Oregon Health Plan (OHP) coverage can end in 2026 for several reasons: a renewal form that never arrived, a household income change, a move out of Oregon, a new job with employer coverage, or an eligibility review that OHA gets wrong. Oregon expanded Medicaid under the ACA, so adults ages 19 to 64 qualify at or below 138% of the Federal Poverty Level (about $22,025 for one person in 2026, per the HHS ASPE poverty guidelines). Losing OHP is a qualifying life event, and federal rules summarized by KFF and healthcare.gov give you a 90-day Special Enrollment Period (SEP) to join a Marketplace plan. Oregon's own guidance describes selecting a plan within 60 days of applying, so treat day 60 as your working deadline. At the same time, you can ask OHA to reconsider or request a hearing, and many procedural closures reverse once the missing paperwork arrives. Medicaid itself has no deadline, so you can reapply year-round at ONE.Oregon.gov if your income falls back under the limit.
Oregon changes how residents shop for private coverage in 2026, and the timing matters if your OHP ended this fall. Through October 31, 2026, Oregon's individual market was served through HealthCare.gov. Beginning November 1, 2026, the state launches its own Marketplace platform, Explore Health, at ExploreHealthOR.gov, with 2027 plans from BridgeSpan, Kaiser Permanente, Moda, and Regence (Providence and PacificSource leave the Marketplace after 2026). Oregon also runs OHP Bridge, a Basic Health Program that covers adults with income above 138% and up to 200% FPL at no premium, which often beats a Marketplace plan for people who just lost OHP. Federal H.R. 1 changes add work or activity reporting for some expansion adults starting January 2027, so keeping OHP after a reinstatement now carries new paperwork. This guide covers the 7 steps, the OHA appeal rules, the household income table, and the documents you need. Oregon residents keep the same ONE.Oregon.gov account for OHP and OHP Bridge, and anyone whose coverage starts January 1, 2027 should compare carriers and networks carefully.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The costliest mistakes Oregonians make after losing OHP coverage in 2026:
- Waiting to see whether an appeal succeeds before shopping. The SEP clock and the hearing clock run at the same time, so file the hearing request and enroll in a backup plan together.
- Skipping OHP Bridge. Adults with 2026 income above 138% and up to 200% FPL often pay nothing for OHP Bridge, yet many shop on the Marketplace first and pay premiums they did not need to pay.
- Missing the 10-day continuation request. Benefits continue during a hearing only if you ask OHA within 10 days of the notice's effective date, and you may owe costs if the original decision stands.
- Reporting 2025 income instead of projected 2026 income. Explore Health calculates premium tax credits from expected 2026 income, and a wrong estimate can produce a large repayment when you reconcile Form 1095-A.
- Forgetting to pay the first premium. Selecting a Marketplace plan does not start coverage until the carrier receives payment.
Why Oregon Health Plan Coverage Ends in 2026 and What Triggers the SEP
Oregon Health Plan closures in 2026 fall into three groups, and each group points to a different next move. Procedural closures happen when OHA cannot confirm information at renewal, such as when a renewal packet goes to an old address, and they are the most likely to reverse once you send the missing proof. Income-based closures happen when data matches show household income above the program limit, and those usually lead to OHP Bridge or a Marketplace plan. Life-change closures follow a move out of Oregon, a new job with employer coverage, or a change in household size. Each type counts as loss of Medicaid coverage, which is a qualifying life event for a Marketplace Special Enrollment Period, as healthcare.gov explains. Keep the closure notice, because it is the proof Explore Health and HealthCare.gov ask for. Procedural closures deserve the fastest response, since OHA can often reinstate coverage by phone without a new application.
Federal rules summarized by KFF give people who lose Medicaid or CHIP 90 days to choose a Marketplace plan, longer than the standard 60-day window for most qualifying life events. CMS aligned that window with the 90-day period in which former enrollees can send missing information to restore Medicaid. Oregon's Marketplace materials describe a 60-day selection period after you apply, so the safe approach is to finish enrollment within 60 days of your OHP end date and treat days 61 to 90 as a cushion, not a plan. Medicaid and OHP Bridge never expire as options, because both accept applications year-round. Oregon residents who lost OHP during the 2023 to 2024 unwinding saw several temporary windows, but those windows have ended, and the standard 90-day rule now governs. Day counting starts the day your coverage ends, not the day you receive the notice, so a late-arriving letter can shorten your real window. Call the Marketplace contact center if a notice reaches you after more than a week has passed, and ask them to document the delay.
