Looking for affordable health insurance in Oregon for you and your family?
You’re at the right place.
Health insurance plans in Oregon can change from year to year, and navigating them can be tricky, so it’s important to keep a few things in mind when deciding how to choose a health plan. Plan premiums depend on health coverage, network providers and type of insurance plans. Health Plans in Oregon is here to help answer any questions you may have and provide you with all the information so you can be confident in the health insurance you choose.
The wrong health plan can end up costing you more money.
Unfortunately, most people shop for the cheapest health plan in the market without realizing the type of insurance plan they purchased is either a short term medical or high catastrophic insurance plan. Short term medical is normally half of the cost of a credible health plan, it’s a high deductible plan that doesn’t cover pre-existing conditions, prescriptions, mental health or maternity coverage and has a lifetime dollar limit. So these type of insurance plans can actually cost you more money.
Navigating affordable health insurance in Oregon can be tricky.
That’s why we’ve put together a step by step guide on buying affordable health insurance in Oregon. It will provide you the basic important information you need to get the best possible health insurance for you and your family.
1. Know where to get insurance.
If you get your insurance through your employer like most people, then you won’t need to use the government’s Health Insurance Marketplace or the state’s Oregon Health Plan. However, some people don’t qualify for work insurance or their employer doesn’t offer group coverage to their employees. In this case, you can buy health insurance plans through the Health Insurance Marketplace and in most cases may qualify for premium tax credits that you can use to help reduce the cost of your health plan’s premium and copays.
Check income limits to qualify for tax credits. See the chart below:
You can also check to see if you qualify for Oregon Health Plan. OHP is a no cost health plan offered through the state of Oregon. You you and/or your family must meet income and residency requirements. Oregonians may also qualify based on age and disability status. Check at the eligibility below:
2. Check for grandfather exemptions.
If your employer makes no substantial changes to your insurance plan, it may be “grandfathered in” and not subject to certain required provisions in the health reform law. These include free coverage (with no copay) for preventive services like blood pressure or depression screening, smoking cessation programs, and immunizations. Plan materials will indicate whether or not the plan is grandfathered, along with the benefits it provides.
3. Decide which plan type best meets your needs.
There are generally three types of plans: health maintenance organizations (HMO), preferred provider organizations (PPO) and point-of-service plans (POS). An HMO requires you use physicians within a specific network, giving you less flexibility but a more affordable cost. A PPO allows you to stay in-network or go out of network for a heftier fee; out-of-pocket costs are usually higher for PPO’s than for HMO’s. POS plans combine elements of HMO’s and PPO’s. They give you the option to pay more for venturing out of network. However, they usually require you to choose a primary care physician within the network and get a referral from that physician before seeing any specialist. In general, PPO health plans in Oregon cost more in premiums than HMO plans.
4. Identify changes before re-enrolling.
This could save you from dealing with unexpected costs if your benefits have changed. Coverage for a particular service such as chiropractic care may have disappeared, or the cost of covering your spouse may have increased or some of your doctors or prescriptions are no longer covered. So, it could pay to change plans. It’s likely, your monthly premiums have gone up, due to rising healthcare costs.
5. Make adjustments to your current plan or consider switching.
Take into account whether your needs have changed. If you’re planning a family, you might need maternity coverage, for example, or perhaps you’d like to add an adult child back onto your insurance. All plans are now required to cover children up to age 26, though grandfathered plans may exclude these young adults if they have access to health benefits through an employer.
6. Compare health plan networks.
It is best if your chosen physician is part of the in-network providers of your health insurance plan because insurance companies contract lower rates with in-network providers. Furthermore, it is advisable to choose a plan that has a local in-network doctors and a wider network to give you more choices.
7. Look for health plans with a wider scope of services.
Identify the services you most need. There are plans that offer better coverage for physical therapy, mental health care and emergency coverage. Choose the plan that best suits your needs so you won’t have to pay for services you don’t need.
8. Size up the cost.
Compare the total cost of various plans using an online quote tool. If you are young and healthy, you may want to trade pricey monthly premiums for a higher deductible (paying more out of pocket costs before coverage starts). Be sure to factor in copays (the physicians’ fees) and coinsurance (your share of the cost for prescriptions or hospitalization). This is one crucial step on knowing how to choose a plan. You may need a trusted healthcare agent to help you on this to make an informed decision. Sometimes it’s more affordable to enroll on a high deductible bronze health plan and add supplemental plans to cover the hospital copay or surgery than buying a gold health plan that offers a low deductible.
