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Oregon uses a state-run health insurance marketplace (exchange) that uses the HealthCare.gov enrollment platform.
Six insurers offer 2023 plans in Oregon’s exchange, including four that offer plans statewide. The overall average rate increase was 6.7% for 2023 coverage, before any subsidies are applied.
Oregon is working to create a Basic Health Program (BHP), and is also hoping to further expand its Medicaid eligibility to create a “bridge” program that will cover people until the BHP is established.
Oregon has a state-run exchange that uses the HealthCare.gov enrollment platform.
Oregon was one of the states that initially opted to run its own exchange, but the state-based enrollment system never worked properly. Following months of efforts to fix the troubled website, Cover Oregon’s board voted on April 25, 2014 to switch to using Healthcare.gov rather than continue to try to repair the existing site. Since then, Oregon has continued to have a state-run exchange but uses the federal enrollment platform.
On March 6, 2015, Oregon Governor Kate Brown signed Senate Bill 1 into law. The legislation dissolved Cover Oregon and its board of directors, and transferred remaining responsibilities to the Oregon Department of Consumer and Business Services (the agency that oversees the Oregon Insurance Division).
The Cover Oregon website also ceased to exist at that point. Instead, the URL now redirects visitors to OregonHealthcare.gov. From that site, residents can enroll in Medicaid if eligible, or will be redirected to Healthcare.gov to enroll in a private plan.
Oregon has reconsidered the possibility of a state-run exchange over the years, and the decision is still up in the air as to whether Oregon will move forward with a new state-based exchange website/enrollment platform or continue to use Healthcare.gov.
The open enrollment period for individual/family health coverage runs from November 1 to January 15 in Oregon. Outside of open enrollment, a special enrollment period (usually triggered by a specific qualifying life event) is necessary to enroll or make changes to your coverage.
If you have questions about open enrollment, you can learn more in our comprehensive guide to open enrollment.
For 2023 coverage, the same six insurers that offered plans in Oregon for 2022 are continuing to do so. Four of the six insurers offer state-wide coverage, so all residents in Oregon can select from at least four insurers when they shop in the exchange (most residents have access to plans from at least five insurers). Plans are available in Oregon’s exchange from the following insurers:
As is the case in most states, insurer participation in Oregon’s exchange has varied over the years. Oregon started out with a very robust exchange, with 11 insurers offering plans for 2014. And for 2015 and 2016, there were still 10 insurers offering plans. But several of those insurers were losing money during those years, and insurer participation dropped sharply for 2017, when only six insurers continued to offer plans in the Oregon exchange.
In mid-October 2015, Health Republic Insurance – one of two ACA-created CO-OPs in Oregon – became the eighth CO-OP to fail, and the fourth as a result of the risk corridor shortfall that was announced on October 1. In all, 10 CO-OPs closed their doors on December 31, 2015, and another – Health Republic in New York – closed at the end of November.
In April 2016, LifeWise Health Plan of Oregon (which offered plans statewide in 2016) announced that they would exit the state at the end of 2016, including both the individual and group market. Enrollees were able to keep their coverage through December 31, but had to pick a different plan for 2017.
Trillium (which primarily provides Medicaid managed care) offered on-exchange plans in 2016, but only in Lane county. In June 2016, the state approved the sale of Trillium to Missouri-based Centene, and Trillium did not file rates to sell plans in any Oregon county for 2017.
Zoom notified DCBS in August 2016 that they would exit the Oregon exchange at the end of 2016. Zoom had been the only exchange carrier that had planned to increase its coverage area for 2017 (they already offered plans in Clackamas and Multnomah counties in 2016, but had planned to add Washington county to their coverage area in 2017). Instead, they only offered off-exchange plans in those three counties in 2017. But Zoom ended up closing entirely at the end of 2017. All Zoom Health members who had off-exchange coverage in 2017 needed new plans for 2018, as the insurer shut down completely at the end of 2017.
