With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Oregon, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Oregon
Oregon ranked 12th overall in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths included a low prevalence of physical inactivity, low rate of preventable hospitalizations, and low prevalence of low birthweight and low infant mortality rate. Its challenges included a low high school graduation rate, a low immunization coverage among children, and many poor mental and physical health days per month.
Oregon individual and family health insurance
Oregon initially launched a state-based health insurance exchange, Cover Oregon. However, the state disbanded its troubled exchange in 2015, and coverage is now offered through the Federal Health Insurance Marketplace website.2
Individuals and families in Oregon may also buy ACA-compliant and supplemental health insurance plans in the private marketplace through websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Oregon’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 68,308 individuals in Oregon selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.3 In 2015, the number of individuals in Oregon enrolled in a marketplace plan increased to 112,024 during the open enrollment period.4
|Oregon’s health insurance exchange:||CoverOregon.com / healthcare.gov|
|Oregon department of insurance:||oregon.gov/dcbs/insurance|
Oregon small group health insurance plans
In 2014, Oregon’s health insurance exchange was not prepared to serve health insurance to small businesses with 50 or fewer employees.5 Nonetheless, Oregon’s small businesses with 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit if they purchase a Cover Oregon–certified plan; to learn more, visit coveroregon.com/employer/financial-assistance. Stay tuned for 2015 website and enrollment information for small businesses in Oregon.
Oregon’s small business owners may also find small group health insurance in the private marketplace through websites such as such as HealthCare.com. Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Oregon’s health insurance exchange.
Oregon state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Oregon offers State Continuation of Coverage, also referred to as mini-COBRA. Highlights of this program include the following6:
|Eligible group sizes||Fewer than 19|
|Maximum continuation period – standard||9 months|
|Maximum premium Increase||100 percent|
|State legislation reference||ORS 743.610 Oregon State / Continuation of Coverage|
Oregon high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.7
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).8
Oregon expanded its Medicaid program cover low-income adults ages 19 to 65 whose annual income is below 138 percent of the federal poverty level on Jan. 1, 2014.9 Medicaid/CHIP open enrollment take place year-round.
The information below is specific to Oregon’s Medicaid program, Oregon Health Plan:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||State of Oregon|
|How to apply||coveroregon.com /oregon.gov/oha/healthplan/Pages/apply.aspx|
|Open-enrollment period||Year-round in all states|
|Eligibility||Qualifications based on income, residency and other criteria (e.g., pregnancy, disabled, sight impared)|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Oregon’s Healthy Kids health insurance program for low-income children:
|Program name||Healthy Kids|
|How to apply||coveroregon.com|
|Eligibility||Under age 19, living in Oregon, legal U.S. resident; income qualifications apply|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Portland Business Journal. “Gov. Brown dissolves Cover Oregon — but it’s not over yet” https://www.coveroregon.com/employer/financial-assistance.
6 OregonLaws.org. “Continuation of coverage under group policy upon termination of membership in group health insurance policy
7 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
8 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
9 Centers for Medicare & Medicaid Services. “Oregon.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/oregon.html.