TABLE OF CONTENTS
Oregon residents have several options for finding affordable health insurance. Many people get insurance through work, while others buy coverage through the state health insurance exchange. Medicare and Medicaid offer several affordable health insurance plans for seniors and people with limited income.
This guide goes over some of your options for finding affordable health insurance plans in Oregon, along with tips for how to get signed up for the care you need.
Residents of Oregon can sign up for affordable health insurance plans through the state’s health exchange website, OregonHealth.gov, or the federal Healthcare.gov website. To get started, use your email address to set up an account. You’ll be asked to choose a unique username and password.
After setting up your account, the site will check your eligibility for affordable health insurance plans in Oregon. You’ll have to provide some personal information, such as your legal name, date of birth, and your Social Security number so that the site can effectively match you with plans you’re eligible for. Be sure you have this information for everybody in your household that needs coverage. If the information you need isn’t available right away, you can save your progress and finish submitting the form at a later time.
Part of the process for establishing your eligibility for tax credits includes asking you questions about your personal situation. To properly assess your status, the system will ask you about:
Once the necessary information is provided, the site displays all of the available plans you qualify for. Alongside the plan names, you’ll see details, including the monthly premium, annual deductibles, coinsurance minimums, and any relevant exclusions. Healthcare.gov allows users to compare up to three plans side by side at the same time.
To complete your signup, you may have to present a copy of your previous year’s tax return as proof of income. You may be required to submit documents proving citizenship and establishing your residence in Oregon.
These six companies offer a variety of affordable health insurance plans in Oregon:
There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:
If you’re overall healthy and don’t have a pre-existing condition, you may be able to keep your costs fairly low with a low-premium/high annual deductible plan. These plans cost relatively little each month, making them a good choice for people with little or no ongoing medical needs. The drawback to a plan like this comes when you need care. The high annual deductible may see you paying a lot out of pocket before your coverage kicks in.
There are different types of plans you can choose from:
Shopping for affordable health insurance plans in Oregon can get more complicated when you have family members who need coverage as well. While you may be healthy and need only minimal medical care, the ongoing medical needs of any member of your family could radically change your priorities regarding what kind of coverage you’re looking for and the costs you’re willing to pay. To get the best health coverage you can for your family, you have to balance the needs of every family member covered by your plan with the cost of your monthly premium, annual deductible, and coinsurance requirements.
Your plan structure is also affected by the needs of your family members. HMOs can work well for routine and low-demand health needs, while the flexibility of a PPO may work better for you if a family member needs ongoing care. When you’re looking for coverage for multiple people, you want to shop around for a plan that offers enough flexibility to accommodate everybody’s needs. If, for instance, you and your spouse have ongoing health needs, a simple HMO plan might serve you well. If you have a child with an ongoing medical condition, however, it might be worth it to shop for a more flexible PPO or POS plan. Before you sign up for a family plan, check your plan details for how much coverage it offers and how flexible it can be.
Oregon’s Health Insurance Marketplace organizes health insurance plans into three major categories which are designated by metals: Bronze, Silver, and Gold. These plans make up a tiered system, with each level offering different coverage levels and pricing structures. Bronze plans tend to be the most affordable health insurance plans with low monthly premiums, though the point-of-service costs for these plans may be high compared with the other options. Silver and Gold plans come with higher monthly costs, but may offer better coverage and lower add-on costs, such as deductibles and copayments. Before you commit to a single plan, be sure that it has the right combination of monthly and per-use costs for you and your family’s needs.
|Average Premiums in Oregon||2018||2019||2020||2021||2022|
|Most affordable Bronze plan||$303||$323||$314||$318||$329|
|Most affordable Silver plan||$406||$434||$428||$426||$430|
|Most affordable Gold plan||$439||$471||$468||$458||$464|
Oregon offers two main programs for low-income health insurance: Medicaid and Citizen Alien Waived Emergent Medical (CAWEM). Medicaid is the standard affordable health insurance plan for low-income households in Oregon, while the other programs in the state are available for people in specific circumstances. Income, asset, and coverage limits vary with each plan.