OHP, OHP Bridge, and Marketplace Income Limits in Oregon for 2026
Oregon's 2026 eligibility ladder has four rungs, and the Medicaid income limits and ACA income limits pages show the national detail. Adults ages 19 to 64 qualify for OHP at or below 138% of the Federal Poverty Level, which is $22,025 for one person and $45,540 for a family of four in 2026. Adults above 138% and up to 200% FPL ($31,920 for one person in 2026) qualify for OHP Bridge. Adults above 200% and up to 400% FPL ($63,840 for one person in 2026) receive Marketplace premium tax credits, and Silver cost-sharing reductions reach up to 250% FPL. Above 400% FPL, the subsidy cliff returned for 2026 after the enhanced credits expired on January 1, 2026. Children qualify for OHP up to 305% FPL, funded through Medicaid and CHIP. Households that straddle two programs, for example a parent at 180% FPL and a child at 250% FPL in 2026, can hold OHP Bridge and children's OHP at the same time.
Income counting differs by program, and that difference trips up many households. OHP and OHP Bridge use gross monthly income, while Marketplace premium tax credits use estimated annual Modified Adjusted Gross Income (MAGI) for 2026. Federal Poverty Level figures come from the HHS ASPE 2026 guidelines. A household near a threshold should run both numbers before choosing, because a few hundred dollars of monthly income can move you from a no-premium program to a subsidized plan with a monthly bill. Self-employed Oregonians should estimate net profit after business expenses, not gross receipts, and should update the estimate if mid-year earnings change. Unemployment benefits count toward MAGI in 2026. Child support received and most Supplemental Security Income do not count, though rules differ by program, so confirm each item with OHA or Explore Health before you submit an application. Reporting an accurate number protects you from owing back premium tax credits when you reconcile Form 1095-A in early 2027.
Explore Health, the New Oregon Marketplace, in 2026 and 2027
Explore Health is Oregon's state-based Marketplace and replaces HealthCare.gov for Oregon residents starting November 1, 2026, according to the Oregon Health Authority. The state holds conditional approval from CMS, and the platform serves people without job-based coverage or a public program such as OHP or Medicare. Oregon's 2027 carriers are BridgeSpan, Kaiser Permanente, Moda, and Regence, while Providence and PacificSource leave the Marketplace after 2026, so anyone on an exiting carrier must also pick a new plan. Reported 2027 rate filings show average premium increases above 20% before subsidies, which makes premium tax credits and OHP Bridge more valuable. Open Enrollment for 2027 coverage begins November 1, 2026, and the closing date has been reported as December 31, 2026 and January 15, 2027, so confirm it at ExploreHealthOR.gov and enroll by December 31, 2026 for January 1 coverage. Plan year 2027 also brings new networks, so verify that your clinics, pharmacies, and hospital systems participate before you select a plan, and compare each plan's deductible and out-of-pocket maximum. The federal 2026 out-of-pocket limit is $10,600 for one person and $21,200 for a family, and 2027 limits will differ.
Keeping OHP After You Win: New Federal Rules Starting January 2027
Federal H.R. 1 changes reshape Medicaid renewals for Oregon expansion adults, and the Oregon Health Authority is publishing details at OHP.Oregon.gov/HR1. Beginning January 2027, some adults ages 19 to 64 must show work, volunteering, education, or training activity at application or renewal, with exemptions for parents of children under 14, certain caregivers, pregnant members, people on disability-based programs, American Indians and Alaska Natives, and people with Medicare. Six-month renewals for many adults follow in late 2027. Households who regain OHP in 2026 should keep their ONE.Oregon.gov contact information current, because missed renewal mail is the most common cause of a repeat closure. Timelines depend on state guidance and system updates, so check the OHA key-changes sheet for current dates. Work requirement rules target expansion adults, not children, and OHP Bridge members should ask OHA whether and how the new rules apply to that program. Reinstated members should also confirm their mailing address and phone number in their ONE.Oregon.gov account.
Frequently Asked Questions
How long do I have to enroll in a Marketplace plan after losing Oregon Health Plan coverage?