On July 8, 2016 the Oregon Department of Consumer and Business Services announced that Oregon Health CO-OP would cease operations as of July 31. Oregon started out with two CO-OPs in 2014, but Health Republic had already failed at the end of 2015. There had been numerous insurer exits from the exchanges and CO-OP failures across the country over the last couple of years, but nearly all of them had been timed to coincide with the end of a calendar year. So Oregon Health CO-OP’s mid-year closure was unusual. Having to switch plans mid-year is challenging for people who have already paid money towards their deductible, since they generally have to start over with a new deductible for the new plan. But the Oregon Department of Consumer and Business Services worked with the other insurers in the state to ensure that CO-OP members’ already-accrued out-of-pocket expenses would count towards their new plans that took effect August 1.
For a while in early 2016, it looked like Moda Health Plan Inc. would also be leaving the exchange at the end of 2016, but they ended up staying, and have continued to offer plans in the Oregon exchange ever since. In January 2018, the Oregon Division of Financial Regulation placed Moda under supervision, and ordered the carrier to cease issuing or renewing individual plans, or enrolling new groups. That same day, Moda said that they would exit the individual market in both Oregon and Alaska in an effort to stem the losses they were incurring. On February 8, regulators in Alaska and Oregon reached an agreement with Moda that allowed the carrier to resume selling and renewing coverage in the individual markets in both states. Part of the agreement was a commitment from Moda to continue to service individual market policy-holders until at least the end of 2016. Ultimately, Moda opted to exit Alaska’s individual market at the end of 2016, but remain in Oregon (Moda had already exited the markets in Washington and California in late 2015, in order to focus on Oregon and Alaska).
In addition to the carriers that did not return to the exchange for 2017 (Oregon Health CO-OP, LifeWise, Zoom, and Trillium), many counties outside the I-5 corridor were facing the possibility of only having one carrier offering plans, as several remaining carriers had planned to reduce their coverage area. But regulators worked with carriers to address the problem, and by August 2016, BridgeSpan and Providence Health Plan (in addition to Regence BCBS outside the exchange) had agreed to continue to offer plans statewide in 2017, but with higher premiums. So every county in Oregon continued to have at least two carriers offering plans in the exchange for 2017, and most had at least three.
All six exchange insurers initially planned to continue to offer coverage in 2018, although Atrio had planned to reduce their coverage area for 2018. But they ultimately opted to withdraw their individual and small group plans in order to focus instead on their Medicare products. That left seven individual market insurers, five of which offered plans in the exchange for 2018 (BridgeSpan, Kaiser, Moda, PacificSource, and Providence). BridgeSpan significantly reduced its coverage area, however, leaving Providence as the only insurer offering coverage statewide in the exchange in 2018. But some insurers expanded their coverage areas, giving residents in some counties more options in 2018 and 2019. The 2018 coverage area chart is available here, and the coverage area chart for 2019 is here (on the second page, below the rate filings).
For 2020, the five remaining insurers continued to offer coverage in the exchange, with Providence still the only insurer offering state-wide coverage. Regence and Health Net continued to offer coverage outside the exchange. Regence joined the exchange for 2021, however, and BridgeSpan, Regence, and Providence all offered plans statewide in the exchange.
For 2022, all six insurers continued to offer plans, and PacificSource expanded to offer coverage statewide. Residents in all areas of the state could choose from at least four insurers for 2022 coverage. And residents in most areas of the state could choose from five or six insurers. This will continue to be the case in 2023.
Across Oregon’s individual market insurers, the weighted average rate change for 2023 was a 6.7% increase. The following average rate changes were implemented for 2023 (note that these rate changes are calculated before any subsidies are taken into account):
State regulators noted that the state’s reinsurance program is continuing to play a significant role in keeping premiums lower than they would otherwise be, for the fourth year in a row.
