Different health coverage programs may cover different services, but most plans help pay for preventive care, doctor visits, hospital care, prescriptions, and other medically necessary services.
Covered services, provider networks, and out-of-pocket costs vary by program and plan.
All health plans sold through Explore Health must cover a set of core services called essential health benefits.
These benefits include:
- Outpatient care
- Emergency services
- Hospital care
- Pregnancy and newborn care
- Mental health and substance use treatment
- Prescription drugs
- Laboratory services
- Rehabilitative and habilitative services
- Preventive and wellness services
- Pediatric services, including dental and vision care for children
Even when a service is covered, you may still have out-of-pocket costs such as:
- Deductibles
- Copays
- Coinsurance
These costs depend on your specific health plan.
Learn more about covered benefits on Marketplace plans on ExploreHealthOR.gov.
OHP covers many medical, behavioral health, dental, and preventive services at low or no cost for eligible members.
Covered benefits include:
- Doctor visits
- Hospital care
- Mental health services
- Substance use treatment
- Prescription drugs
- Preventive care
- Pregnancy care
- Dental care
- Vision services for eligible members
Most OHP members receive services through a Coordinated Care Organization (CCO), which helps coordinate care and services.
Covered services and provider networks may vary slightly by CCO.
Medicare covers many preventive and medically necessary services.
Original Medicare
Original Medicare generally includes:
- Hospital coverage (Part A)
- Medical coverage (Part B)
Covered services may include:
- Doctor visits
- Hospital stays
- Preventive screenings
- Vaccines
- Durable medical equipment
- Home health care
- Some rehabilitation services
Prescription drug coverage
Prescription drug coverage is available through:
- Medicare Part D plans
- Many Medicare Advantage plans
Medicare Advantage plans
Medicare Advantage plans often include additional benefits such as:
- Dental coverage
- Vision coverage
- Hearing services
- Fitness programs
Covered services and costs vary by plan.
VA health care provides eligible veterans with access to a wide range of services.
Covered services may include:
- Primary care
- Preventive care
- Specialty care
- Mental health services
- Substance use treatment
- Prescription medications
- Hospital care
- Rehabilitation services
Some veterans may also qualify for:
- Dental care
- Vision services
- Long-term care services
Eligibility and covered benefits depend on factors such as military service history, disability status, and income.
Immunizations and vaccines
Most health coverage programs help cover recommended vaccines for children and adults.
Common vaccines may include:
- Flu (influenza)
- COVID-19
- Measles, mumps, and rubella (MMR)
- Tetanus
- Hepatitis A and B
- Pneumococcal
- Shingles
- HPV
Coverage recommendations may vary based on age, medical conditions, and risk factors.
Important things to know
- Covered services vary by plan and program.
- Some services may require referrals, prior authorization, or use of in-network providers.
- Preventive services are often covered at low or no cost when received from participating providers.
- Always review your plan documents or contact your health plan to understand covered benefits and costs.
Need help understanding your benefits?
Free help is available to:
- Compare plans and coverage options
- Understand covered services
- Learn about costs and provider networks
- Find local providers
- Get help using your coverage
Local enrollment assisters and community partners can help you understand your options.