Health Insurance Marketplace​

Understanding Your Healthcare Options

Healthcare is a crucial aspect of our daily lives and choosing the right insurance plan is vital to ensure we receive the best medical care possible. 

The Health Insurance Marketplace, also known as the Affordable Care Act (ACA), was established to help people access affordable health insurance. In this article, we will explore what the Health Insurance Marketplace is, how it works, and the different options available to you.

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What is the Health Insurance Marketplace?

The Health Insurance Marketplace is an online platform that offers individuals and families access to affordable health insurance plans. It provides a convenient and easy-to-use interface for people to compare different insurance plans and enroll in the one that best suits their needs. The marketplace is designed to help people who are uninsured or who have coverage through the individual market.

Health insurance plans are often stereotyped as an additional expense rather than a valuable protection. The World Health Statistics tells us “too many people are still dying of preventable diseases” and “too many people are unable to get the health services they need.” 

Having adequate health plan protects you and your family from experiencing medical bills. If you have never had any health plans before, or if you’re worried about the premium, Health Plans in Oregon can help get you find affordable health plans and assist you in seeing what financial assistance you may qualify for through the Health Insurance Marketplace better known as healthcare.gov.

Here are some benefits of enrolling through the Health Insurance Marketplace:

1. Obtain Financial Assistance:Many people, including those who are working, may qualify for financial help or tax credits as long as your Employer doesn’t offer group insurance. 

  • Upon qualification to the Health Insurance Marketplace, individuals or families will pay their portion to their insurance carrier and the feds will pay the rest of the premium.
  • Premium tax credits are generally not available for people eligible for affordable health care plans through an employer
    • “Affordable” means no more than 9.5% of an employee’s W-2 income.
  • If you are receiving advance monthly payments of the tax credit, the amount of the tax credit is automatically applied to the monthly premium—you only pay the remaining balance
  • Premium tax credits are not available to those eligible for Medicare or Oregon Health Plan
  • If you choose not to enroll on a qualified health plan for next year, you are subject to a penalty based on your household income

2. Cost Sharing Reductions

  • Oregonians that make up to 250 federal poverty level qualifies for cost sharing reductions to help reduce the out of pocket expenses such as deductibles, co-insurances, co-pays. 
3. Health Insurance Plan options in all Oregon
  • Every single county in Oregon has access to private health insurance plans through HealthCare.gov. With multiple plans available in each area, no matter where in Oregon you live, you can rest easy knowing you can participate in open enrollment for 2022.

4. Dental Options

  • As part of the Health Insurance Marketplace plat form, Oregonians can also choose from a variety of dental plans
5. Additional Savings for Alaska Natives and American Indians
  • Members of federally recognized tribes are eligible for zero cost-sharing if they meet the income criteria of less than 300% of the federal poverty level. 

The Health Insurance Marketplace offers creditable health benefit plan that meets a minimum set of qualifications and coverage such as: 

