Are you an Oregon resident who’s having trouble choosing between your health insurance options? We can help. There are several different options you can choose from, but some of those options are better than others. Then again, what works for one person might not be the best choice for you and your family. It’s all about knowing what your options are, in and out. Once you have all the relevant information, it’ll be much easier to make a choice that gives you affordable health care which is also comprehensive. By the time you finish reading this, you should know everything you need to know to make that choice – and if you’re still unsure, we strongly encourage you to reach out and ask for our help.
Major Medical Insurance in Oregon
Most people usually try and find major medical coverage when they are looking for health insurance for themselves and their family. Major medical coverage is any health insurance policies sold through the Health Insurance Marketplace, or qualifying equivalent coverage obtained through an employer. Those are pretty much the only two ways that you can get guaranteed issue, comprehensive coverage to help you meet your health care needs.
If you want to obtain coverage through your employer, then you will have to follow their instructions for doing so. But if you want to join the millions of Americans who have obtained their major medical coverage through the ACA, then you’ll have to go to HealthCare.gov and enroll starting November 1st during the Open Enrollment period. Open Enrollment usually lasts until December 15th, but it can sometimes vary from year to year based on needs and demands in your state. Although technically Oregon has its own state-run health insurance exchange, you will have to enroll through HealthCare.gov in order to get coverage. And if you’re in need of coverage due to a serious change in your life circumstances outside of the Open Enrollment period, then you should visit HealthCare.gov and look up information on Special Enrollment Periods to see if you qualify for immediate coverage.
We mentioned guaranteed-issue coverage a minute ago. This is important because, until a few years ago when the Affordable Care Act was first passed, guaranteed issue health insurance was almost non-existent within the United States. Guaranteed issue coverage means that you can apply without fear of being rejected based on pre-existing conditions. You also don’t have to worry that you will be charged exorbitantly higher monthly premiums based on any pre-existing conditions you might have. As a matter of fact, there are only four reasons why your insurance company can justify charging you higher premiums compared to a healthy person if you get your health care coverage through the ACA:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
In the days before the ACA, insurance companies had more control over what types of coverage they would sell you – and they oftentimes skimped on preventative care or things like mental health counseling in order to keep their own costs down. But thanks to the language of the ACA, every single health plan comes with the following guaranteed Essential Health and Wellness Benefits for optimal care:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
But how can most people afford this coverage? Doesn’t offering guaranteed issue policies with guaranteed benefits cost a whole lot of money? It can be expensive for some – unless they qualify for a subsidy, that is. Most of the time these subsidies are referred to as premium tax credits, and they go towards lowering the cost of your monthly premiums. In the state of Oregon, as long as you’re making over 138% of the federal poverty limit, you will likely qualify for one of these tax credits. And they can make your monthly premiums for your ACA major medical coverage substantially more affordable. Just look at the chart below and compare it to your household size and annual income in order to see whether or not you qualify.
|Household Size||Annual Income (138% of FPL)|
So what happens to people who fall below the 138% threshold? Lucky for you, as a citizen of Oregon, you got to apply for Medicaid. Oregon was one of the first States to accept and use free federal funds to extend Medicaid to low-income families who made more than enough to qualify for Medicaid, but not quite enough to qualify for a premium tax credit. But there may be other requirements besides being low income that you must meet in order to apply for the Oregon Health Plan Medicaid Program. Furthermore, it does not appear as though an online application is available at this time. But you can call the contact number on this page to find your local OHP application center and follow their directions in order to apply.
Short Term Health Insurance in Oregon
Rules for short-term health insurance in Oregon are a little more restrictive than they are in other states. Short-term health insurance is limited to a maximum of three months, including renewals. But the state of Oregon uses a different definition of “renewal” when it comes to short-term health insurance than other states. Technically, if you try to purchase another short-term health insurance plan within 60 days of the termination of one short-term plan, that falls under the definition of a renewal and is not legal. You might be able to skirt this regulation by waiting more than 60 days between your short-term plans and purchasing a different insurance plan from a completely different company; but regardless of how you handle it, you will be subjected to lots of medical underwriting with each short-term health insurance purchase. This can make things a little complicated and potentially more expensive if, for example, you just missed the most recent Open Enrollment period and need insurance coverage to hold you over until next year.
Medical underwriting is the process by which a health insurance company evaluates you and decides how much they should charge you for your monthly premiums – or if you need to be rejected for coverage. If you have a pre-existing condition, especially an expensive one that will require lots of medical care, you are more likely to be rejected for short-term health insurance coverage or charged a higher monthly premium. That being said, short-term health insurance premiums can cost up to 1/3 less than the price of an unsubsidized ACA major medical plan. They also come with better consumer protections and give you legal rights to litigation if you feel your short-term health insurance company has unjustly refused to pay out on your claims. To a certain extent, you may even be able to customize your level of coverage to the point where you get almost all of the same Essential Health Benefits that you would if you went through the ACA – although not all providers will be willing to sell you such a comprehensive level of coverage.
