Medicaid Eligibility in Oregon: Income Limits & How to Apply
Medicaid Eligibility in Oregon
Oregon expanded its Medicaid program under the Affordable Care Act, opening Oregon Health Plan (OHP) to adults aged 19-64 whose income falls at or below 138% of the federal poverty level. In 2026, that works out to roughly $21,597 for one person or $44,367 for a family of four.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for Oregon Health Plan (OHP) with free or very low-cost coverage. No premiums, no deductibles.
Under Oregon's expanded program, coverage extends to:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About Oregon Health Plan (OHP)
If you're an Oregon resident trying to navigate the complexities of health coverage, understanding the Oregon Health Plan (OHP) and marketplace subsidies is key to accessing affordable care. The Oregon Health Plan (Medicaid) provides free or low-cost health coverage to eligible Oregonians. Adults aged 19-64 can qualify with incomes up to 138% of the Federal Poverty Level (FPL). For a single person, this means a monthly income of about $1,800, or an annual income of approximately $21,800. For a family of three, the income limit is around $3,065 per month, or about $37,000 annually. Children and teens up to age 18 can qualify with family incomes up to 305% FPL, and pregnant individuals up to 185% FPL. As of 2023, approximately 987,200 people are enrolled in Medicaid or CHIP in Oregon, demonstrating it's a vital program for a significant portion of the state's population.
If your income is slightly above the OHP threshold, you may still have excellent, affordable options through the HealthCare.gov marketplace. Oregon has a benchmark Silver plan costing around $485 per month. If your income falls between 138% and 200% of the FPL, you might qualify for OHP Bridge, a new program launching in July 2024. This program offers comprehensive medical, dental, and behavioral health coverage with $0 premiums and no cost-sharing, similar to OHP Plus. For a single person, this means an annual income between $20,820 and $31,300, and for a family of three, between $35,448 and $53,300. If your income changes, you could shift between OHP and marketplace plans, so it's important to report any income fluctuations to ensure you remain in the correct program. After the end of the COVID-19 public health emergency, Oregon successfully maintained coverage for over 80% of its Medicaid members during the "unwinding" period, and those who lost coverage can reapply at any time if their circumstances change.
The Oregon Health Plan provides comprehensive benefits, including medical, dental, prescription, and behavioral health care, typically at no cost to members. Unlike some other states, Oregon does not have an asset test for most OHP applicants, meaning your savings or property generally won't prevent you from qualifying based on income. Oregon also has unique programs like "Healthier Oregon," which, as of July 2023, provides full OHP benefits to eligible individuals regardless of immigration status. Additionally, Oregon's 1115 Medicaid Demonstration waiver, running until September 2027, includes initiatives to address health-related social needs such as housing, nutrition, and climate supports, along with extended continuous eligibility for children (birth to age six) and adults (two years). Telehealth services are also widely covered, allowing you to access care from home via video, phone, or online appointments.
When applying for OHP or managing your coverage, be aware of a few key things. While Oregon has made efforts to streamline the process, you may still experience processing delays for applications or renewals, especially if submitting paper documents. It's crucial to provide all requested documentation promptly, such as proof of income, birthdate, and Social Security number, to avoid delays. Keep your contact information updated with OHP, as official notices regarding your eligibility or renewals will be sent by mail. If you have questions or concerns about your OHP services or providers, you can contact OHP Client Services or your coordinated care organization (CCO). To take an immediate step, gather your household's income and demographic information and visit ONE.Oregon.gov to start your application and see what coverage you qualify for.
Oregon Medicaid Income Limits 2026
The following table shows the key income thresholds for Oregon in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for Oregon Health Plan (OHP). If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
Oregon's average benchmark premium of $485/month is near the national midpoint. For residents earning between 100-400% FPL, premium tax credits offset most of this cost.
Marketplace Insurance in Oregon
Oregon residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Oregon costs approximately $485/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Oregon might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Oregon uses the federal marketplace at HealthCare.gov for ACA enrollment. When you apply, the system automatically checks your Medicaid eligibility — if you qualify, your application is forwarded to the state Medicaid agency.
Since expanding Medicaid, Oregon has enrolled hundreds of thousands of adults in Oregon Health Plan (OHP). Residents whose income fluctuates around the 138% FPL threshold can move between Medicaid and subsidized marketplace coverage as their circumstances change.
How to Apply for Oregon Health Plan (OHP)
- Apply online through HealthCare.gov. The system will automatically check your Medicaid eligibility based on your income and household size.
- Apply directly through your state's Medicaid agency. You can apply year-round — there is no enrollment period for Medicaid.
- Call the Medicaid hotline for Oregon to get help with your application or check your eligibility over the phone.
- Visit in person at your local Department of Social Services or county human services office.
Have the following ready: recent pay stubs or tax returns, proof that you live in Oregon, Social Security numbers for everyone in your household, and details on any existing health insurance.
Calculate Your Subsidy in Oregon
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Oregon.
Check Your Eligibility →Frequently Asked Questions
What is the income limit for Medicaid in Oregon?
In 2026, the Medicaid income limit in Oregon is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Has Oregon expanded Medicaid under the ACA?
Yes, Oregon has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for Oregon Health Plan (OHP).
How do I get help paying for health insurance in Oregon?
Yes. Oregon residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the Oregon Medicaid program called?
Oregon's Medicaid program is known as Oregon Health Plan (OHP). It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What happens if I lose Medicaid coverage in Oregon?
If your Oregon Health Plan (OHP) coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Does working disqualify me from Medicaid in Oregon?
Yes. Medicaid eligibility in Oregon is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for Oregon Health Plan (OHP) even if you work full-time. Many Oregon Health Plan (OHP) enrollees are working adults.
What's the difference between Medicaid and marketplace insurance in Oregon?
Medicaid (Oregon Health Plan (OHP)) is free or near-free with no premiums or deductibles. Marketplace plans in Oregon average $485/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- California Medicaid Eligibility — Expansion state
- Idaho Medicaid Eligibility — Expansion state
- Nevada Medicaid Eligibility — Expansion state
- Washington Medicaid Eligibility — Expansion state