Oregon is a state that is famous for its geographically diverse features having abundant water bodies, forests, volcanoes and high deserts. Nicknamed as The Beaver State, Oregon has received five grant awards to build its Health Insurance Marketplace. Ranked at 18th spot in the state health rankings, there is certainly a room for improvement as far as health of its residents are concerned. Oregon currently has a state-based marketplace but use the federal HealthCare.gov site for eligibility and enrollment. Oregon was second after Alaska to obtain federal approval for a reinsurance program, which receives federal pass-through funding. The reinsurance program kept the premium rates low that also resulted in smaller premium subsidies. The subsidy was passed on to the state by the federal government, who used the fund along with the state fund to run the reinsurance program. To improve the life of its residents the Oregon Health Insurance Marketplace provides people with the access to affordable and high quality health insurance plans.
Highlights and Updates :-
- Oregon has a state-run health insurance exchange but residents can enroll for health plans through federal HealthCare.gov site.
- In Oregon open enrollment for 2020 coverage will end on December 15, 2019. After that date, only people with a qualifying event will be able to enroll for the 2020 coverage.
- As per Oregon law, short-term health insurance plans are available for a duration of no more than three months, including the renewal periods.
- Oregon is considering switching to a state-based marketplace platform for health insurance, though this might not happen soon.
- In Oregon’s individual health plan market for 2020, there is 1.5% average premium rate increase.
- To obtain health plan coverage for 2019, 148,000 residents enrolled.
- Five insurance carriers will be offering coverage in 2020 in Oregon.
Individual and Family Health Insurance Plan
Residents of Oregon have the option to choose from health insurance plans that are specially designed for individuals and groups. These plans can be purchased from participating private insurers through HealthCare.gov, the federal exchange. All the individual and family plans offered by private insurers have to offer ten standardized essential benefits along with state mandated additional benefits. Some of the Oregon state mandated benefits include clinical trails, hearing aids, brain injury, off-label prescription drugs, brain injury, physical therapy and rehabilitative speech therapy. All the qualifying individual and family plans available in Oregon belongs to one of four metals plans such as Platinum, Gold, Silver, and Bronze. For individual and family health plans market, the average premium increase in Oregon is 1.5%.In Oregon following types of individuals and families health plans are available:
Preferred Provider Organization – PPO plans are health plans having a contract with a network of healthcare providers and members have access to the network of healthcare providers participating in their selected PPO plan. In this plan members do not need to choose a primary care physician and do not require referral for visiting a specialist. Members of the PPO plan have an option to select any of the in-network medical provider to obtain health care and they only need to pay their deductible and office visit copay. Though, members can even select an out-of-network provider but they will need to pay a slightly higher amount. In some of the PPO plans members are required to meet a deductible before the start of their coverage. PPO plan is designed to give more flexibility in choosing health care provider and the cost of healthcare is quite affordable if the members stay in-network.
HMO – In HMO plans, a network of doctors, hospitals and other healthcare providers agree to coordinate care within a network. HMO healthcare providers render services in return for a certain payment rate that are generally paid on a per-member basis, regardless of the number of times they see a member. HMO plans generally covers care received from the in-network providers and the members of the plan need to select a primary care doctor to manage their health care need and to provide reference to visit a specialist within the network. HMO plans are popular choice of budget conscious people, as these plans have lower monthly premiums and lower out-of-pocket costs. Members of the HMO plans don’t have to file claim, as health care are generally received from in-network doctors.
HDHP with HSA – A Health Savings Account is a saving account that is generally used as a part of a High Deductible Health Plan that allows members to pay for health expenses and build savings for future qualified medical health expenses on a tax-free basis. Members enrolling in HDHP plans usually have to pay lower monthly premium but higher deductible and when it is combine with Health Saving Account, then they can pay the deductible and other qualified expenses using the money set aside in this account that is tax-free. The balance amount in the HSA can rolls over year to year so that members can build reserves to pay for health care items and services, which they might need later.
