Oregon Health Insurance: Find Affordable Plans

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.

• Marketplace plans: Oregon residents can buy a marketplace plan if you’re not covered by an employer-provided or public health insurance plan.
• Open enrollment: You can enroll on the Oregon Health Insurance Marketplace from November 1 through January 15 for 2022 plans.
• Health Insurance Marketplace: Oregon’s Health Insurance Marketplace offers affordable plans for residents at all income levels. Working with the federal exchange program, Oregon offers financial support to qualified applicants through the Advanced Premium Tax Credit.
• Off-market plans: If you opt for direct enrollment with an insurance company, you can choose the plans you want, but there’s no premium subsidy for plans bought this way in Oregon.
• Coverage types: A little over 93% of Oregon residents have health insurance. Employer-based health insurance accounts for 49.3%. Nearly 21% of Oregon’s population is enrolled in Medicare, while 16.2% is covered by Medicaid. 7.1% of the state is uninsured.

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:

• Your marital status
• The number of dependents you claim on your tax return
• Your expected taxable income for the year ahead
• Whether you consent to the system checking for financial assistance you may be eligible for

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:

• BridgeSpan Health Company
• Kaiser Permanente
• Moda Health
• PacificSource Health Plans
• Providence Health Plan
• Regence BlueCross BlueShield of Oregon

There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:

• Medical needs
• Preferred plan type
• Premium affordability
• Individual vs. family deductibles

Insurance for individuals in Oregon

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:

• A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
• A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
• A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in Oregon

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.

• Bronze plans offer some of the lowest monthly premiums, but you may have to pay up to 40% of any costs for the care you receive. Bronze is a good level for many young adults, single people, and beneficiaries with little to no ongoing need for medical care. The lowest premium rate for Bronze plans in Oregon is $329 a month.
• Silver plans are a middle tier that balances the cost of premiums with the cost of care. People with Silver plans can expect to pay 30% of their medical costs. This option is popular for older adults and people with families who need group coverage. The most affordable Silver premium in Oregon is $430 a month.
• Gold plans are the highest tier of coverage, offering extensive benefits for relatively low coinsurance and other direct costs at the time of care. Monthly premiums for these plans are higher than for other tiers. Gold and Platinum can be good choices for people with ongoing conditions who need extensive care. Gold plans in Oregon start at $464 a month and go up based on the benefit details.

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 in Oregon

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:

• A citizen or legal resident of the United States
• A resident of the state of Oregon
• In need of medical care

In addition to these requirements, Oregon Medicaid requires that you be at least one of the following:

• Pregnant
• A minor age 17 or under
• Disabled or responsible for a dependent with a qualifying disability

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.

CAWEM in Oregon

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.

• Original Medicare is the basic form of Medicare managed by the federal government. It consists of Part A (inpatient care), and Part B (preventive care and outpatient medical services). It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs – these plans are known as Medicare Part D.
• Medicare Advantage Plans are sold by private insurance companies. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as prescription medications, dental, and vision.

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.

Eligibility

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).

Enrollment

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:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

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.

• Benefits.gov | Last accessed December 2021
• Centers for Medicare and Medicaid Studies | Medicare | Last accessed December 2021
• COVID/American Rescue Plan | Last accessed December 2021
• Healthcare Oregon | Last accessed December 2021
• Healthcare.gov | Last accessed December 2021
• Healthcare.gov | Deductible | Last accessed December 2021
• Healthcare.gov | Health Maintenance Organizations (HMO) | Last accessed December 2021
• Healthcare.gov | Point of Service Plans (POS) | Last accessed December 2021
• Healthcare.gov | Preferred Provider Organizations (PPO) | Last accessed December 2021
• Healthcare.gov | Special Enrollment Period (SEP) | Last accessed December 2021
• Kaiser Family Foundation | Last accessed December 2021
• Medicaid.gov | Last accessed December 2021
• Medicare.gov – Joining a health or drug plan | Last accessed December 2021
• Medicare.gov | Open Enrollment | Last accessed December 2021
• Oregon Health Insurance Marketplace | Last accessed December 2021
• Oregon Law Help | Last accessed December 2021
• Oregon.gov | Last accessed December 2021
• SSI – Apply For Benefits | Last accessed December 2021
• Who is eligible for Medicare? | Last accessed December 2021