9. Don’t get lured by those new freebies.
While new plans now require you to pay nothing for certain routine preventive care, you might not need to switch your old plan to get these benefits. Many plans were already offering preventive services at minimal or no cost prior to the passage of health reform, says Randall Abbott, a senior health care consultant with Towers Watson, a global consulting firm based in New York.
10. Consider opening an HSA account for your medical expense.
To save on monthly premiums, consider setting up a healthcare savings account. This account is designed to help pay for prescriptions, contact lenses, and other medical expenses. In 2019, the maximum family contribution is $7,000 and $3,500 for a single person. Contributions to a health savings or flexible spending account are subtracted from your pretax income— a big plus. However there are, some drawbacks to both. A health savings account has to be paired with a high deductible plan — with an annual deductible of $1,350 for self only coverage and $2,700 for a family. In 2019, out of pocket expenses are $6,700 for single and $13,500 for family. According to DataPath, HSA’s increased from 6.76 million accounts to 22.21 million in 2017.
11. Health insurance terminologies
Understanding these terms is key for healthcare costs for the coming year.
- Premium – the amount you pay for your health insurance every month
- Co-pay – a fixed amount for a covered service, paid by a patient to the insurance company before patient receives service from physician
- Deductible – an out-of-pocket expense ceiling that you must meet before certain facets of your plan kick in
- Coinsurance – the percentage of costs of a covered health care service you pay (i.e. 20%) after you’ve paid your deductible
12. Compare out-of-pocket costs.
Services paid thru out of pocket should be clearly laid out in a health plan’s summary of benefits. It’s useful to have a trusted personal agent to help you compare what is best for you. It could be a plan with higher out of pocket costs and lower monthly premiums or vice versa.
13. Choose Metal Tier that fits your needs.
Health insurance are offered in four metal categories which are Bronze, Silver, Gold and Platinum. These health insurance tiers have little to do with the quality of care you will receive. However, it is based on how you and your health coverage divides the costs of your health care.
Which insurance plan is best for you?
Bronze plan is best for you if you’re relatively healthy. If you are just looking for an affordable plan to shelter you from worst-case medical situations, like severe illnesses or injury, this plan is worth consideration. You’ll have to pay for most of your routine care but a low monthly premium.
Silver plan is right for you if you are willing to pay a slightly higher monthly premium than Bronze so more of your routine care is covered. Moreover, this is your best choice if you qualify for “extra savings”.
Gold plan is worth considering if you use a lot of care services. You’ll have more expenses covered when you getting medical treatment but you’ll have to pay more each month.
Platinum is right for you if you usually require a lot of care and you are willing to pay a higher monthly premium, knowing that nearly all other expenses will then be covered.
|Plan Category||Your insurance pays…||You pay…||Description|
|Bronze||60%||40%||LOWEST monthly premium, HIGHEST costs when you need care|
|Silver||70%||30%||MODERATE monthly premium, MODERATE costs when you need care|
|Gold||80%||20%||HIGH monthly premium, LOW costs when you need care|
|Platinum||90%||10%||HIGHEST monthly premium, LOWEST costs when you need care|
What is the ideal health plan that fits your current needs and budget?
- One that lets you see your current doctors and other health care providers
- Has premiums, deductibles, and other costs that are affordable to you
- Covers services that you need
- Covers your prescription drugs and preferred pharmacies
- Offers a satisfactory quality of services
When can I change my health insurance plan?
Annual Open Enrollment Period
- The time to make changes to your current plan.
- It runs from Thursday, November 1, 2019, to Saturday December 15, 2019
- If you don’t have an Oregon health insurance from another source, you must sign up.
- You may have to wait for a year to enroll if you miss open enrollment.
Is there a better health plan every year?
*** You might be automatically re-enrolled on the same plan but with change in costs and services offered. So, always remember to check for any changes in your current plan. Moreover, it is always best to confirm if new or more affordable insurance plans are available in your area to assure you the best protection available at the lowest cost offered.
It’s easy to compare health plans online, but for more comprehensive details, it is BEST to ask your local Oregon licensed agent for free help.
Now that you have read about the importance of health insurance. As one of the 24 Oregon health insurance agencies selected by the Department of Consumer and Business Services — Health Plans In Oregon is here to help you shop for the best affordable health plan options. We are here to give you the service you deserve before, during and after you’re covered.