  1. Inpatient Care
    Insured people can seek inpatient treatment in a hospital or any health care facility from a partner of their insurance provider and get the medical attention they need without fear of huge financial impact.
  2. Outpatient Care
    This variation allows patients the freedom to leave the facility once their procedure is over as long as there are no serious complications. One advantage to this is patients can recover in the comfort of their own homes rather than being confined in a hospital room. There are also fewer costs incurred from outpatient procedures.
  3. Laboratory Tests
    People need more routine check-ups and laboratory tests than they may think. Having blood, urine, or body tissues examined regularly will help doctors diagnose medical conditions as early as possible. The results also assist in the planning or evaluation of treatments and can monitor previously diagnosed diseases as well. Insured people do not have to worry about lab test costs.
  4. Prescription Drugs
    Patients must have a check-up before a doctor can recommend medications. However, health insurance coverage will pay for both the doctor visit and the prescribed drugs.
  5. Preventive Services
    Screenings such as check-ups and patient counseling can prevent illnesses, diseases, and other health-related problems are covered under insured plans. Thankfully, the US Affordable Care Act required the majority of health plans to ensure clients with a set of preventive services without requiring copayments, coinsurance, or meeting deductibles before receiving certain preventive services.
  6. Recovery Services and Devices
    Whether you are injured or have a disability or any chronic condition, there are services and devices available through insurance plans to help you recover. Some of the inclusions are physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation.
  7. Emergency Room Insurance
    Accidents are inevitable, and the emergency room is among the most costly of the average American patient’s medical bill as it often includes ambulance transportation, ER doctors, equipment tests, and emergency medication. Investing in health care to cover these costs can save you from more expensive fees later.
  8. Mental Health and Substance Use Disorder Services
    There are also policies that cater to people with special needs and require particular attention. Sometimes, these two conditions occur together, with one subsequently leading to the other. Covered treatments may include behavioral health treatment, counseling, and psychotherapy.
  9. Pregnancy and Childbirth Care
    The cost associated with pregnancy and childbirth can cause trepidation in women when considering motherhood. However, all prenatal, delivery, and postpartum care is included in comprehensive insurance plans.
  10. Pediatric Services
    Adults are not the only ones who need medical coverage; kids do, too. While getting an additional plan for your children means another expense for you, it is less than you would have to pay in the event of an uninsured accident or illness.

Benefits of Affordable Care Act in Oregon

Affordable Care Act benefits you depending on your insurance status. If you don’t have health insurance:

  • Individuals, families and business owners in Oregon may be eligible for the tax credit or financial assistance 
  • Financial assistance is on a sliding scale
  • Less income means qualification for more financial assistance

What are the different options available in the Health Insurance Marketplace?

The Health Insurance Marketplace offers four different types of plans: Bronze, Silver, Gold, and Platinum. Each of these plans offers different levels of coverage and costs.

  • Bronze plans are the most affordable and offer the least amount of coverage. They typically have lower monthly premiums but higher out-of-pocket costs.
  • Silver plans offer a higher level of coverage and lower out-of-pocket costs than Bronze plans. They are ideal for people who need regular medical care.
  • Gold plans offer the highest level of coverage and the lowest out-of-pocket costs. They are ideal for people who have frequent medical needs and want the best coverage possible.
  • Platinum plans are the most expensive but also offer the best coverage. They are ideal for people who need a lot of medical care and want the best possible coverage.

Different Plan Options You Can Choose From

Before choosing a particular health plan, you must know the distinctions of every single policy.  Here are different type of health plans in Oregon you can choose from base on network of providers you use. 

  1. PPO
    The Preferred Provider Organization plan is a group health insurance policy which makes a network of preferred doctors and hospitals available to employees. With its flexibility, convenience, lower premiums, and large choice of providers, PPO could be the best option for your small business and your employees.
  2. HMO
    The Health Maintenance Organization Health Insurance plan allows for a lower out-of-pocket expenses for employees and provides a broader range of coverage in terms of preventive services compared to other policies. However, there are usually fewer options for physicians and hospitals than in other plans.
  3. POS
    The Point of Service health insurance policy is a combination of the features of HMO and PPO. This option is a balance of greater provider choice and lower premiums.
  4. EPO
    The Exclusive Provider Organization plan is similar to that of HMO in that they employ an exclusive network of physicians who their members must use, with an emergency as the only exception. Members are responsible for small copayments, and may sometimes require deductibles.

Whether you are seeking a health plan for yourself, your family, or your business, there’s a lot of choices to choose from. Health Plans in Oregon is here to help. Call us now: 503-928-6918

Who Qualifies to Purchase Insurance on the Marketplace?

To buy health insurance through the marketplace, you must:

  • Live in the US
  • Be a US citizen/national
  • Not be in prison
  • Not be covered by Medicare

Is the Marketplace for Individuals Only?

No, it’s not. The marketplace is useful for individuals, families, and even small businesses. Additionally, private marketplaces like eHealth offer a wide range of health insurance options.

