Individuals and Families

Health Insurance in Oregon


Having the right health insurance plan is very important to protect you and your family from paying huge amounts of medical bills. If this is your first time to get health insurance or if you are just looking for someone to assist you, then we can definitely help. Health Plans In Oregon will help you find affordable health insurance plans based on your needs and budget– we’ve been doing this since 2006. Furthermore, we will help you apply for any financial assistance you may qualify for through the Health Insurance Marketplace to help reduce your health insurance monthly costs.

A recently conducted survey  suggests that 95 percent of Oregonians have health insurance — that is about 3.7 million people in Oregon out of 4.1 million. Even though levels of insurance coverage in Oregon remain stable, there will always be a recurring battle in sustaining manageable coverage rates. As per an article on 2019 Health Insurance Rates, overall increases are relatively modest this year. But all consumers should still review all available policies and pick a health insurance plan that is really suited for their needs and budget.

What Types of Coverage for Individuals and Families in Oregon:

  1. Private health insurance through the Health Insurance Marketplace
    The Marketplace offers private health plans and financial help for people who earn too much to get Oregon Health Plan and don’t qualify for any other health coverage elsewhere. In general, all plans include comprehensive health benefits that meet state and federal requirements. Over half of 185,000 Oregonians receive tax credits that  pay below the full price of health plan cost. Find out how much monthly tax credits you may qualify for: GET A QUOTE

2019 income eligibility for subsidy or premium tax credit to help pay for your premium:


  1. Oregon Health Plan (OHP)
    The Oregon Health Plan is a free health insurance plan for low income Oregonians who meet income, age and other immigration and residency requirements. OHP covers medical care (doctor visits, hospital services), mental health care, dental and some vision care. Oregon became the 7th state in the country that provides healthcare for all kids. Cover all Kids extends healthcare coverage through the OHP for all children up to 300% of federal poverty level.
  2. Compact of Free Association (COFA)
    The Premium Assistance Program for COFA provides free health insurance for low-income citizens who live in Oregon from the:
    — Republic of the Marshall Islands
    — Federated State of Micronesia
    — Republic of Palau

To be eligible: at least 19 years old, not pregnant, resident of Oregon, earn less than the income criteria and not eligible for any other coverage elsewhere.

  1. Special options for members of tribes
    If you are a member of a federally recognized tribe (American Indians and Alaska Natives), you will be given special benefits (zero-cost sharing plan) when you enroll for a private health insurance through the Marketplace if your income is at or below the limit for your family size ($75,300 for a family of four).
  2. Medicare
    Medicare Insurance is a federal health insurance program, mostly for people age 65 or older. However, if you are younger than 65 and are receiving Social Security Disability Income (SSDI) or if you have permanent renal failure, you may also qualify for Medicare.
  3. Coverage for small businesses
    You can check and enroll if your  employer offers group health insurance to its employees. It’s normally offered to full time employees and employer can cover at least 50% of the employees premium.

Here are some of the popular health insurance plans in Oregon:

Take note that there are even more plans depending on your area and you may ask us for further details and quotes.


Over the years, one the biggest concern that people have is pre-existing condition. Thanks to the Affordable Care Act (ACA) that took effect in January 2014, millions of Americans can no longer be denied health insurance because of complex qualifications or pre-existing condition such as heart disease, asthma, previous injuries, cancer and the likes. Due to this insurance companies were prohibited from charging higher premiums, limiting benefits, or denying coverage to those who need it. The ACA even created a Pre-existing Condition Insurance Plan that takes care of primary and specialty care services and prescription drugs. At present, more than 50,000 Americans have enrolled and PCIP – a major increase in health insurance enrollment.

Below are the significant benefits that ACA has to offer:


  • Better access to quality care

The ACA allows young adults to remain on their parents’ insurance until age 26. This has been a great help not only for Oregonians but for American nationwide. New college graduates now have access to health insurance even if they were unable to find a job right away.

  • Lowered health care expenses

The ACA also control the fast-rising health care costs while making sure that people still get quality health care services. To date, it is required that all insurance plans covers important preventive services which includes various health screenings, critical immunizations, health screenings, and counseling services, with no cost-sharing.

In addition, the Affordable Care Act also worked to close the Medicare Part D prescription drug coverage gap, giving more savings to Medicare patients. It is said that an average Medicare beneficiary will save $4,200 from 2011 to 2021, while the ones with higher prescription drug expenses will save as much as $16,000 over the same period.

  • Improved consumer protection nationwide.

