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Oregon Health Insurance

Oregon Medical Insurance Overview

There are a lot of programs that offer insurance to residents living in the state of Oregon.  Among them are state-sponsored programs, group health plans from employers and individual insurance policies.  Despite the various options made available to Oregon’s residents, a good number of people in this state do not have health insurance benefits.  With the enactment of the Affordable Care Act, there are laws now in place that make it much easier for the state’s residents to obtain insurance coverage despite health conditions or level of income.

This summary is an overview of the health status of the residents in Oregon along with the various program options available in the state.

Oregon’s Health Care Issues
The state of Oregon is ranked in the 20th position by the United Health Foundation.  As such, the state’s overall health is relatively decent, but the state also has room for improvement.  The below information represents some of the strengths and weaknesses in Oregon:

Low rate of cardiovascular deaths
Low prevalence of physical inactivity
Low prevalence of low birthweight

Low rate of high school graduation
Low immunization coverage among children
Low immunization among adolescent males for HPV

Understanding Oregon’s Uninsured Population
As of 2014, the Henry J. Kaiser Family Foundation shows that 8 percent of the population of non-elderly residents were not insured using any means.  This is a four percent decrease from the percentage in 2013, which shows that the uninsured rate of residents is decreasing slowly.

Of the total population of uninsured residents, 4 percent of them were under the age of 18.  Between the ages of 19 and 64, 12 percent of the population had no insurance coverage.
Shockingly, five percent of the uninsured population of Oregon earned over 400% of the Federal Poverty Level.  It has yet to be revealed why this portion of the population can afford coverage, but opts not to obtain it.

Overall, the state’s uninsured population has decreased, which is a great sign of improvement for those living in Oregon.

Group Health Plans
In Oregon, you can find insurance through a variety of means.  For those working residents, some companies offer group insurance plans for their employees.  However, they are not required to do so in the state of Oregon.  If employers offer this type of coverage to employees, it must be made available to all eligible employees.  Either the employer or the insurance company can decide the amount of the monthly premiums, but usually the employer will cover a specific amount of the associated costs.

Health insurance providers offering group plans cannot decline to cover you or your dependents because of a pre-existing condition.  Despite that, they can make you wait a period of six months before you are able to use your insurance benefits.  This period does not affect dependents under the age of 19.

Additionally, insurance companies covering groups of up to 50 workers cannot treat pregnancy as if it were a pre-existing medical condition.  In 2014, 48 percent of residents had this type of insurance coverage.

Under the law in Oregon, there are several services that are required to be covered by health insurance providers offering group coverage.  Among them are chemical dependency services, mammograms, mental health services and more.  In addition, a lot of companies offer self-insured plans to their workers – meaning that they pay the costs of benefits directly from company funds instead of purchasing a plan.

Individual Health Plans
For people who don’t have group coverage or aren’t able to get insurance through a state-sponsored program, the ability for them to obtain individual insurance coverage exists.  Those planning to go this route can typically buy a policy directly from an insurance company or agent.  In order to get this type of coverage, the applicant and any dependents you wish to have covered need to fill out an Oregon Standard Health Statement.  This is a detailed health insurance application that insurance companies use to determine your eligibility for coverage.  Any dependents under the age of 19 cannot be declined coverage based on a pre-existing medical condition.  When filling out this information, it is imperative that you do so as accurately as possible.

Insurance premiums can range depending on the level of coverage obtained, the applicant’s age, the size of your family and the county of which you reside.  The insurance provider cannot make a determination on rates based on any claims you’ve made in the past or health.  In some cases, premium rates may go up if the policyholder ages into another bracket.

Oregon COBRA
In the state of Oregon, COBRA coverage offers continuation insurance coverage on a temporary basis and is administered by BenefitHelp Solutions (BHS).  The law regarding this type of coverage allows the formerly covered person to continue receiving insurance coverage for a period of 18 months following the termination of the original group policy.  The required premiums are equal to the cost of the entire group premium amount with an extra two percent for administrative costs.

When applicable, BenefitHelp Solutions mails out information on COBRA coverage to those who are eligible for coverage.  The information includes forms for enrollment, instructions and rates for coverage under the plan.  For those taking advantage of COBRA in the state of Oregon, the premiums should be sent directly to BenefitHelp Solutions.

