Overview of Oregon’s Health Insurance Exchange
When the Affordable Care Act was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. Starting October 1, 2013, Oregon’s healthcare exchange, Cover Oregon, offers individuals and small businesses the opportunity to apply for health insurance. Consumers must apply through an insurance agent or community partner organization. These agents and partners can help customers shop for, compare, and sign up for health insurance through Cover Oregon’s online enrollment system, and get financial assistance as well. As of November 1, 2013, Cover Oregon does not yet let individuals or businesses apply online without help from a partner or agent.
Cover Oregon is offering 102 individual plans and 72 small group medical plans from the following carriers: ATRIO Health Plans, Kaiser Permanente, Trillium Community Health Plan, Providence Health Plan, PacificSource Health Plans, Oregon’s Health CO-OP, Moda Health, Health Republic, Health Net, LifeWise Health Plan of Oregon, and BridgeSpan Health.
Dental plan carriers include BEST Life and Health Insurance Company, Dental Health Services, Dentegra Insurance, Guardian Life Insurance, Willamette Dental Group, Kaiser Permanente, Trillium Community Health Plan, ODS Health Plan, and PacificSource Health Plans.
For more information and links to carriers, visit the Participating Carriers page on the Cover Oregon website.
You can start shopping for a plan on October 1, 2013. Individual applications (i.e. without the help of agents or community partners) will be available online to Oregonians at an unannounced date in the future. Open enrollment lasts until March 1, 2014. Your plan will be effective on January 1, 2014.
Community partners, agents and, customers will be able to search using several different criteria, including plan type (HMO, PPO), carrier, provider, deductible, price, location, out-of-pocket maximum, quality rating, and metal level (Bronze, Silver, Gold, or Platinum).
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
As mentioned earlier, Cover Oregon is also offering dental plans for adults.
There are four basic plans available with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower plans have lower premiums, but higher out-of-pocket costs. A catastrophic plan with a high deductible is available for folks under the age of 30
Adults living at or below 133 percent of the federal poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), and pregnant women living at or below 185 percent of the FPL, can qualify for Medicaid in Oregon based on eligibility standards that take effect January 1, 2014.
Additional federal financial protection provisions will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chance of bankruptcy.
Tax credits are based on the Silver Plan, so you can easily determine what your additional out-of-pocket costs will be if you elect a higher or lower plan compared to Silver. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.
Individuals and families with incomes less than 400 percent of the federal poverty level (and who are covered by an exchange plan) are eligible for healthcare tax credits. The payment of credits will begin in 2014.
People want to how much their subsidies are, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your wages, which amounts to $2,926 a year, or $244 a month. The challenge is to compare the costs of Bronze, Silver, Gold and Platinum, and decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
The mid-level Silver Plan in Oregon for a 40-year-old non-smoker will range from $215 per month for a Health Net Silver Plan in Portland to $344 per month for a Trillium Silver Plan in the Medford Area. The 36 counties of Oregon are organized into seven different areas with varying rates and plans available for different age groups.
Information on Subsidies
This calculator on the Cover Oregon site will help you find out if you are eligible for financial assistance.
To learn more about Cover Oregon, please visit http://www.coveroregon.com, email firstname.lastname@example.org, or call 1-855-COVEROR (1-855-268-3767).