Federal rules summarized by KFF give you 90 days from the date your Oregon Health Plan (OHP) coverage ends to enroll in Marketplace coverage under the Medicaid-loss Special Enrollment Period. For example, if OHP ends October 31, 2026, your window runs November 1, 2026 through January 29, 2027. Oregon's Marketplace materials describe selecting a plan within 60 days of applying, so aim to finish by December 30, 2026. Enroll by December 31, 2026 for coverage starting January 1, 2027. After the window closes, you wait for the next Open Enrollment Period, although OHP and OHP Bridge accept applications year-round.
How do I document losing OHP for the Marketplace SEP?
Your OHP closure or denial notice from the Oregon Health Authority (OHA) or ODHS is the main proof of the qualifying life event. Explore Health and HealthCare.gov may ask you to upload it, and the system usually allows about 30 days to send requested documents. Also gather Social Security numbers, proof of Oregon residence, and projected 2026 household income records such as pay stubs or an unemployment award letter. If you also left a job, add the employer termination letter or COBRA notice. Keep copies of every upload and confirmation number.
What happens if I miss the 90-day SEP after losing OHP?
Missing the 90-day Special Enrollment Period means you cannot buy a Marketplace plan until the next Open Enrollment Period, which begins November 1, 2026 for 2027 coverage on Explore Health. Until then, you may be uninsured unless another qualifying life event opens a new window, such as a move, marriage, or birth. OHP and OHP Bridge never expire as options, because Oregon accepts those applications year-round at ONE.Oregon.gov. If your 2026 income is at or below 200% FPL, apply the same day you notice the deadline passed.
Can I get retroactive coverage after losing Medicaid in Oregon?
Marketplace plans bought during your SEP generally start on the first day of the month after you select a plan, and selecting a plan before OHP ends can avoid a gap. If you win an OHA hearing or send missing renewal information in time, OHA generally restores OHP back to the closure date, so claims from the gap can be covered. Marketplace coverage does not reach back to before your plan start date. Confirm the exact effective date on your Explore Health confirmation and on any OHA decision letter.
What is the difference between COBRA and a Marketplace plan after losing OHP?
COBRA applies only if you also lost employer group coverage, and it costs 102% of the full premium, roughly $400 to $900/mo for one person and $1,200 to $2,800/mo for a family in 2026. A Marketplace plan through Explore Health, with premium tax credits for income up to 400% FPL in 2026, is almost always cheaper. OHP Bridge costs no premium for adults above 138% and up to 200% FPL. COBRA fits only when you need a specific provider outside Marketplace networks or want to protect a deductible you already met. You have 60 days to elect COBRA.
What Oregon-specific rules apply when I lose OHP?
Oregon runs OHP through the Oregon Health Authority, with applications and renewals at ONE.Oregon.gov and help at 800-699-9075. OHA hearing requests are due within 60 calendar days of the Notice of Denial, and you ask to continue benefits within 10 days of the notice's effective date. OHP Bridge covers adults above 138% and up to 200% FPL. Oregon moves to its own Marketplace, Explore Health, on November 1, 2026. Federal H.R. 1 work or activity rules reach some expansion adults beginning January 2027, with several exemptions.
Do I qualify for OHP or OHP Bridge after losing coverage?
Oregon adults ages 19 to 64 qualify for OHP at or below 138% FPL, which is $22,025 for one person and $45,540 for a family of four in 2026. Adults above 138% and up to 200% FPL ($31,920 for one person, $66,000 for four in 2026) qualify for OHP Bridge. Income above 200% and up to 400% FPL ($63,840 for one person in 2026) qualifies for Marketplace premium tax credits. OHP uses gross monthly income, so compare your current monthly pay with the table on this page and apply at ONE.Oregon.gov.
What happens to my children's coverage when I lose my OHP?
Your children's OHP coverage is separate from yours and does not end automatically when your adult coverage closes. Children ages 0 to 18 qualify for OHP at household income up to 305% FPL in 2026, funded through Medicaid and CHIP, and enrollment is open year-round. Check each child's status at ONE.Oregon.gov or call 800-699-9075, and file a new child application if a notice says coverage ended. Parents above the adult limits can still enroll themselves in OHP Bridge or an Explore Health plan while their children stay on OHP.
