Oregon Health Insurance

 Health insurance in Oregon

● Oregon's has a state-run health insurance market, but enrollment is through HealthCare.gov.

● Open enrollment for Oregon 2021 health insurance plans begins on November 1, 2020. Before that, residents with qualified events can enroll or make changes to Oregon's medical insurance coverage for 2020.

● Short-term health insurance plans in Oregon cannot be longer than three months.

● Six insurers will offer 2021 health insurance coverage through the Oregon market.

● For 2021, average rate changes in the Oregon market range from a decrease of 3.5% to an increase of about 11%.

● A record number of Oregonians enrolled in 2018 medical insurance coverage through the Oregon market, but enrollment declined in 2019 and again in 2020.

● Oregon implemented the expansion of the ACA's Medicaid coverage in 2014, and Enrollment in Medicaid/CHIP has grown by 66% since then.

● Oregon has strong consumer protections tied to Medigap plans

This page is dedicated to helping consumers quickly find health insurance resources in the state of Oregon. Here you will find information about the many types of health insurance coverage available. You can find the basics of Oregon's health insurance market and upcoming open enrollment periods; a brief overview of the expansion of Medicaid enrollment in Oregon; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for Oregon residents.

Oregon's health insurance marketplace

Oregon has a state-run health insurance (exchange) market that uses the Healthcare.gov registration platform. Cover Oregon's website - which was used in late 2013 and 2014 as the state's health insurance exchange platform - is no longer operational.

Consumers can use OregonHealthcare.gov to learn about health insurance plans and the suitability of the state health insurance market; when they are ready to apply and sign up, they are taken to the federal market website at HealthCare.gov.

The market is used by individuals and families who purchase their own health insurance coverage. This includes people who retired (and lost employer-sponsored coverage) before the age of 65, people who are self-employed, and people who work in a small business that does not offer health benefits to workers.

Enrolling through the market is the only way Oregon residents can get income-based premium subsidies and cost-sharing reductions, which serve to reduce monthly premium costs and out-of-pocket costs for eligible enrollees.

Open enrollment period and dates in Oregon

Open enrollment in Oregon for 2021 health insurance plans will begin on November 1, 2020. Outside of that window, residents need a qualifying event to sign up or make changes to their coverage.

The open enrollment period is an opportunity for subscribers to change or renew coverage for the following year and update the financial information that the exchange has on file. It's also an opportunity for people to sign up for individual market coverage recently. The open enrollment period applies both on the stock exchange and off-exchange (i.e., even outside the exchange, open enrollment is the only time a person can enroll in individual market health insurance without a qualified event).

Six insurers offer coverage for 2021 through Oregon's health insurance market, including Regence, which previously offered only plans outside the market. For individual market coverage 2021, policies will be available in the Oregon market from BridgeSpan, Mode, PacificSource, Regence, Providence, and Kaiser.

Individual changes in Oregon's health insurance rate for 2021 range from an average decrease of 3.5% to an 11.1% increase. This applies to full-price premiums; rate changes for people receiving premium subsidies can be very different, depending on the price fluctuations of the reference plan in each area.

Enrollment in private health insurance plans for 2020 through oregon's health insurance market reached 145,264 people during the open enrollment period. This was the second year in a row with a drop in enrollment, although enrollment likely increased during the COVID-19 pandemic as people switched from employer-sponsored coverage to exchange plans.

Medicaid expansion in Oregon

Using federal funds to expand Medicaid coverage eligibility to 138% of the poverty level has played a significant role in reducing the uninsured rate in Oregon.

Oregon has seen some of the nation's most dramatic jumps in enrollment in the Medicaid plan under the ACA. From 2013 to May 2020, average monthly enrollment in Oregon's Medicaid plans grew by 66%, the sixth highest increase of all states. As of May 2020, there were more than a million Oregonians covered by Medicaid/CHIP.

Oregon's "Cover All Kids" law went into effect in January 2018, ensuring that all children under the age of 19 with a family income of up to 305% of the poverty level have access to Oregon health plan coverage, regardless of immigration status.

Short-term health insurance in Oregon

New federal regulations expanded access to short-term health insurance coverage and the association's health insurance plans in 2018, but the effects of those regulations were deactivated in Oregon. Oregon limits short-term health insurance plans to three months in duration, so federal rules don't apply.

How did Obamacare help Oregon?

In 2013, about 14.7% of Oregon residents did not have medical insurance -- a little higher than the national average.

Despite the problems the Oregon health insurance market encountered before moving to enrollment platform HealthCare.gov, the state's support approach to the ACA, including Medicaid expansion, resulted in a significant decrease in the percentage of residents who do not have health insurance coverage. In 2018, the uninsured rate stood at 7.1%, less than half of what had been pre-ACA. It rose slightly, to 7.2 percent, in December 2019.