It’s important to understand that the overall average rate changes are calculated before subsidies are applied, and thus do not reflect the actual net rate changes for most enrollees. Most people with coverage through Oregon’s exchange are receiving subsidies, especially now that the American Rescue Plan has been implemented and the subsidy enhancements have been extended through 2025 by the Inflation Reduction Act. For subsidized enrollees, net rate changes also depend on how their subsidy amount changes from one year to the next. Overall average rate changes also don’t account for the fact that premiums increase with age. Fortunately, subsidies also increase as a person gets older, to keep up with the age-related premium increases.
For perspective, here’s a look at how rates in Oregon’s individual/family health insurance market have changed over the years:
146,602 people enrolled in coverage through Oregon’s exchange during the open enrollment period for 2022 coverage. This was up from 141,089 people the year before, after three consecutive years of declining enrollment in Oregon’s exchange.
Here’s a look at enrollment numbers over the years in Oregon’s exchange:
Oregon has a state-run exchange, run by the Oregon Department of Consumer and Business Services (DCBS), but they’ve been using Healthcare.gov’s enrollment platform since the second open enrollment period, after the state’s own exchange platform (Cover Oregon) failed to perform adequately in the first year. So the exchange is considered an SBE-FP (State-Based Exchange on the Federal Platform).
On this page, you can see meeting agendas and minutes for Oregon’s Health Insurance Marketplace Advisory Committee.
The federal government charges SBE-FPs a fee equal to 2.25% of premiums for use of Healthcare.gov in 2022 (this percentage has fluctuated quite a bit over the years, but it will remain at 2.25% in 2023). Oregon has considered the possibility of switching back to having a fully state-run exchange, and after reviewing bids from three technology vendors, DCBS put out a report in May 2016 detailing the pros and cons (and costs) of both options.
At that point, Oregon decided to continue to use Healthcare.gov, with plans to revisit this decision within three to five years. They noted that the decision was a toss-up, as it would have been a little more expensive to run their own exchange platform, but would have enabled the state to have a more finely-tuned enrollment platform, specific to Oregon’s needs. But they felt that they couldn’t go ahead with another significant change without it being clearly advantageous all-around.
Two years later, however, Oregon was once again considering running its own enrollment platform. The fees to use HealthCare.gov and the lack of flexibility in the platform were concerns for the state, and they were looking into whether they can establish a more efficient, lower-cost platform and transition away from HealthCare.gov. That would give the state more flexibility in terms of things like open enrollment dates and special enrollment periods (this is less of a concern now that the Biden administration has permanently extended open enrollment so that it continues through mid-January).
But the discussion is very much ongoing in Oregon, and if any changes are made, they will not be hasty. The minutes of a June 2018 Oregon Marketplace Advisory Committee meeting made it clear that all options were on the table, including the possibility of switching to a fully federally-run exchange. But members of the committee also expressed dissatisfaction with the HealthCare.gov call center’s lack of knowledge pertaining to Oregon’s regulations and health plans.
In another meeting in late November 2018, the Oregon Marketplace Advisory Committee talked by phone with leaders from other state-run exchanges, including Nevada and New Mexico, both of which were in the process of transitioning to their own enrollment platforms. The committee was gathering information about what other states have experienced, so that Oregon could determine what approach will be most beneficial in the state.
In April 2019, the Oregon Department of Consumer and Business Services put out a request for information, seeking proposals from vendors interested in creating a state-run exchange platform and customer service center. They received responses from 10 vendors, and the information in the proposals is being used by state officials to determine the financial feasibility of transitioning to a fully state-run exchange.
But Oregon is still using HealthCare.gov with the SBE-FP model as of 2023, and plans to continue to do so for the foreseeable future. Stakeholders noted in mid-2022 that the SBE-FP model was serving the state well.
Under Section 1331 of the ACA, states have the option to create a Basic Health Program (BHP). Thus far, only Minnesota and New York have done so, and both have had successful BHPs for several years.
