Assisting Oregonians since 2006

Individuals and Families

Health Insurance in Oregon

Having the right health insurance plan is very important to protect you and your family from huge amounts of medical bills. If this is your first time researching health insurance or if you are just looking for someone to assist you, we can help! Health Plans In Oregon has helped individuals and families find affordable health insurance plans based on their unique needs and budgets since 2006. We also help you apply for financial assistance you may qualify for through the Health Insurance Marketplace to help reduce your monthly health insurance costs.

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Significant Benefits of ACA

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.

Longer Access to Quality Care

The ACA allows young adults to remain on their parents’ insurance policy until age 26. New college graduates now have access to health insurance even if they are unable to find a job right away.

Lower Health Care Expenses

The ACA controls rising health care costs by requiring all insurance plans to cover preventive services, including various health screenings, critical immunizations, health screenings, and counseling services with no cost-sharing.

Medicare Part D

The ACA covers the prescription drug gap, giving more savings to Medicare patients. The average Medicare beneficiary will save $4,200 from 2011 to 2021, and the ones with higher prescription drug expenses will save as much as $16,000 over the same period.

Improved Consumer Protection Nationwide

The ACA requires insurance companies to provide consumers with easy-to-understand facts about their health insurance and its costs and protects consumers from irrational price hikes thru reinforced rate-review laws. Moreover, the Medical Loss Ratio (80/20 standard) prohibits insurance companies from spending more than 20 percent of premium dollars on non-medical expenses such as marketing, administrative costs, etc.

Types of Coverage for Individuals and Families in Oregon

Special options for members of tribes

If you are a member of a federally-recognized Native American and/or Alaska Natives tribe, you can qualify for special benefits, including a zero-cost sharing plan, when you enroll for a private health insurance through the insurance marketplace. Eligibility requirements depend on income at or below the limit for your family size, such as $75,300 for a family of four.

Medicare

Medicare insurance is a federal health insurance program for people aged 65 and older or those receiving Social Security Disability Income (SSDI), and those in permanent renal failure.

Coverage for small businesses

If you work for a small business, check to see if your  employer offers group health insurance. It is normally offered to full-time employees and the employer can choose to cover at least 50% of the employees premium.

Private Health Insurance Through the Health Insurance Marketplace

The insurance marketplace offers private health plans and financial help for people who earn too much to qualify for the Oregon Health Plan and/or cannot get health coverage elsewhere. All plans in the insurance marketplace include comprehensive health benefits meeting state and federal requirements and many receive tax credits that  pay below the full price of their health plan cost.

Oregon Health Plan (OHP)

The Oregon Health Plan is a free health insurance plan for Oregonians who meet income, age, and other immigration and residency requirements. OHP covers medical care like doctor visits, hospital services, mental health care, dental, and some vision care. Oregon became the 7th state in the country to provide free healthcare for kids through the Cover all Kids initiative. It extends healthcare coverage through the OHP for all children up to 300% of federal poverty level.

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, the Federated State of Micronesia, and the Republic of Palau. Eligibility requirements include adults at least 19 years-old, not pregnant, residing in Oregon, earning below the income criteria, and who are not eligible for coverage elsewhere.

A recent survey suggests 95% of Oregonians have health insurance (about 3.7 million out of 4.1 million people in Oregon). Despite these stable levels of insurance coverage, managing sustainable coverage rates is always a battle. An article on 2019 Health Insurance Rates shared that increases are relatively modest this year, but individuals and families should still review all available policies and pick a health insurance plan that is best suited for their needs and budget.

When is the best time to enroll in health insurance?

  • The annual open enrollment for individuals and families health insurance begins November 1 and end December 15 for an effective date of January the next year
  • Individuals and families with a qualifying life event (QLE) are eligible for a special enrollment period (SEP) and can enroll within 60 days of lapsed coverage (See below for more information)
  • Employers re-enroll on their anniversary dates
  • Small businesses can enroll anytime

What if you’ve missed Annual Open Enrollment?

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

If you answer “Yes” to any of the answers below, you are still able to enroll in a plan within 60 days after a qualifying life event.

Special-Enrollment-Questions

Special-Enrollment-Questions

What does health insurance cover?