When it comes to short-term health insurance, even though you are saving money on monthly premiums, you may still have to worry about out-of-pocket costs like a $5,000 deductible. This deductible must be paid upfront by you before your short-term health insurance provider will start paying out on your claims. You might also have to deal with caps on your annual and lifetime benefits. So if you face a truly catastrophic medical emergency, you could run out of coverage and go back to paying out-of-pocket sooner than you think. At the same time, having one of these policies on hand can protect you from paying for 100% of your medical costs out-of-pocket. And if those medical costs are coming from an unexpected medical emergency, it could literally save you a fortune.
Christian Health Plans/Health-Sharing Plans in Oregon
In truth, Christian health plans were a lot more popular back when the individual mandate still existed in Oregon. But as of 2019, the individual mandate was no longer the law of the land on a federal level and the state of Oregon has not imposed an individual mandate on the state level, either. The individual mandate made Christian health plans – also known as health share plans – attractive because they were cheaper than unsubsidized ACA coverage due to the fact that they were not guaranteed issue health insurance nor did they offer all of the Essential Health and Wellness Benefits. But because they were offered by religious, nonprofit institutions, they provided an exemption to the individual mandate.
In a lot of ways, Christian health plans are more similar to short-term health insurance than they are most other health insurance options. Just take a look at all of the things they have in common:
- These plans are NOT guaranteed issue
- They have unlimited out-of-pocket costs
- They have lifetime and annual benefit caps
- They likely won’t have all of the guaranteed essential health benefits
But they also have some very important differences, starting with the lack of consumer protections that people have when they sign up for a Christian health plan compared to short-term health insurance. Since there’s technically no contract between you and your Christian health plan, there’s no legal recourse if they, for whatever reason, don’t pay out on your claims. The language is also different, mostly for legal reasons. You pay a monthly share amount instead of a typical monthly health insurance premium. You will also be expected to pay a “personal responsibility amount” or an “unshared amount” in place of a co-pay, a coinsurance charge, or a deductible. Christian health plans will also delve into your personal life a little bit and require you to follow membership guidelines which may include (among other things): declaring a specific faith, attending church on a regular basis, stopping all tobacco use, and more. But the fact that you pay less in monthly fees and still receive a comparably comprehensive level of coverage means that these plans can work out if you find a reputable health share plan provider and don’t require extensive medical care.
Fixed Indemnity Plans in Oregon
Fixed indemnity plans are different from major medical coverage in two major ways: they pay out a fixed amount of benefits as opposed to a shared percentage cost of your total medical expenses, and they aren’t restricted to specific medical networks. But they are a far from adequate replacement for major medical coverage. This is mostly due to how much more of the financial burden is on you rather than your insurance provider. Your benefits are paid out on a daily, weekly, monthly, per incident, or per visit basis. You will also be subjected to medical underwriting and caps on your benefits at both the annual and lifetime level.
So why go for a fixed indemnity plan? Well, these actually make great supplemental policies to help lower your out-of-pocket costs when you have major medical coverage but require more frequent medical care. And since you aren’t restricted to a specific medical network, you’ll have greater flexibility with shopping around for the providers that can give you the care you need at the price you want. You just have to be careful about the medical underwriting and the lack of a limit on your out-of-pocket medical costs. Also, if you’re looking at a fixed indemnity plan to replace major medical instead of supplementing it, you might only want to consider this option if you are relatively healthy. Because if you require lots of medical care, you could be rejected for coverage in the first place or still have substantial out-of-pocket cost to struggle with without any other form of insurance coverage – but it can definitely help you take the edge off of your out-of-pocket costs if you are relatively healthy and face an unexpected medical emergency.
Discount Cards in Oregon
Medical discount cards are a bit of a double-edged sword. On the one hand, if you find a good card offered by a reputable company who offers decent discounts from a variety of providers, it can be extremely beneficial at helping you cover your medical costs. But at the same time, it is frighteningly easy for people to fall victim to scams or to fall into a medical discount card program that offers them less than they bargained for. And by the way, anyone who tells you that medical discount cards are perfectly adequate replacement for major medical health insurance coverage are lying to you and most likely offering one of these scams.
Here’s how a medical discount card works: it’s similar to something like the AARP where you pay a membership fee and receive a card in the mail – then you simply present it when you make a purchase or pay for services at a qualifying establishment. You can save money on prescription drugs, certain medical providers, and even supplemental care like vision or dental with the right medical discount card. But not all of these cards are created equal, and not all companies are completely honest about the discounts you are eligible for or the providers they claim to work with. Sit down, do the math on how much your card costs versus how much you can save with discounts, and call around to make sure that they are working with the providers they claim to be. If everything checks out, medical discount cards can be a great way to take some of the sting out of your medical costs alongside something like major medical coverage, a short-term health insurance plan, or the like.