When can you sign up for insurance on the marketplace? 

Health Insurance Marketplace Enrollment Periods

The Annual Open Enrollment period for most people to enroll or change plans is November 1- January 15. If you enroll  from Nov. 1-Dec. 15, your coverage will start Jan. 1 the following year. And if you enrolled between Dec. 16- Jan. 15, then your coverage start Feb. 1. 

If you missed the Open Enrollment Period, qualified individuals may be eligible to a “special enrollment period” under certain circumstances:

  • Marriage
  • Birth of child
  • Involuntary Lost of coverage through work, OHP, Cobra, and others.
  • Moving to a new residence
  • Divorce, legal separation or death
  • Newly gained eligible immigration status
  • Release from incarceration

During which, you could enroll in Qualified Health Plan (QHP) or may be able to change enrollment from one QHP to another.

If you enroll directly through any of the carriers in Oregon, you won’t be able to receive the tax credits or financial assistance. Since Health Insurance Marketplace started in 2014, Open Enrollment starts November 1 and ends December 15 and insurance plans take effect the following year.  

You must enroll during this time otherwise, you will have to wait for the next Open Enrollment unless you’re currently covered with Oregon Health Plangroup insurance or Medicare Insurance. If you involuntary lose your coverage, then you may be able to enroll any time during the year through Special Enrollment Period. 

>>Click here for Explainer Video

Are all health insurance marketplaces run by the government?

No, both government and private companies operate health insurance marketplaces. Out of the 14.5 million people who enrolled in 2022, 10.3 million chose a plan through the federal marketplace, and 4.2 million selected a plan through a state-based marketplace.

Types of Marketplaces:

  1. State-run marketplaces – run by the state where you reside.
  2. Federal marketplace – for residents of states without their own marketplace.
  3. Private marketplaces – offering ACA plans with the same essential Obamacare benefits as government marketplaces. If eligible for federal subsidies, subsidies remain the same on private marketplaces.

What are the different types of health insurance plans offered through the marketplace?

The health insurance marketplace offers various types of major medical insurance plans that comply with the Affordable Care Act and provide the ten essential benefits. These include:

Frequently Asked Questions

Is it possible to enroll in Medicare through the marketplace?

Yes, it is possible to enroll in Medicare through a health insurance marketplace. Some people may automatically be enrolled in Medicare. However, if you already have Medicare coverage, there is no need to reapply through a marketplace. 

Selling a marketplace plan to someone who already has Medicare is illegal. But, you have additional coverage options, like enrolling in a Medicare Advantage Plan or Medicare Supplement, to enhance your existing Medicare plan.

Is it Cheaper to Buy a Marketplace Plan on a State Exchange, Federal Exchange, or Private Exchange?

No matter where you purchase a marketplace plan, the price will be the same. Your premiums and subsidies will remain the same on state and federal exchanges, as well as private sites like eHealth.

Prices for marketplace plans can vary based on your state, income, and household size, but the cost of a specific plan will not vary between sources. You don’t have to search multiple places to find the best price.

Health Plans in Oregon can assist in finding the lowest prices on the desired health insurance, offering comparison and no additional fees for a better shopping experience.

Is the Health Insurance Marketplace the same as Medicare or Medicaid?

No, the Health Insurance Marketplace is not the same as Medicare or Medicaid. Medicare is a federal health insurance program for people who are 65 or older or have certain disabilities. Medicaid is a state-run health insurance program for people with low income. The Health Insurance Marketplace is for people who are uninsured or who have coverage through the individual market.

Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.

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I GRANT PERMISSION FOR A LICENSED INSURANCE AGENT TO CALL OR EMAIL ME REGARDING MY MEDICARE OPTIONS INCLUDING MEDICARE SUPPLEMENT, MEDICARE ADVANTAGE, AND PRESCRIPTION DRUG PLANS . Not affiliated or endorsed by Medicare or any state or federal governmental agency.

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