According to healthcare.gov, these health care benefits should all be covered:

  • Ambulatory patient services (outpatient received without admittance to a hospital)
  • Emergency services
  • Hospitalization (like surgery and overnight stays)
  • Pregnancy, maternity, and newborn care (both pre and postnatal)
  • Mental health and substance abuse disorder services, including behavioral health treatment (counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (helping people with injuries, disabilities, chronic conditions, or recovering mental and physical skills)
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services, including dental and vision care

The best part of health insurance for individual and families is plans must cover treatment for pre-existing medical conditions. No credible health insurance carriers can decline or ask you to pay more for your needed health coverage just because of a medical condition you had before your plan started.

Pre-Existing Conditions and the Affordable Care Act (ACA)

One of the biggest concerns of clients in the healthcare industry is finding insurance with a preexisting condition. Thankfully, the ACA made it possible for millions of Americans to no longer be denied health insurance because of complex qualifications or preexisting conditions when it went into effect in January of 2014.

Insurance companies are now 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 (PCIP) which takes care of primary and specialty care services and prescription drugs. More than 50,000 Americans have since enrolled in PCIP.

Metal Tiers

Bronze

This plan has the lowest monthly premiums but the highest deductibles. On average, the deductibles for bronze are $6500/person. You must pay medical costs until you reach the deductible amount before the insurance company will pay for health care services. These plans are best for healthy individuals and families who rarely see the doctor.

Silver

This plan has moderate monthly premiums and is a good choice for those who qualify for subsidies or tax credits.  You will pay slightly higher premiums than the bronze plan, but more health care services are covered and the deductible is often lower.

Gold

This plan has the highest monthly premiums with the lowest deductibles and is best for those who often need care and medical treatment.

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 services only to its members. With this health plan, you have a primary care doctor who must be in your HMO network. If you need a specialists, they must refer you. If you see a doctor outside of this network, you will have to pay the full amount. Kaiser Permanente is a well-known example of an HMO plan in Oregon.

Preferred Provider Organization (PPO)

PPO plans allow you to see any in-network health care provider without a referral from your primary care physician. You may see out-of-network providers but you will pay a higher amount. PacificSource is one of the PPO plan options in the Oregon market.

Exclusive Provider Organization (EPO)

Like PPO, EPO plans let you see health care providers without referral from primary care, however, you must visit doctors and hospitals within the EPO network. There are no out-of-pocket benefits, so you will pay the full amount if you go to a provider outside of your plan network. Providence Health Plan is known for its EPO plan in Oregon.

In essence, these plans don’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.

Health Insurance Terms

What do all these health plan terms mean? We are here to help them make sense!

Premium The amount you pay your health insurance company every month

Deductibles The amount you pay for health care services before your health insurance company starts to pay. For example, a plan with a $2,500 deductible means you pay the first $2,500, and after you pay that amount of medical bills, you usually pay just a copay or coinsurance percentage while the rest is paid by your insurance company

Co-pay A small amount you pay each time you use a specific healthcare service (this payment does NOT go toward meeting your deductible)

Co-insurance The amount you pay for healthcare expenses after your deductible is met. For example, if your plan has a $1,000 deductible and you have spent $1,000 on medical bills, your insurance will now start paying a predefined percentage of your costs and the remaining percentage is the coinsurance you are responsible to pay

Out of Pocket Cost The highest 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.

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

Here is just a snapshot of the most popular health insurance plans in Oregon for individuals and families, however there are even more plans depending on your area we can offer further details and quotes from. Take note that there are even more plans depending on your area and you may ask us for further details and quotes.

Need Help Applying for 2019 Health Insurance?

 

With rising coverage rates, you need to find the best health insurance plan for you and your family. To see if you qualify for subsidy and financial assistance to reduce your healthcare costs, Health Plans In Oregon is here to help.

Getting the right information and signing up for the best health insurance plan for you might be complicated, but Health Plans in Oregon can answer all your questions and help you find the right health plan for your needs and get you covered!

Health Plans in Oregon offer free assistance for Oregonians to get the help you need to sign up for any Oregon health insurance. We are here to answer all your questions and give you affordable quotes.