Tarjeta de id. de miembro
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.
Health Share of Oregon
Teléfono:
Toll-free:
TTY:
Horario:
de lunes a viernes de 8 a.m. a 5 p.m.
Correo electrónico:
You can also do this by logging into the MyCareOregon mobile app, tapping “View my Member ID card” and selecting “Mail Member ID card”.
Finding care
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.
Autoridad de Salud de Oregon (OHA)
Toll-free:
TTY:
Horario:
de lunes a viernes de 8 a.m. a 5 p.m.
Correo electrónico:
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.
Using your plan
If any of your personal information—such as your home address—has changed, report the change within 10 days to the Oregon Health Plan.
Autoridad de Salud de Oregon (OHA)
Toll-free:
TTY:
Horario:
de lunes a viernes de 8 a.m. a 5 p.m.
Correo electrónico:
Sitio web:
No. Nunca le cobraremos por ningún servicio cubierto por el OHP o Medicaid. 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. Es posible que deba pagar un copago en farmacias por determinados medicamentos recetados para la salud mental que cubre el estado. If a medical office asks you for a copayment, ask the staff to call Customer Service. Cuando programe una cita, infórmele al consultorio que tiene la cobertura de 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.
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.
Con la aplicación móvil MyCareOregon puede acceder a lo siguiente desde su teléfono inteligente:
- Digital Member ID card and other benefits information
- Recetas médicas y calendario de renovaciones
- Medical claims history
- Información de contacto del proveedor de atención primaria
- Información de contacto del proveedor dental
- CareOregon provider search
- Atención al Cliente de CareOregon
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.
Getting help
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. No es necesario llamar antes a su médico, dentista o plan de salud. You are covered for urgent and emergent care, and prior authorization is not needed.
Algunos problemas como los resfríos comunes, el estreñimiento, la dermatitis del pañal, el dolor de espalda y el dolor de dientes son abordados de mejor manera por su PCP o dentista, quienes lo conocen y están al tanto de sus antecedentes médicos. Asegúrese de llamarlos primero cuando tenga este tipo de problemas. Ellos harán todo lo que esté a su alcance para atenderlo lo antes posible.
If you need to be seen sooner than your provider can see you, go to an urgent care clinic instead of the ER. En general, es más rápido y conveniente. 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.
Si no está satisfecho con CareOregon o Health Share of Oregon, con sus servicios de atención médica o con su proveedor, puede presentar una queja en cualquier momento, por cualquier motivo que no sea una denegación de servicio. Su proveedor o representante autorizado también puede presentar una queja en su nombre con su consentimiento por escrito. Intentaremos solucionar el asunto.
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 y Health Share of Oregon trabajarán para resolver su queja o reclamo tan rápido como lo requiera su afección médica. Si necesitamos más de cinco días laborables, le enviaremos una carta para hacerle saber el motivo. Usted recibirá una respuesta final dentro de los 30 dias corridos. No le informaremos a nadie sobre su queja a excepción de que usted nos pida que lo hagamos.
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.
Si denegamos, interrumpimos o reducimos un servicio médico que su proveedor haya ordenado, le mandaremos una carta de Aviso de acción para informarle la razón de tal decisión. You have a right to ask to change it through an appeal and a fair hearing. Deberá solicitar una apelación en un plazo máximo de 60 días a partir de la fecha que se encuentra en la carta de aviso de acción. Puede solicitar un aviso de denegación que muestre que un servicio no está siendo cubierto si:
- no recibió un aviso de denegación escrito o;
- su proveedor le indica que debe pagar por el servicio que no está cubierto.
For full instructions on the appeals process, visit the Health Share appeals page.
Provider appeals
Su proveedor tiene el derecho de apelar por usted cuando las órdenes de su médico son denegadas por un plan. Usted debe consentir esto por escrito. 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 se compromete a proporcionar materiales traducidos a aquellos miembros que hablan otro idioma que no sea el inglés.
También ofrecemos servicios de interpretación. Si necesita un intérprete para las visitas o llamadas telefónicas al consultorio de su proveedor (o al de su hijo), tiene derecho a recibir este servicio de forma gratuita. Es posible que haya recibido una Tarjeta de Idioma de Preferencia cuando se incorporó a 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.
OHP and Medicaid
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. Las personas que quieran obtener OHP Bridge deben:
- Tener entre 19 y 65 años de edad.
- Tener un ingreso entre el 139 % y el 200 % del nivel de pobreza federal (FPL).
- Tener una ciudadanía o condición de inmigrante elegible para calificar.
- No tener acceso a otro seguro de salud asequible.
OHP Bridge is almost the same as OHP Plus
Los dos paquetes de beneficios son casi iguales. Hay algunas cosas que OHP Bridge no cubre. Si desea conocer qué es lo que no cubre OHP, consulte la siguiente tabla.
| OHP Bridge cubre: | OHP Bridge no cubre: |
|---|---|
|
|
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.
| Family Size | 200% FPL |
|---|---|
| 1 | $30,120 per year |
| 2 | $40,880 |
| 3 | $51,640 |
| 4 | $62,400 |
OHP Bridge is free to members
Al igual que OHP Plus, OHP Bridge es gratis para los miembros. That means no premiums, no copayments, no coinsurance, and no deductibles.
OHP members with income changes may be moved to OHP Bridge automatically
Si ya tiene OHP ahora, no es necesario que haga nada para obtener OHP Bridge. Si indica que su ingreso es mayor al momento de renovar OHP, es posible que lo trasladen a OHP Bridge.
People who do not have OHP right now can apply for OHP Bridge
Go to one.oregon.gov to apply. También puede usar ese enlace para buscar información sobre cómo solicitarlo en persona, conseguir ayuda con la solicitud u obtener una solicitud impresa. 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.