Oregon Health Benefit Exchange
The state of Oregon opted to create and implement its own health insurance marketplace called Cover Oregon.  This website services as a central platform for people who are interested in purchasing insurance and comparing options for coverage.  It also offers resources for residents who require financial assistance in covering medical expenses.

Individuals and Families
If affordable health insurance is not available from the workplace, individuals and families can obtain coverage using Cover Oregon.  Using this system, you can compare different insurance options along with the costs associated with each.  Resources on financial assistance are also available and annual income guidelines allow a family of four to earn up to $94,200 and still qualify to receive assistance financially.

This website will also work to help cover the costs of premiums based on your level of income.

Small Employers
For smaller companies, it will be easier to offer health insurance to employees because of Cover Oregon.  This option was initially laid out to offer those companies with 50 or fewer workers the ability to offer health benefits.  In 2016, it is expected to expand enrollments for companies with more than 100 workers.  Those companies that qualify will be required to pay a certain amount toward the costs of health insurance for their workers and the employees can then shop the various options available on the website.  Using Cover Oregon, those who need coverage can compare costs, plan options and purchase insurance benefits.  Through Cover Oregon, the company providing the health plan will receive one monthly bill.

Oregon State Insurance Programs
Those living in the state of Oregon have a multitude of options with regard to state-funded insurance programs.  If you are an Oregon resident and are earning a low income, you may be able to qualify for one of the plans listed below based on your age, sex, health condition and income level.

Oregon Health Plan (OHP)
OHP is Oregon’s state Medicaid program.  It offers benefits for low income people living in Oregon that includes children, working families, pregnant women, single adults and seniors.

Coverage is not provided for cosmetic surgeries, fertility treatments, weight loss programs or conditions that get better without medical attention.  In order to qualify, you may need to have gone without medical insurance for a period of six months, but there are exceptions, such as pregnant women.

Family Health Insurance Assistance Program (FHIAP)
This program helps families in the state of Oregon to pay their monthly insurance premiums for private health benefits.  This can cover anywhere between 50-95% of the premiums for uninsured Oregon residents as long as income guidelines are met.  Children up to the age of 18 can receive 100% of their premiums paid.  Under FHIAP, individuals and families can use subsidies to pay for group health benefits or benefits under an individual plan.

Oregon State Children’s Health Insurance Program (CHIP)
This program serves dependents who are aged 19 and under and non insured by any other state program, including the Medicaid program.  To qualify, you must be a resident of Oregon and certain income requirements must be met.

Oregon Prescription Drug Program (OPDP)
OPDP is a state-funded program that provides residents of Oregon with a prescription discount card free of charge.  This program is available to all people living in Oregon and there is no cost associated with signing up.  Oregonians are able to save over half of the costs of prescription medications through this program.

Babies First/CaCoon
Under these plans, families and young children can receive home nursing care, parent-child interaction assessment, immunizations assessment, health education, encouragement and support.

Women’s Health
Oregon Women’s Health Network is a program that provides education, research and advocacy to put the spotlight on the medical needs of women living in the state.  Coverage provided includes health screening services, mental health assistance and pregnancy resources.

Contraceptive Care
CCare in Oregon is a program that strives to provide participants with the latest methods in birth control.

This program helps those individuals living with HIV/AIDS pay for the costs of medical care.  CAREAssist was designed to improve the lives of HIV positive residents of Oregon by offering financial assistance to pay for the costs of insurance premiums and co-payments.

Oregon Medical Insurance Pool
This program is a high risk program for people living with pre-existing medical conditions who are not currently insured through any other program.

Health Insurance Portability and Accountability Act (HIPAA)
Under the Health Insurance Portability and Accountability Act, group health plans cannot impose a pre-existing exclusion if you have had creditable coverage for at least a year if you have had a gap in coverage that lasted less than 63 days.  HIPAA allows for pre-existing conditions to be excluded in the event that treatment was received in the previous six months.  Genetic information cannot be used to determine whether or not you have a pre-existing condition and pregnancy is not considered a pre-existing condition.