.png){kind=small}
Whether you are self-employed, unemployed, or otherwise not able to obtain adequate health insurance through your employer, there are health insurance options available to you in Oregon.
In this blog, we discuss individual health plans available for individuals under 65 and families living in Oregon. For health insurance options for those over 65 years old or with qualifying disabilities, learn more about Medicare.
Health Coverage Options
The State of Oregon offers several ways to obtain health coverage. Summaries are provided below, but we encourage you to learn more at Oregon.gov and contact us for more details.
Marketplace Private Health Insurance
Some insurance companies may offer health insurance privately, however, we recommend exploring the Marketplace. All plans sold through the Marketplace are regulated by the State of Oregon and offer essential health benefits as determined by the State. Additionally, financial assistance is only available through the Marketplace, not through private health insurance companies. HealthCare.gov reports that, “In 2020, the average Oregonian who enrolled through HealthCare.gov and qualified for a subsidy got $451 per month in financial assistance.”
Special savings are available to enrolled Tribal members and Alaska Natives. Learn more about benefits for members of tribes here.
It is important to note that dental and vision coverage are not automatically included in Marketplace plans, but may be available.
Oregon Health Plan (OHP)
Oregon Health Plan (OHP) is Oregon’s Medicaid program offering free coverage to residents who meet certain financial and residency eligibility requirements. Income limits change over time. Refer to the Oregon Health Authority’s (OHA) latest income eligibility updates or contact us for guidance.
If you are just above the income limit for OHP, you may still be eligible for OHP Bridge, a new coverage available to adults with incomes between 138 and 200 percent of the federal poverty level (FPL).
OHP covers health care services that are medically necessary. This includes preventative health care such as annual screenings for physical and behavioral health, eye exams, and dental cleanings. To explore more benefits, visit OHA’s benefits page.
Children’s Health Insurance Program (CHIP)
Families who make too much to be eligible for OHP may still find assistance for their children through the Children’s Health Insurance Program (CHIP). CHIP provides low or no-cost health coverage. There is still a financial eligibility requirement – the family income must be at or below 200% of the FPL. Children ages 0-18 may be eligible for CHIP, but they will need to find another form of health insurance when they turn 19.
Health Insurance for Veterans
The federal VA operates a health care system for veterans across the country. Learn more about resources available in Oregon here.
When to Make Changes to or Apply for Different Health Coverage
Health insurance plans may be started or changed annually during Open Enrollment which is November 1-January 15. However, if you want the change to be in effect by the new year, you must request the change by December 15. Otherwise, the change will not be effective until February.
It is recommended to evaluate your plan each year as new, more affordable options may be available. Our staff have vetted the available plans and are able to discuss options with you. Schedule an appointment during Open Enrollment by calling 541-426-4208.
Open Enrollment is the only time to enroll or make changes to your plan unless you qualify for a Special Enrollment Period (SEP). An SEP is triggered by certain life events such as losing health coverage, moving, getting married, having a baby or adopting a child, or if your household income goes below a certain amount.
If you already have a Marketplace plan, changes to income or other life updates can be reported through your online HealthCare.gov account. Follow the steps provided by HealthCare.gov to submit a change. Or, you may work with a qualified assister, such as our agents.
How to Apply for Health Insurance through the Marketplace
The easiest and quickest way to apply for a Marketplace health insurance plan is through their online portal, HealthCare.gov. You may also apply over the phone or via mail.
Local assistance is available. For example, residents of Wallowa County and Union County, Oregon may find it convenient to visit the Hillock Insurance office in Enterprise for in-person support.
If you live elsewhere in Oregon, use HealthCare.gov’s search tool to find assistance in your area.
Selecting the Health Insurance Plan Best for You
It may feel difficult and overwhelming to select the best plan for you or your family. There are a few key things to consider. By focusing on these items, you can narrow down your search.
The “Metal”: Health insurance plans are classified by Bronze, Silver, Gold, and Platinum. Bronze has the lowest premium but highest deductibles and least comprehensive coverage. It is typically recommended for young, healthy individuals. Platinum is the opposite.
Premium vs. Deductible Priority: Depending on your health concerns, you may want to prioritize a more affordable premium or a lower deductible. Those who need frequent medical attention should opt for a higher premium plan such as a Silver, Gold, or Platinum as deductibles in the Bronze plan will quickly add up.
Plan and Network Types: Some plan types allow you to visit nearly any doctor or health care facility, while others are more selective. Especially if you live in a rural area like Wallowa or Union County, you will want to ensure that your plan is accepted by the health care providers in your area.
Assisters can guide you through the plans. If you are feeling unclear, please do not hesitate to reach out.
Find Support for Getting Health Insurance
We know it can be tricky to navigate the various online resources, prepare an application, and pick the plan best suited for you. It has been our privilege to help folks like you navigate the Marketplace, Oregon Health Plan (OHP), CHIP, and Medicare for the past 20 years. Please contact us for guidance on your health insurance questions and assistance with your applications.
Comentarios