Flexible Spending Accounts – A Flexible Spending Account is a special account in which people can put money to pay for copayments, deductibles, some drugs and certain out-of-pocket health care costs. People don’t have to pay taxes on the money saved in this account. The amount saved in this account can also be used to cover costs of medical equipment like crutches, bandages and diagnostic devices like blood sugar test kits.
Short-term Health Insurance in Oregon
As per Oregon State law, short-term health insurance plans is available for a duration of no more than three months that include renewal periods too. The law also clarifies that renewal also include a scenario in which the person needs to buy short-term plan from the same insurer within 60 days of the termination of a previous short-term plan. As per Oregon definition of health benefit plan, short-term plans are exempted if the plan doesn’t have a total duration of more than three months and there is at least a 60-day gap before the insurer issues an additional policy to the same person. Despite new federal laws expanding the duration of short-term plans but these rules do not apply in Oregon. Seven insurance companies are offering short-term plans in Oregon. The best thing about short-term plans are their affordability and the benefits covered by these plans are typically related to emergency care. It means that these will work for individuals who don’t require regular medical care like frequent visit to the doctor or expensive prescriptions. These plans do not have many benefits like major health insurance but they provide some coverage that is still affordable for many people, who can’t afford more comprehensive health insurance plans. People looking to purchase short-term plans must also keep in mind that these plans typically do not cover pre-existing medical conditions or minimum essential benefits that are mandatory for qualified health plans under the ACA.
Dental Insurance Plans in Oregon
Dental insurance in Oregon works exactly like medical insurance where people have to pay monthly premium to obtain certain dental benefits like regular checkups, dental cleanings, x-rays and other dental services essential for promoting general dental health. Dental plans in Oregon vary by the monthly premium rate, insurance company’s network of dentists, and the amount insured pay after every visit to the dentist. Oregon dental insurance plans are classified under the following plans:
Preferred Provider Organization – PPO plans have a network of participating dentists to whom the members of the plans are supposed to visit for any dental care service. Oregon dentists participating in the network agree to render dental care services at a pre-negotiated rates with the insurance companies, thereby keeping the cost of the dental care down for the members of the PPO plan. The dental care claim is submitted by the dentists to the insurance companies on behalf of the insured. Thus, people enrolled in PPO dental plans have less paper work and lower out-of-pocket costs. Members of this plan can go out of network but it certainly increase their out-of-pocket costs.
Indemnity Dental Plans – Indemnity dental plans of Oregon allow members to visit to any dentist of their choice, as there is no network of dentists with this plan. Thus, this plan has a broader selection of dental care providers but they will have to pays for the covered dental services upfront and can later on obtain reimbursement from their insurance carrier. The insurance companies after receiving the bill of the dental care, cross-check the rate with their network of dentists and then only pay that amount which they would have charged. Thus, insurance companies pay usual and reasonable amount.
Dental Discount Plans – These are not like original dental insurance plans instead members of these plans receive discounts on the dental care services obtained from the in-network dentists. Members can visit any dentist within the network to obtain dental care at discounted price, which they have to pay upfront. There will be no bill and no insurance form to fill out.
Vision Insurance Plans in Oregon
With the skyrocketing health insurance costs, vision insurance is often left behind. Most of the residents in Oregon rely upon either government based health plans or on employer plans to avail health insurance and so both these options leave them with either no vision coverage or one size fits all type of vision insurance. Individuals and families living in Oregon can purchase vision insurance from private insurance carriers who give them choice in vision insurance plans. Vision insurance plans offering by private carriers will supplement medical plans and will help insured to offset the costs of routine checkups and vision correction wear prescribed by the eye doctor. Some of the best vision care insurance companies in Oregon are VSP, EyeMed, and United Healthcare.
Insurance Carrier in Oregon
Oregon’s health insurance exchange has five insurers offering health coverage for 2020 in the state. Most of the counties of Oregon have the options of two or three insurers. All the five insurance companies were offering exchange plans even in 2019 and two insurance companies BridgeSpan and PacifiCare have expanded their coverage area in 2020. Two insurance companies, HealthNet and Regence, are offering health plans only outside the exchange. The five insurance companies operating in Oregon include: