FAQs - Frequently Asked Questions

Or you can send us a new question 🙂

Share with us
FAQs

FAQs

Who is covered with Affordable Act?

84% of Oregonians who have insurance have more choices and stronger coverage than ever before. And for the 16% of Oregonians who don’t have insurance or Oregon families and small businesses who buy their coverage but aren’t happy with it, a new day is here.
In 2010, 636,000 people were uninsured, according to the Oregon Insurance Division. State officials expect 237,100 people to get insurance through the Health Insurance Exchange in Oregon in 2014.

Will using a certified agent like Health Plans in Oregon cost me extra?

No, our commission is built into your premium whether or not you use Certified Agents or not. Our consultation is free and could save you thousands of dollars. DO NOT risk thousands of dollars in potential tax penalties because you assumed the plan bought through Healthcare.gov complied with the law.

Who’s not covered?

  • Not a U.S. citizen or legal resident.
  • Offered enrollment with eligible employer sponsored plan providing “minimum value and affordable”. Minimum value is at least 60% of the actuarial value (bronze plan). Affordable is no more than 9.5% of employee’s W-2 income.

When can I enroll?

  • Individuals or Families Open Enrollment begins NOVEMBER 15-FEB.15, 2015 deadline-Health Insurance Annual Enrollment.
  • Employers on their anniversary date.
  • Small Business-anytime.
  • Medicare Beneficiaries begins October 15-December 7.
  • Coverage begins January 2015.
  • Check our Enrollment Events here
  • Or get your free quote 

Are pre-existing health conditions covered?

Beginning 2014, health insurers can no longer be able to charge more or deny coverage to anyone because of a pre-existing condition.

Will the definition of pre-existing conditions change by 2014, when the Affordable Care Act goes into full effect?

A pre-existing medical condition is commonly considered an illness or disability a person has prior to applying for health insurance coverage. Yet, the definition change on states and even by insurance plans.

However, when the law takes full effect in 2014, that definition will lose its importance. Under the law, no one can refuse health care insurance for any reason, including an existing medical condition.

How can Health Plans in Oregon help me?

We are experienced licensed agents in the Health, Life, Property and Casualty markets.

We also have Errors and Omissions insurance to help protect our clients.

We are certified and trained with Federal Health Insurance Exchange.

Oregonians can now get health coverage, even with pre-existing health conditions as well as access to financial help if you qualify.

Want to know more about the team?

Is there a penalty if I don’t enroll in a health plan?

Under the new rules, individuals choosing not to carry insurance are subject to a penalty of $325 per person each year, or 2.5% of your household income, whichever is greater, beginning in 2014. Over time, the penalty increases, so by 2016 the penalty is $695 per person, or 2.5% of household income. Subsequent years will be calculated based on a cost-of-living formula.

To avoid paying the tax, individuals and families must purchase health insurance that includes a minimum of 10 essential health benefits – such as hospitalization, maternity care, prescription drugs and more – and it must cover at least 60 percent of their medical costs. People who have coverage through their employers or are enrolled in government-subsidized health plans such as Medicare, Medicaid, the Children’s Health Insurance Program or TRICARE don’t need to worry about the tax penalty.

In October of 2013, millions of uninsured Americans with low and moderate incomes will be eligible for tax credits (to help pay premium costs) and government subsidies (to help pay out-of-pocket expenses) when they purchase health insurance through the Health Insurance Exchange or Marketplace. In addition, millions of the nation’s poorest residents will be newly eligible for Medicaid in the states that have agreed to expand the federal-state health program for people with low incomes, as proposed by the law.

What are the different tiers on ACA/OBAMACARE health plans in Oregon?

  1. Bronze plans are the cheapest because insurers pay only 60 percent of a policyholder’s covered health expenses, and the policyholder must come up with the other 40 percent.
  2. Silver plans split covered expenses 70-30%. 70% of policyholder’s covered health expenses.
  3. Gold plans split covered expenses 80-20%. 80% of policyholder’s covered health expenses.
  4. Platinum plans split covered expenses 90-10%. 90% of policyholder’s covered health expenses.

What is the cheapest ACA/OBAMACARE health plan I can buy in Oregon?

Bronze plans are the cheapest plans that at a minimum is required so you won’t face any penalty. This health plan offers really high deductible and co-insurance that’s why it’s the cheapest.

How do I get financial assistance or tax credits through Affordable Care Act or OBAMACARE?

To qualify for tax credit or financial assistance, we need basic information about yourself, family and or business. Any type of financial assistance is always based on the annual income of an individual, family or business.

The process may feel like filing for your tax return. It’s very important to put your expected income so you will get the most accurate financial assistance. Financial assistance is also set up in a sliding scale of commercial premium tax credits for people making under 400% of the poverty level which $94, 200 for a family of four or $45, 960 for an individual.

Small business also gets more tax credits for small business with less than 25 employees. And for people that makes less than 250% of the poverty level are eligible for cost-sharing or co pay reductions which means less out of pocket expense.

Lastly, for people that makes less than 138% of the poverty level may enroll automatically in the low-income Oregon Health Plan. Click here to see how much you qualify for to help pay for your insurance- Health Insurance Exchange in Oregon.

Do I need my most current tax return to get tax credits?

You should have your most recent tax return to based on your income on and also your projected income estimate for 2014.

If your estimate is more 10% different than your 2012 income on tax returns then Cover Oregon will ask for some documentation or evidence why? If you can’t provide any documents then, the state will adjust your tax credits accordingly.

Sometimes it maybe hard to project how much your income is going to be especially if someone is in sales or any job with commission or bonuses.

So if you make more than your estimated income you’ve put in on your application, your estimated tax credit will be reconciled accordingly.

I’m under my parents health insurance plan, do I need to get my own insurance?

The law allows people 26 and under to stay on their parent’s insurance policy.

What if I’m on COBRA or have a Portability Plan?

If you’re on COBRA, you can choose to keep it but you may find it cheaper to shop in the open market or on the exchange because all portability plan are going away next year. You may qualify for financial assistance to help pay for your medical coverage.

Don't find what you need?

If this FAQs is not enough for you, feel free to contact us now 😀