As of 2020, there were more than 135,000 Oregon residents with coverage obtained through Oregon's health insurance market, all with coverage for the ACA's essential health benefits. More than three-quarters of them also received grants that reduce the monthly costs of premiums.

In 2017, the state launched a website, 95percentoregon.com, to highlight how the ACA is helping Oregon and its residents.

Oregon Co-Op

Oregon started with two CO-Po's under the ACA, but currently has no CO-OP after the July 2016 closure of Oregon's health CO-OP and the 2015 closure of Health Republic Insurance.

Oregon and The Affordable Care Act

In 2010, both Oregon's U.S. senators - Jeff Merkley and Ron Wyden - voted yes to the Affordable Care Act. In the U.S. House, four of Oregon's five representatives were Democrats and voted in favor of the law; Greg Walden, a Republican, has said the only No, and he's still the only Republican in the Oregon congressional delegation.

Under former Governor John Kitzhaber, a former physician who made health and health reform priorities during his years in the public service, Oregon chose to expand Medicaid and manage its own exchange, known as Cover Oregon.

Medicaid expansion was a success in Oregon, but unfortunately, the implementation of the state exchange did not go well. The online registration system has been unusable for months and the exchange has had to process thousands of paper applications.

In late April 2014, Oregon's health insurance market board voted to use HealthCare.gov instead of continuing to try to fix the broken website, and Oregon residents began using HealthCare.gov during the 2015 open enrollment. They have since continued to do so, although the state is considering returning to a state-run exchange platform.

Does Oregon have a high-risk pool?

Before the ACA was implemented, individual health insurance was underwritten from the point of life in Oregon, as in almost all states. Because medical history was a factor in suitability for coverage, people with severe pre-existing conditions were often unable to purchase a policy in the private market, or if they received a cover offer, it often included a substantial rate increase or pilot to exclude pre-existing conditions.

To address this problem, the state created the Oregon Medical Insurance Pool (OMIP) in 1990 to provide an alternative for people who were unable to obtain private individual health insurance.

Now that medical underwriting is no longer used in the individual market – thanks to the ACA – there is no longer a need for state-run high-risk pools. Oregon planned to close the OMIP in late 2013, but technical problems with the exchange made it difficult for OMIP members to move to a new plan. So Oregon created a temporary pool that provided coverage for OMIP members for the first three months of 2014. This coverage ended on 31 March 2014.

Medicare coverage and enrollment in Oregon

As of August 2020, there were 885,102 Oregon residents enrolled in Medicare plans. Most are eligible because of their age, but 13% are under the age of 65 and are eligible for Medicare due to a long-term disability, SRIA, or end-stage kidney disease.

Oregon has significant protections for Medigap enrollees, including an annual "birthday rule" enrollment period, during which a Medigap enrollee can switch to any Medigap plan with equal or minor benefits, without a medical subscription. The state also grants access to Medigap plans for Medicare enrollees under the age of 65 (federal law only grants access when enrollees are 65).

Do you have any questions about Medicare's open enrollment period? Our guide can help you.

Oregon Health Insurance Resources

● OregonHealthcare.gov: A state-run service that connects Oregon residents with health coverage options.

● HealthCare.gov — The market for individuals and families who purchase their own health coverage; premium subsidies and cost-sharing reductions are available for eligible members using the market.

● Oregon Division of Financial Regulation — Licenses and regulates health insurance companies in Oregon, as well as agents and brokers. It can answer consumer questions and complaints about regulated entities.

● Medicare Rights Center - A national resource that can answer questions about Medicare and provide information that beneficiaries need.

● Oregon Senior Health Insurance Benefits Assistance - A local service that can provide enrollment assistance, information, and counseling to Medicare beneficiaries and their caregivers.

Oregon health reform at the state level

Brown signed OR SB1 into law on March 6, 2015, which led to the dissolution of Cover Oregon and its board of directors. The remaining responsibilities have been transferred to the Oregon Department of Consumer and Business Services. Although the act was immediately effective, the full transfer was not completed until June 2015.

Oregon HB2342 was signed into law in August 2017, giving the state the authority to take a variety of actions to stabilize the individual market, if and when federal changes are made to the ACA.

SB558 was also signed into law by Governor Brown in August 2017, granting access to Oregon Health Plan (Medicaid) coverage for all children with family incomes up to 305% of the poverty level, regardless of immigration status.

SB250, enacted in 2019, codifies various ACA consumer protections into state law.