Oregon Health Insurance

Updated on: September 10th, 2020

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Oregon’s 4.1 million residents get their health insurance through their employer, the private individual market, Affordable Care Act (ACA; also known as Obamacare) plans, Medicare and the Oregon Health Plan (OHP), which combines Medicaid and Children’s Health Insurance Program (CHIP).1

Almost half of residents get coverage at their job, while nearly two out of five receive it through Medicare or Medicaid. Before the ACA was rolled out in 2013, 15% of Oregonians were uninsured; by 2018, that had dropped to just 7%.2

Since its implementation, the ACA covered between 6% and 8% of Oregon residents, but enrollment dropped in 2019 to 3.5%.3 All ACA plans include 10 “essential health benefits,” such as preventive care, hospital care and prescription drug coverage.

The Beaver State was one of the first to expand Medicaid, as allowed under the ACA. By including adults earning less than 138% of the federal poverty level, in 2017 nearly 500,000 adults in Oregon were enrolled in the Medicaid expansion.4 

Read on to learn more about your options for health insurance as a resident of Oregon.

How Do I Enroll in Oregon’s Health Insurance Marketplace?

Every year, open enrollment lasts from November 1 to December 15. If you buy a plan during this time, your coverage will start the following January 1. (To avoid a break in coverage, you’ll need to re-enroll each year.) More than 145,000 Oregonians enrolled in health insurance during the 2020 Open Enrollment Period (OEP).5

Under Obamacare, Oregonians can buy nongroup (individual) coverage and possibly qualify for subsidies (which will help you pay for your insurance) through its state-based Health Insurance Marketplace. Oregon relies on the federal government to handle signups for insurance through healthcare.gov; the state ensures that any plans sold on the Marketplace meet ACA guidelines.

Policies can also be purchased directly from an insurance company or broker, too, but keep in mind that these plans won’t qualify for subsidies.

If you miss the OEP, you’ll have to wait until next year’s enrollment period unless something happens to  leave you uninsured or changes the size of your family. This triggers what’s called a Special Enrollment Period, which opens a short window for you to get insurance.6

Which Companies Offer Individual Health Insurance in Oregon? 

In 2020, five health insurance companies offer individual policies on the state Marketplace, down from 11 in 2014.7 They are BridgeSpan, Kaiser Permanente, Moda Health, PacificSource and Providence. At least seven health insurance plans are available in every Oregon county, with as many as 43 plans in some areas, through these insurers.8

How Much Does Marketplace Health Insurance Cost in Oregon?

Whether you choose a plan within or outside the Marketplace, all are organized by levels of cost-sharing, also known as “metal” tiers of gold, silver and bronze.

Premiums for these plans in Oregon have increased between 3% and 7% since 2018, with the silver plans rising by 5%. Here are the average monthly costs a 40-year-old resident would pay for bronze, silver and gold plans sold through the Oregon Marketplace for the last three years:9

Average Premiums for Oregon Marketplace Plans (for a 40-year-old person)2018 2019 2020
Lowest-Cost Bronze Plan$303$323$314
Lowest-Cost Silver Plan$406$434$428
Lowest-Cost Gold Plan $439$471$468

(The government uses the second-lowest-cost silver premium for a 40-year-old person as a “benchmark” for calculating subsidies.10 Since 2018, this benchmark has risen in Oregon by almost 8%.)

What Are My Coverage Options in Oregon If I’m Low-Income?

ACA Marketplace Plans (Obamacare)

If you earn between 100% and 400% of the federal poverty level (FPL), you qualify for help paying your monthly premiums. A family of three, for example, that earns between $21,720 and $86,880 a year would qualify in 2020. As mentioned above, to receive subsidies, you must purchase plans through the Marketplace.11

In 2019, nearly three-quarters of ACA enrollees in Oregon received help paying for monthly premiums via subsidies, also called advanced premium tax credits.12 The monthly subsidies averaged $453.13

Here are some examples of how much you might save with the help of these tax credits:

  • A 28-year-old in Salem who earns $24,000 a year could get a silver plan for $122 per month after subsidies.14 The same policy would cost $371 per month without the premium tax credits that cover 67% of the cost.
  • A family of three in Portland with an income of $50,000 a year could pay $322 a month after subsidies for a silver plan.15 This policy would cost $881 per month without the premium tax credits that cover 63% of the cost. 

