OHP/Medicaid

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Your Oregon Health Plan Benefits

The Oregon Health Plan (OHP) decides which benefits are available to people who sign up for coverage. Many, but not all, healthcare services are covered.

To find out what benefits you have with FamilyCare Health, look at your member ID card.

  • If your member ID card says CCOA, you have physical, dental, mental health, and chemical health benefits.
  • If your member ID card says CCOB, you have physical, mental health, and chemical health benefits.
  • If your member ID card says CCOE, you have mental health benefits.
  • If your member ID card says CCOG, you have dental and mental health benefits.

The below benefits apply to most, though not all, members. Listed benefits are for contracted providers; seeing a non-contracted provider requires prior authorization from FamilyCare Health. Benefits are subject to change. To confirm your benefits, please contact FamilyCare Health at 503-222-2880 or 800-458-9518 toll-free (TTY 711).

2017

Visit the Exceptional Needs Services webpage for information about these benefits.

Visit the Wraparound and Intensive Care Coordination webpage for information about these programs.

Doctor Visits Your Cost Authorization/Referral Limits
Primary Care Provider $0 Not required No limit with assigned PCP.
Specialist $0 Referral required from your PCP, except for contracted women's health or behavioral health providers for routine care services. Number of visits based on plan's approval.
Preventive Services Your Cost Authorization/Referral Limits
Well Child visits for babies, children and teens $0 Not required As recommended
Routine physicals $0 Not required As recommended
Well Women visits $0 Not required As recommended
Mammograms (breast x-rays) for women $0 Physician's order required As recommended
Family Planning $0 Not required No limits
Prostate exams for men $0 Not required No limits
Screening for sexually transmitted diseases (STDs) $0 Not required No limits
Testing and counseling for AIDS and HIV $0 Not required No limits
Prescription Drugs (Up to a 30-day supply) Your Cost Authorization/Referral Limits
Many, but not all, drugs are available with a provider's prescription. A full list can be found in our Medicaid Formulary. No cost for covered drugs. Mental health drugs are managed by the state. Copays for those drugs vary. See the Oregon Health Authority website for more information. Some drugs may require prior authorization in addition to a prescription. No limit with a prescription and prior authorization, if required. If a drug requiring prior authorization is denied, it will not be covered.
Hospital Stays Your Cost Authorization/Referral Limits
Emergencies $0 Not required No limits
Scheduled Surgery $0 Authorization required No limits
Dental Care Your Cost Authorization/Referral Limits
Exams, Cleaning, and Fluoride Treatment $0 Not required One annual exam for adults; two for children age 18 years old and younger; follow-up care allowed.
X-rays $0 Not required Covered annually; Panoramic or full mouth x-ray series every 5 years.
Sealants $0 Not required Once every 5 years for permanent molars for children under 16 years of age only.
Basic restorative care like a filling $0 Not required No limit.
Extractions (removing teeth) $0 Authorization required for wisdom teeth. Not required for other extractions. No limit. This benefit does not apply to orthodontics.
Root Canals $0 Authorization required Contact FamilyCare Health to find out your Dental Care Organization (DCO).
Dental urgent or immediate treatment (Emergency) $0 Not required No limit
Orthodontic treatment $0 Authorization required Contact FamilyCare Health to find out your Dental Care Organization (DCO).
Stainless Steel Crowns $0 Authorization required For all primary teeth for children; for posterior permanent teeth for adults.
Dentures and partials $0 Authorization required Full dentures every 10 years and partial dentures every 5 years for adults.
Gum Disease $0 Authorization required Deep cleaning for gum disease every 2 years for adults. Routine care for gum disease every 6 months for adults.
Mental Health Your Cost Authorization/Referral Limits
Routine, Outpatient Counseling and Therapy $0 Not required Self-referral to contracted providers.
Exceptional Needs Services $0 Authorization required Call FamilyCare Health for more details; also see Exceptional Needs webpage (link at top of page)
Alcohol and Drug Services Your Cost Authorization/Referral Limits
Routine Outpatient Counseling/Therapy $0 Not required Self-referral to contracted providers.
Residential Treatment $0 Authorization required Approval based on OHP guidelines. Call FamilyCare Health for details.