Oregon is now considering the possibility of creating a BHP (so is Kentucky, although Kentucky’s may be paused for the time being). In 2022, Oregon enacted H.B.4035. Among other things, the legislation directs the state to create a “bridge program to provide affordable health insurance coverage and improve continuity of coverage for individuals who regularly enroll and disenroll in medical assistance program due to frequent fluctuations in income.“
A BHP would provide coverage for people in Oregon with income between 138% and 200% of the poverty level. For now, these individuals are mostly eligible for subsidized coverage in the exchange. But in Minnesota and New York, the BHP provides very robust coverage with little or no monthly premiums for this population, providing them with lower total costs than they would have with a private plan in the exchange.
In the meantime, Oregon is also working to further expand Medicaid eligibility to create a “bridge to the bridge” program that would allow people with income up to 200% of the poverty level to have Medicaid coverage until the state’s BHP is up and running (BHPs are often referred to as a “bridge” program, because they provide stable coverage when a person earns too much to qualify for Medicaid but not enough to afford a robust marketplace plan). The state submitted an 1115 waiver amendment addressing this in November 2022, which is under review by the federal government (details of the waiver amendment are available here).
The purpose of this is to address the fact that approximately 300,000 people would otherwise be expected to lose access to Medicaid when routine eligibility redeterminations resume starting in April 2023. Oregon hopes to use the temporary additional Medicaid expansion to keep these people on Medicaid until the BHP can provide them with robust, stable coverage.
In August 2017, Oregon enacted H.B.3391, which includes mandated coverage of comprehensive reproductive health care (most of its provisions didn’t take effect until January 2019). New York also adopted a measure in 2017 to protect access to contraceptive coverage.
H.B.3391 applies to any plans regulated by the state, which includes the individual market, Oregon Medicaid (Oregon Health Plan, overseen by Oregon Health Authority), and fully-insured group plans. But self-insured group plans are not subject to state regulations; instead, they’re regulated under federal law via the Employee Retirement Income Security Act (ERISA). And the majority of very large employers self-insure their workforce, as opposed to purchasing fully-insured group plans. In Oregon, 27.7 percent of the state’s population is covered under state-regulated plans, while 21.6 percent are covered under federally-regulated self-insured plans (the rest are on Medicare, Medicaid, TRICARE, and other federal health programs).
H.B.3391 requires health plans regulated by the state to cover a wide range of reproductive health care — including the full range of FDA-approved contraceptives at no cost to the insured. The ACA also requires that, but only for female contraceptives. Vasectomies are not required to be covered under the ACA, although female sterilization is. Oregon’s measure, however, includes coverage for voluntary sterilization for both men and women.
H.B.3391 also requires abortions to be available to Oregon residents with no cost-sharing (ie, no copay or deductible), so the cost is built into health insurance premiums. The bill’s protection of access to abortion applies without regard to immigration status: For undocumented immigrants without health insurance, the state of Oregon will pick up the tab for abortions, estimated at about $300,000 a year. The abortion coverage requirement has an exemption for religious employers to allow them to opt out of contraceptive and abortion coverage (not only does the ACA not require coverage for abortions, it also requires each state’s exchange to include at least one plan that doesn’t cover abortions).
Oregon’s new law also prevents health plans from discriminating based on gender or gender identity (Section 1557 of the ACA currently prohibits discrimination),
Oregon was already at the forefront of ensuring access to contraception: In 2016, the state began requiring pharmacies to provide on-demand birth control pills and patches, and also began requiring health insurers to cover a 12-month supply of contraception at one time, rather than requiring refills throughout the year (although the Oregon Insurance Division reported in late 2017 that they get a significant number of complaints about pharmacies not dispensing 12 months of birth control at a time). But H.B.3391 puts Oregon clearly in the lead in terms of protecting access to reproductive care, including contraceptive and abortion.
As of March 2018, Oregon began prohibiting out-of-network providers at in-network facilities from sending balance bills to patients, unless the patient had been informed that the provider was out-of-network and opted to receive services from that provider anyway. Federal protections from surprise balance billing took effect in 2022, but Oregon stepped in to protect consumers in state-regulated plans a few years earlier.
