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Potentially eligible for Oregon Health Plan? What now?

If you have submitted your application to HealthCare.gov and been told that you are potentially eligible for Oregon Health Plan benefits, it may be frustrating to not see anything happen right away. It is essential to remember that the process is still moving. Here is what happens:

  1. Your HealthCare.gov application is sent to the Oregon Health Authority (OHA), which manages the Oregon Health Plan (OHP). OHA will review your application and determine if you are actually eligible for OHP benefits.
    • OHA may ask you to answer a few more questions or submit documents to verify your eligibility. It is important to keep an eye on your postal mail to make sure you do not miss any deadlines for submission.
  2. OHP will send you an Eligibility Notice after it reviews your information.
    • If you are found eligible for full OHP benefits, your Eligibility Notice will state when your benefits are active. You must take action on your Marketplace coverage (see step 3 below).
    • If you are found eligible for Citizen Alien Waived Emergent Medical (CAWEM) emergency medical care for non-citizens benefits, you may still be able to get full coverage with substantial financial assistance through the Marketplace. Log back in to your Marketplace application and report that you were found not eligible for full OHP benefits to access this coverage and savings.
    • If you are found not eligible for full OHP benefits: Log back in to your Marketplace application and report that you were found not eligible for OHP. This will allow you to keep your Marketplace coverage and any financial assistance you may be eligible for.
  3. If you were enrolled in coverage through the Marketplace before submitting your application, you must report that you got OHP benefits and cancel your Marketplace plan. You are no longer eligible for financial assistance if you are eligible for OHP benefits, even if you decline that coverage.

Navigating between the Marketplace and Oregon Health Plan can be confusing. We highly recommend working with an expert for these steps to avoid missing deadlines or having to pay back any financial assistance. Community partners specialize in Oregon Health Plan benefits, and can help you navigate these systems. Find local help at OregonHealthCare.gov/GetHelp.



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