Medicaid is a joint state-federal health insurance program that is open to all residents of Oregon who meet the enrollment criteria. The program pays all or some of the costs for approved medical office visits, emergency care, and stays in the hospital. Some prescription drugs are also covered by Medicaid, though the list of covered drugs may be limited.
If you receive coverage through Medicaid, you’re not required to pay more than the share of the cost the program assigns to you, and providers may not send you a bill for the medical equipment or services you receive. You may, however, be required to reimburse Medicaid for some or all of the costs of your care. The amount owed can even be deducted from your estate if you pass away with an unpaid balance.
Medicaid requires its beneficiaries to meet certain eligibility standards before it can extend coverage. These include basic eligibility criteria and financial limits. The basic requirements for getting Medicaid are that you must be:
In addition to these requirements, Oregon Medicaid requires that you be at least one of the following:
Once your eligibility is established, Medicaid requires that you establish a financial need by providing income and asset information for review. Oregon Medicaid maintains maximum income limits for its recipients, with a share of cost imposed for the higher income levels within its field of eligibility. The income limits in 2022 are $17,131 per year for a single adult or $35,245 for a family of four.
Oregon offers limited health insurance coverage for people who live in the state but whose immigration status is in question. If you have low income but can’t get Medicaid because you are not a citizen or legal residency, you can get emergency and/or prenatal care through CAWEM. CAWEM provides full-cost coverage for emergency visits for anyone who qualifies, as well as prenatal maternal care for pregnant mothers. The program also covers the cost of hospital care for the delivery, and babies born on the program can get up to a year of extended children’s health coverage, though it’s necessary to reapply annually for continued benefits.
There’s no cost to beneficiaries of CAWEM, and program staff do not report your citizenship status to the authorities. You do not have to have an ongoing emergency to apply for CAWEM, but you can request a card at any time. You do not need a Social Security number or resident alien ID to get coverage under CAWEM.
Seniors have a few options for getting affordable health insurance plans in Oregon through the federal Medicare program.
If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months’ worth of payments from the Social Security Disability Insurance program. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
The Oregon Health Plan (OHP) provides Medicare beneficiaries, their families, or their caregivers with free, unbiased, and confidential advice and counseling on their Medicare options in Oregon. This includes providing information about Original Medicare, Medicare Advantage Plans, Medicare Part D, and other aspects of Medicare. These trained and certified counselors can also help you with other health insurance questions and will never try to sell you a plan.
Residents of Oregon can buy short-term health insurance from private insurers, though the state imposes strict limits on the issuers of this type of insurance. Policies must not run for longer than three months, including extensions. New policies can’t be sold to prior beneficiaries within 60 days of the previous policy expiring. While short-term health insurance can be a cheap health insurance option, your coverage is likely to be limited.
All Oregon residents are required to carry health insurance that meets the standards of the Affordable Care Act (ACA). Individuals who earn less than necessary to file a federal tax return are exempt from the coverage requirement.
You do not have to use the state marketplace to get affordable health insurance plans in Oregon. Residents are free to buy insurance through employers or privately if they wish.
The most popular form of cost-sharing plans are faith-based plans. In a faith-based plan, members share health care costs with other members. You don’t need to be a member of a particular denomination (or even religious), to participate in a plan. While these plans can be relatively low-cost, most faith-based plans don’t conform to ACA standards and don’t cover pre-existing conditions, mental health care, or pregnancy.
Health savings accounts and flexible spending accounts in Oregon are offered as supplements to existing health insurance plans, not as replacements for them.
As a rule, short-term disability benefits are used to pay household expenses, but they are not specifically for medical costs. You still need health insurance to help with your medical costs.
Long-term disability is a lot like short-term benefits in that the funds are not specifically earmarked for health care costs. You probably still need regular health insurance if you’re on disability in Oregon.