Also related to health insurance consumer protections, H.B.2342 was enacted in 2017 in Oregon. It grants the state the ability to take a variety of actions that may become necessary to stabilize the individual market, if and when federal changes are made to the ACA.
Specifically, the law authorizes the Department of Consumer and Business Services (DCBS) to promulgate rules (valid for up to six months) that aren’t in compliance with Oregon Insurance Code, if the federal government were to make changes that the Oregon DCBS believes “will cause imminent destabilization of insurance market and risk life or health of state residents.”
(As noted above, the ACA is no longer in any imminent danger at the federal level.)
HealthCare.gov debuted optional “Simple Choice” standardized plans for 2017, although HHS stopped designing or highlighting standardized plans as of the 2019 plan year (but plans to bring them back as of 2023). But some of the state-run exchanges — including Oregon’s — had implemented standardized health plans in previous years.
In 2013, the Commonwealth Fund reported that Cover Oregon (a fully state-run exchange at that point) was allowing health insurers to offer, at each metal level, one standardized plan, two non-standardized plans, and two “innovative” plan designs.
Oregon’s state-run exchange now uses the HealthCare.gov enrollment platform, but the state still oversees the design of the standardized plan options. Coverage provided by Gold, Silver, and Bronze standardized plans in Oregon in 2022 is detailed here.
As noted above, Oregon S.B.250, enacted in 2019, allows state regulators to require more than one standardized plan at the bronze and silver level, in order to ensure access to coverage and the availability of HSA-qualified plans.
Transitional (grandmothered) plans that were purchased after the ACA was signed into law but before the end of 2013 were allowed to remain in force (at carrier discretion) in Oregon until the end of 2015. That means anyone in Oregon who still had a non-ACA-compliant, non-grandfathered plan, had to select new coverage for 2016.
Oregon is one of two states – the other is Colorado – where grandmothered plans were allowed to remain in force in 2015, but had to be replaced by ACA-compliant coverage for 2016.
The Oregon legislature authorized a state-run health insurance exchange in 2011, and the exchange developed a formal business plan, which the Legislature approved in February 2012 as a final go-ahead for the exchange. The U.S. Department of Health and Human Services (HHS) gave conditional approval to Cover Oregon in December 2012. The exchange had a 2014 budget of $105.7 million, which was covered with federal grant money, and $62.4 million budget in 2015 according to a Cover Oregon spokesperson.
Before its dissolution, Cover Oregon acted as an “active purchaser,” meaning it actively negotiated with insurers in terms of the plans that were offered in the exchange. Participating insurers were required to offer a bronze, silver, and gold plan and had the option to offer additional plans.
The Oregon Medical Insurance Pool – a state-run high-risk pool – closed at the end of December 2013, but the state implemented a temporary medical insurance program that automatically covered risk pool members who were not able to enroll in an exchange plan with a January 1 effective date. The temporary plan remained in force until March 31, 2014 but ceased operation at that point.
The FBI and federal prosecutors launched investigations into the failed exchange – which cost $300 million in tax dollars and was never able to enroll applicants entirely online. In early June 2014, Governor John Kitzhaber asked Oregon Attorney General Ellen Rosenblum to take legal action against Oracle – the creator of the Cover Oregon website – in order to recover funds spent on the site. But Oracle fought back, saying that officials at Cover Oregon and Oregon Health Authority were to blame for the debacle. Both sides sued each other, and the issue was highly contentious.
On February 18, 2014 four and a half months after open enrollment began, Cover Oregon’s website was finally functional enough for insurance agents and navigators to be able to process enrollments start to finish online. Although the site was never fully functional for the general public to complete the entire enrollment process online, the availability of some electronic enrollment was a huge improvement after months of relying solely on paper applications.
Despite the fact that Cover Oregon was the only exchange relying solely on paper applications for the first four months of open enrollment, its total enrollment numbers for 2014 were around the middle of the road when compared with enrollment in other states – all of which were using much more efficient online applications for months.
Healthcare.gov (call center: 1-800-318-2596)
Oregon Health Plan (Oregon Medicaid)
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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