Detox $0 Authorization required Self-referral to contracted providers.
Laboratory and X-Ray Your Cost Authorization/Referral Limits
Blood Draw $0 Physician's order required No limit
X-Rays $0 Physician's order required No limit
CT Scans $0 Physician's order required No limit
MRIs $0 Authorization required No limit
Immunizations/Shots Your Cost Authorization/Referral Limits
Vaccines $0 for recommended vaccines Not required for recommended vaccines Flu vaccines can be given at your provider's office or another location, such as a pharmacy or health department. Vaccines for travel not covered.
Pregnancy Care Your Cost Authorization/Referral Limits
Our BabyCare program can help new moms get prepared for baby. $0 Not required Please let FamilyCare Health and the Oregon Health Authority know when you are expecting.
Prenatal visits with your provider $0 Not required No limit
Routine vision services $0 Not required Available for pregnant women and children 20 years and younger. Use a VSP provider for your vision care (Contact VSP at 800-877-7195 or https://www.vsp.com).
Additional dental benefits $0 Authorization required Additional cleanings, fluoride treatments, and anterior crowns if dentally appropriate. Contact your Dental Care Organization.
Birthing Classes $0 Not required Contact FamilyCare Health for details.
Prenatal vitamins $0 Not required Prenatal supplements are covered with a prescription.
Labor and Delivery Your Cost Authorization/Referral Limits
Vaginal and Cesarean deliveries $0 Not required Please let FamilyCare Health and the Oregon Health Authority know when you have delivered. You will need to separately apply for OHP for your child. Home births are not covered. Please contact OHP Client Services for home birth options.
Tubal ligation $0 Not required Sterilization consent form required for 15 and older.
Breast pumps $0 Not required Prescription required from provider and supplied by our contracted durable medical equipment providers.
Postpartum care, care you get after your baby is born $0 Not required No limit
Lactation classes $0 Not required No limit
Circumcisions for boys $0 Not required To be completed within 90 days of birth. After 90 days a prior authorization is required; call FamilyCare Health for details.
Therapy Your Cost Authorization/Referral Limits
Physical Therapy $0 Authorization required 30 combined visits (PT, OT & ST) allowed per calendar year.
Occupational Therapy $0 Authorization required 30 combined visits (PT, OT & ST) allowed per calendar year.
Speech Therapy $0 Authorization required 30 combined visits (PT, OT & ST) allowed per calendar year.
Acupuncture $0 Authorization required Number of visits based on plan's approval.
Chiropractic $0 Authorization required Number of visits based on plan's approval.
Alternative Therapy Management (ATM) $0 Authorization required (No authorization for the first 15 combined visits of acupuncture, chiropractic manipulation, and osteopathic manipulation to a contracted provider) Contact FamilyCare Health for details.
Vision Your Cost Authorization/Referral Limits
Eye Exams $0 Not required. Contact VSP Available for pregnant women, children (20 years and younger), and eligible adults with medical diagnoses of Aphakia, pseudoaphakia, congenital aphakia, keratoconus, or cataract surgery.
Eye Glasses $0 Not required. Contact VSP Available for pregnant women and children (20 years and younger), and eligible adults with medical diagnoses of Aphakia, pseudoaphakia, congenital aphakia, keratoconus, or cataract surgery.
Medical Eye Exams $0 Authorization required Number of visits based on plan's approval.
Specialty Services Your Cost Authorization/Referral Limits
Medical Equipment and Supplies $0 Authorization required Approval based on OHP Guidelines, call FamilyCare Health for details.
Hearing Aids and Exams $0 Authorization required Approval based on OHP Guidelines, call FamilyCare Health for details.
Home Health $0 Authorization required Approval based on OHP Guidelines, call FamilyCare Health for details.
Skilled Nursing Facilities $0 Authorization required Approval based on OHP Guidelines, call FamilyCare Health for details.
Hospice $0 Authorization required Approval based on OHP Guidelines, call FamilyCare Health for details.
Osteopath $0 Authorization required Approval based on OHP Guidelines, limitations may apply, call FamilyCare Health for details.
Medical Transportation Your Cost Authorization/Referral Limits
Contact Ride To Care to schedule a ride: 503-416-3955 or https://www.ridetocare. $0 Authorization required Limitations may apply, call FamilyCare Health for details.

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