointment, call Ride to Care to schedule transportation at least two business days before you need it.

You can request vehicle-provided rides, public transit passes (like a Hop card for the TriMet area), or mileage reimbursement if you have someone drive you. For urgent same-day appointments, call Ride to Care as soon as possible.

Learn more on our Transportation assistance page.

To get extra help with your CareOregon health plan, you can use our Care Coordination program. It helps with complex medical needs, getting your providers to work together and getting more services. This team of nurses, mental health experts, and medical staff can help if you have multiple health issues, need help following your treatment plan or have trouble getting to appointments.

We want to give you access to your health care in the language of your choice, including sign languages. CareOregon is committed to providing translated materials to our members who speak a language other than English.

We also provide interpretation services. If you need an interpreter for visits or phone calls to your (or your child's) provider's office, you are legally entitled to this service free of charge. You may have received a Preferred Language Card when you joined CareOregon. This helps inform your provider's office of your spoken language.

If you need any help with language services or have any complaints, contact CareOregon Customer Service.

Learn more on our Language translation and interpretation page.

CareOregon members can request assistance for nutrition, climate devices, housing and many other supports through the Social needs assistance section of our website. You can submit a request online or by email, and CareOregon will assess your eligibility through our Health Related Social Needs (HRSN) or Flexible services programs.

For general community support, call 211 for referrals to housing programs, or use the 211 online database.

To find a gender-affirming care provider through CareOregon, start with your primary care or mental health provider for a referral. For those in the Portland area, the Oregon Health & Sciences University (OHSU) Transgender Health Program also offers a dedicated program that can help find various providers and services.

You can learn more about accessing care and view a list of providers on our Gender-affirming care page.

Yes, both hospice and special home care are available for an advanced illness.

Through our partner Housecall Providers, CareOregon offers an Advanced Illness Care program at no charge for eligible members. This is a form of outpatient palliative care to give relief from the symptoms and stress of a serious illness while you may still be receiving treatments to cure a condition or extend your life.

Visit the Advanced illness care page for more details.

Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans with low incomes, including eligible low-income adults, children, pregnant people, elderly adults and people with disabilities. It is administered by states under federal guidelines.

Learn more about it on the Medicaid website.

The Oregon Health Plan (OHP) is Oregon's Medicaid and Children's Health Insurance Program plan. You can get OHP if you meet income limits and other requirements. People of all ages and any immigration status can qualify. OHP provides free health coverage.

Learn more on the OHP website.

There are many different requirements and different programs covered under OHP. Visit our Am I eligible page to learn more.

People may also qualify based on age and disability status. To apply, older adults and people with disabilities should call the Aging and Disability Resource Connection (ADRC) at 855-ORE-ADRC (855-673-2372).

If you have Health Share/CareOregon as your CCO, you can use our Find a provider tool to find a doctor close to you.

If you need assistance, contact Customer Service.

Yes, OHP covers undocumented children and teens younger than 19, regardless of immigration status, as long as they meet the income and other eligibility criteria for Medicaid. This coverage, paid for using state funds only, includes medical, vision, dental and mental health services.

Once your baby is born, you or the hospital must add your baby to OHP within 30 days after birth. This helps make sure your baby gets all the health benefits they need.

Many hospitals will send a Newborn Notification Form to OHP for you. If the hospital doesn't send it, call and ask for a copy. You can bring this form to the hospital or your baby's first doctor's visit.

Read more on how to sign your baby up for OHP and other benefits you’re eligible for on our Pregnancy and family support page.

OHP Bridge is an Oregon Health Plan (OHP) benefit package that covers adults with higher incomes. Những người có thể nhận được OHP Bridge phải:

• Từ 19 đến 65 tuổi; 
• Có thu nhập từ 139 phần trăm đến 200 phần trăm mức nghèo liên bang (FPL); 
• Có tình trạng nhập cư hoặc quốc tịch đủ điều kiện để đủ điều kiện tham gia; và 
• Không được tiếp cận với bảo hiểm y tế có giá cả phải chăng khác. 

OHP Bridge is almost the same as OHP Plus 

Hai gói quyền lợi gần như giống nhau. Có một vài dịch vụ mà OHP Bridge không chi trả. Để tìm hiểu thêm về những gì OHP Bridge không chi trả, vui lòng xem bảng dưới đây.

OHP Bridge will cover adults up to age 65 who: 

• Have income above traditional OHP Plus limits up to 200 percent of the federal poverty level (FPL),  
• Do not have access to affordable health insurance, and 
• Have an eligible citizenship or immigration status to qualify.  

Income limits shown below apply through February 2025. FPL is updated annually.

OHP Bridge is free to members 

Cũng giống như OHP Plus, OHP Bridge miễn phí cho các hội viên. That means no premiums, no copayments, no coinsurance, and no deductibles.

OHP members with income changes may be moved to OHP Bridge automatically 

Nếu quý vị có OHP ngay bây giờ, quý vị không phải làm bất cứ điều gì để nhận OHP Bridge. Nếu quý vị báo cáo thu nhập cao hơn khi gia hạn OHP, quý vị có thể được chuyển sang OHP Bridge.

People who do not have OHP right now can apply for OHP Bridge 

Go to one.oregon.gov to apply. Quý vị cũng có thể sử dụng liên kết đó để tìm thông tin về cách đăng ký trực tiếp, nhận trợ giúp đăng ký hoặc để nhận đơn đăng ký bằng giấy. To apply over the phone, call the ONE Customer Service Center toll-free at 800-699-9075 (all relay calls are accepted).  

For more information about the OHP Bridge benefit, visit the Oregon Health Authority web page for OHP Bridge

If you have both Medicare and Medicaid, it means you are "dual-eligible," and covered by both Medicare and Medicaid. Often, Medicare benefits are applied first, with Medicaid benefits applied second to help with costs like premiums, deductibles and copayments. CareOregon has a Medicare Advantage plan, a Dual-Eligible Special Needs Plan (D-SNP), which combines your Medicare and Medicaid benefits into a single plan for easier management. It is called CareOregon Advantage.

This dual-eligibility can also give you extra benefits not covered by Medicare, such as dental, vision and long-term care services. And it may include automatic enrollment in programs like Extra Help whihc helps pay for prescription costs. 

Learn more about dual-eligibilty and Medicare benefits at CareOregon Advantage.