If you earn between 100% and 250% of the FPL, purchase a silver plan on the Marketplace, and receive premium tax credits, you may qualify for cost-sharing reductions (CSRs) to lower your out-of-pocket costs even more. In 2019, 35% of enrollees in Oregon Marketplace plans received CSRs.16

Medicaid 

Oregon’s Medicaid program is known as Oregon Health Plan, or OHP. It has three parts:

  • OHP Plus covers children from birth to 18 and adults ages 19 to 64. 
  • OHP with Limited Drug covers adults who qualify for both Medicaid and Medicare Part D (prescription drug coverage).17
  • OHP Plus Supplemental covers pregnant adults aged 21 or older and includes prenatal, postpartum and newborn care. In 2018, the program financed half the births in Oregon. If you’re a new parent and you want to maintain Medicaid eligibility after your pregnancy coverage ends, your income must be below 138% of the FPL.18

Oregon elected to expand Medicaid under the ACA to cover almost all nonelderly adults under 138% of the FPL. As of March 2020, about 870,000 people in the state had enrolled in Medicaid and 130,000 had joined in the Children’s Health Insurance Program (CHIP).19 Together, they represent nearly one-quarter of residents, nearly a 60% increase in enrollment since 2013.20 

To qualify for Medicaid, recipients must earn a percentage of the FPL. Those percentages vary for different groups:21

  • Parents: 138%
  • Childless adults: 138%
  • Pregnant women: 190%
  • Children: 305%
  • Seniors: 74%
  • People with a disability: 74%

You can check your eligibility through OHP Customer Service or call (800) 699-9075.

OHP also offers emergency medical services through Citizen-Alien Waived Emergent Medical to anyone who is blocked from receiving Medicaid due to their immigration status.22

Children’s Health Insurance Program (CHIP) 

Low-income children who are under 19 and part of a family earning up to 300% of the federal poverty level have access to health insurance through CHIP, which in Oregon falls under the OHP Plus program mentioned above. 

In 2017, Oregon passed the Cover All Kids law, which ensures the right to healthcare coverage  regardless of a child’s immigration status. These children can access the full range of health services, from primary and preventive care to specialty and inpatient hospital care.23 

What Are Oregon’s Medicare Plans for Seniors and People with Disabilities?

Medicare is a federal program that helps cover healthcare costs for Americans who are 65 and over; younger and living with a disability; or who have ALS or end-stage renal disease. One in five Oregon residents receives Medicare benefits. Each year, the Open Enrollment Period to sign up for Medicare runs from October 15 through December 7. 

In 2017, over 17% of Medicare beneficiaries in Oregon also signed up for the state’s Medicaid program.24 Enrollment could be through a Medicare Savings Program that helps cover your premiums, deductibles, coinsurance and copays.25 

Of Oregon’s roughly 860,000 Medicare members, nearly 45% enrolled in private Medicare Advantage (Part C) plans as opposed to Original Medicare (Parts A and B).26 Both plans provide enrollees with Part A (hospital insurance) and Part B (medical insurance).

Medicare Advantage offers extra benefits; it could include Part D prescription drug coverage which, under Original Medicare, you would have to purchase separately as a standalone plan. In 2020, 12 companies in Oregon offer Medicare Advantage plans.27

Over 600,000 Oregonians purchased a separate Medicare Part D drug plan.28 Monthly plan premiums in the state range from $13.20 to $120.00 in 2020; the average premium is $42.90.29 In 2017, over one-quarter of people with Medicare with Part D coverage in Oregon received both low-income premium and cost-sharing subsidies.30   

If you have Original Medicare, you can choose from 30 insurers to add private Medicare Supplement Insurance (what’s called a Medigap policy) to your benefits. Medigap policies pay the portion Medicare doesn’t pay. Oregon allows beneficiaries to change Medigap plans annually. 

The 10 available Medicare Supplement Insurance plans are standardized, which means that the benefits remain the same for all plans, though monthly premiums vary by company. For example, in 2020, a Plan G policy at age 65 runs from $116 to $215 monthly, depending on the company you choose.31

If you need help, the Oregon Senior Health Insurance Benefits Assistance (SHIBA) program can tell you more about your Medicare options; visit the SHIBA site or call (800) 722-4134. 

What Are My Options for Buying Short-Term Health Insurance in Oregon?

Short-term health insurance can help fill temporary insurance gaps, such as being between jobs or missing the Obamacare enrollment window.

Oregon limits temporary plans to three months, including renewals. (If you buy another short-term plan from the same insurer within 60 days of the expiration of a previous plan, that’s considered a renewal.)32 

It’s important to know, though, that these plans, available from seven insurers in the state, don’t include the “minimum essential coverage” required by the Affordable Care Act.33 Check disclosures carefully to see what coverage is guaranteed by any policy you consider.