Significantly, the ACA continues to strengthen consumer rights and protections. All insurers are now required to provide consumers with easy-to-understand facts about their health insurance and its costs. To give more transparency, ACA also gives protection from irrational price hikes thru reinforced rate-review laws. Moreover, ACA formulated a Medical Loss Ratio (80/20 standard) that prohibits insurance companies from spending more than 20 percent of premium dollars on non-medical expenses such as marketing, administrative costs and the likes.

When is the best time to enroll in health insurance?

  • Individuals or Families health insurance Annual Open Enrollment begins November 1 to December 15 with January the following year as the plan’s effective date.
  • For those with Qualifying Life Events (QLE), you can enroll within 60 days after you lost coverage, this is called Special Enrollment Period (SEP) — see below
  • Employers on their anniversary date
  • Small Business can enroll anytime

What if you’ve missed Annual Open Enrollment?

Good news: You may still qualify for Special Enrollment Period (SEP).

If the answer to any of these questions is YES, then you are still good to enroll in a plan as long as it is within 60 days after qualifying event.

What does health insurance cover?

Listed on are these health care benefits that should be covered:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both before and after birth)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

And the best part:

Health insurance plans cover treatment for pre-existing medical conditions. None of the credible health insurance carriers can decline or ask you to pay more for your needed health coverage just because of any medical condition you had before your plan started.

Pregnant? No worries.. If you’re pregnant when you enroll in a plan, your pregnancy is covered from the day your plan starts.

individuals-families-health-insurance-oregonLet’s dig a little deeper and know health plan terms:

  • Premium – Amount you pay your health insurance company every month.
  • Deductibles – Amount you pay for health care services before your health insurance company starts to pay. For example, for a plan with $2,500 deductible, you pay the first $2,500. After you pay that deductible amount, you usually just pay for copayment or coinsurance and the rest of covered health care services will be paid by your insurance company.
  • Co-pay – a small amount you pay each time you use a specific healthcare service. Take note that this payment doesn’t go toward meeting your deductible.
  • Co-insurance – the portion you pay for your healthcare expenses after your deductible is met. Let us say you have $1,000 deductible and you’ve already spent $1,000 on your medical services. Your insurance will now start paying 80% of your costs if for instance you have a 20% co-insurance.
  • Out of Pocket Cost – most amount you have to pay for covered health care services in a plan year. Once you meet your out of pocket cost, your health insurance company pays 100% of the cost of covered benefits.

Different types of health insurance plans:

Health Maintenance Organization (HMO)

HMO plans offer health care services through a network of providers who agree to lower rates or provide service only to its members. With this health plan, you have a primary care doctor who needs to be in HMO network that will manage your care and may refer you to specialists if needed. If you see a doctor who is not in the network, you’ll have to pay full amount for office visit. Kaiser Permanente is well known as an HMO plan in Oregon.

Preferred Provider Organization (PPO)

PPO plans allow you to see any in-network health care provider without referral from primary care physician. You may see out-of-network providers but you’ll pay more. Pacific Source is one of the PPO plan options in the Oregon market.

Exclusive Provider Organization (EPO)

EPO plan lets you see health care providers without referral from primary care just like PPO plan. However, you can only see doctors and go to hospitals within the EPO network. There’s no out-of-pocket benefits, you need to pay the full price of health service if you need to go to providers that is not in your plan network. Providence Health Plan is known for its EPO plan in Oregon.

In essence, these plans doesn’t differ just on health plan cost but also the size of the plan network, ability to see specialist and coverage for out-of-network services.

And how about those metal tiers?

  • Bronze – this plan has the lowest monthly premium but with high deductible.  On average, deductible for bronze is $6500/person which means you need to pay medical cost yourself up to deductible amount before the insurance company helps you pay for covered health care services. Most who gets this plan are those that are healthy and rarely see the doctor.
  • Silver – this plan has moderate monthly premium, this is a good plan for those who qualify for subsidy or tax credit.  You will pay premium slightly higher than bronze plan but there will be more covered health care service with less deductible.
  • Gold – this plan has the highest monthly premium with lowest deductible, this plan is good for those who always need care and medical treatment.

With the rising coverage rates, you’ll need to find the best health insurance plans that can protect you from financial burden when sickness or accident strikes. To see if you qualify for subsidy and financial assistance to reduce your healthcare costs, Health Plans In Oregon is here to help.


Getting information and signing up for health insurance plan maybe complicated BUT it is very important to get a health plan and get covered!

Need help in applying for 2019 health insurance?

We have been assisting Oregonians for free and you too can get all the help you need when it comes to signing up for any Oregon health insurance. We are here to answer all your queries and give you affordable quotes.