Sources

1.  Kaiser Family Foundation. “Population Distribution by Age.” kff.org (accessed April 18, 2020).    

2.  Kaiser Family Foundation. “Health Insurance Coverage of the Total Population.” kff.org (accessed April 18, 2020).

3.  Centers for Medicare & Medicaid Services. “2020 Federal Health Insurance Exchange Enrollment Period Final Weekly Enrollment Snapshot.” cms.gov (accessed April 18, 2020).

4.  Kaiser Family Foundation. “States Health Care Snapshots: Oregon.” kff.org (accessed April 18, 2020).   

5.  Kaiser Family Foundation. “Marketplace Enrollment, 2014-2020.” kff.org (accessed April 18, 2020). 

6.  U.S. Government Website for the Federal Health Insurance Marketplace. “Getting health coverage outside Open Enrollment.” healthcare.gov (accessed April 18, 2020).  

7.  Kaiser Family Foundation. “Number of Issuers Participating in the Individual Health Insurance Marketplaces.” kff.org (accessed April 18, 2020).   

8.  Oregon Department of Consumer and Business Services. “Health insurance plans.” healthcare.oregon.gov (accessed April 18, 2020).  

9.  Kaiser Family Foundation. “Average Marketplace Premiums by Metal Tier, 2018-2020.” kff.org (accessed April 18, 2020). 

10.  Kaiser Family Foundation. “Marketplace Average Benchmark Premiums.” kff.org (accessed April 18, 2020). 

11.  Centers for Medicare & Medicaid Services. “APTC and CSR Basics.” cms.gov (accessed April 18, 2020). 

12.  “State Health Care Snapshots: Oregon.”

13.  Kaiser Family Foundation. “Estimated Total Premium Tax Credits Received by Marketplace Enrollees.” kff.org (accessed April 18, 2020).

14.  Kaiser Family Foundation. “Health Insurance Marketplace Calculator.” kff.org (accessed April 18, 2020).

15.  Kaiser Family Foundation. “Health Insurance Marketplace Calculator.” kff.org (accessed April 18, 2020).

16.  Centers for Medicare & Medicaid Services. “Early 2019 Effectuated Enrollment Snapshot.” cms.gov (accessed April 18, 2020).    

17.  Oregon Health Authority. “Apply for OHP.” oregon.gov (accessed April 18, 2020).

18.  “States Health Care Snapshots: Oregon.”  

19.  U.S. Government Website for Medicaid. “April 2020 Medicaid & CHIP Enrollment Data Highlights.” medicaid.gov (accessed April 18, 2020).

20.  Kaiser Family Foundation. “Total Monthly Medicaid and CHIP Enrollment.” kff.org (accessed April 18, 2020). 

21.  “States Health Care Snapshots: Oregon.”  

22.  Oregon Health Authority. “Eligibility Categories.” oregon.gov (accessed April 18, 2020). 

23.  Oregon Latino Health Coalition. “Oregon Becomes Seventh State in the Nation to Provide Health Care for All Kids.” orlhc.org (accessed April 18, 2020). 

24.  “States Health Care Snapshots: Oregon.” 

25.  Oregon Health Authority. “Oregon Health Plan (OHP) Handbook.” state.or.us (accessed April 18, 2020). 

26.  “State Health Care Snapshots: Oregon.”    

27.  Oregon Department of Consumer and Business Services. “Oregon Guide to Medicare Insurance Plans.” healthcare.oregon.gov (accessed April 18, 2020).  

28.  Cubanski, Juliette; Damico, Anthony and Neuman, Tricia. Medicare Part D in 2018: The Latest on Enrollment, Premiums and Cost Sharing, May 17, 2018. Kaiser Family Foundation. (accessed April 18, 2020).

29.  Centers for Medicare & Medicaid Services. “Prescription Drug Coverage – General Information.” cms.gov (accessed April 18, 2020). 

30.  “State Health Care Snapshots: Oregon.”

31.  “Oregon Guide to Medicare Insurance Plans.”  

32.  Oregon Division of Financial Regulation. “Guidance for short-term health insurance.” dfr.oregon.gov (accessed April 18, 2020). 

33.  Oregon Division of Financial Regulation. “Standard Provisions for Group or Individual Short Term, Limited-duration health insurance (that is less than 3 months) including renewals.” dfr.oregon.gov (accessed April 18, 2020).    

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