Oregon health insurance marketplace guide 2023

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:

• BridgeSpan (statewide)
• Kaiser
• Moda
• PacificSource (statewide)
• Providence (statewide)
• Regence (statewide)

All six insurers have filed plans for 2024, with an average proposed rate increase of 6.2%, and the same four carriers continuing to offer coverage statewide.

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.

The six insurers that offer individual/family health insurance in Oregon have proposed an overall average rate increase of 6.2% for 2024. The following 2024 rate changes were proposed by each insurer, and will be reviewed by state regulators during the summer of 2023 (note that these rate changes are calculated before any subsidies are taken into account):

• BridgeSpan: 8.4% increase
• Kaiser: 7.9% increase
• Moda: 3.9% increase
• PacificSource: 3.5% increase
• Providence: 8.5% increase
• Regence: 4.7% increase

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 fifth 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:

• 2015: Average decrease of 2.5%. PricewaterhouseCooper LLC tracked 2015 rates throughout the fall of 2014, and comparing them with 2014 rates. In Oregon, the weighted average across all 13 carriers (on and off-exchange) was a rate decrease of 2.5 percent. And the Commonwealth Fund conducted an analysis of rates for a 40-year-old non-smoker, and found an average rate decrease of 5 percent in Oregon. But for the cheapest Silver plans from 2014, most areas of the state saw a rate hike of around 10 percent for 2015.
• 2016: Average increase of 24.2%. Carriers requested a weighted average rate increase of about 23 percent. But Oregon’s Insurance Commissioner determined that some of the rates filed – from Health Net (off-exchange), Kaiser, Health CO-OP, and Providence – were too low, and wouldn’t be adequate to meet projected claims costs. To mitigate the problem, the state needed to require higher rates than some of the carriers had proposed. On July 1, 2015, Oregon became the first state to release final rates for 2016, and Oregon regulators did indeed increase rates beyond what several carriers had requested. But they also ended up reducing the proposed rate hikes for two carriers – PacificSource and LifeWise. Ultimately, the weighted average rate increase in Oregon’s individual market came in at 24.24 percent for 2016.
• 2017: Average increase of 26.5%. Oregon regulators initially gave tentative approval for 2017 rate changes. But when four carriers (Atrio, BridgeSpan, Providence, and — off-exchange — Regence) later agreed to cover a broader service area than they had originally intended for 2017, state regulators also allowed them to further increase their premiums, due to the increased risk they would be shouldering. Final approved average rate increases for Oregon’s exchange carriers ranged from an average increase of 14.5 percent for Kaiser Permanente, to an average increase of 29.6 percent for Providence Health Plan, with an overall weighted average increase of 26.5 percent. Ethan Baldwin, an Oregon’s Department of Consumer and Business Services rate review analyst, noted that state regulators “do have the authority to reject rate increases, but that doesn’t happen. I can’t remember the last time that’s happened.”
• 2018: Average increase of 15.7%, plus an additional 7.1% increase on silver plans to account for the loss of CSR funding. There was considerable uncertainty and instability in the individual insurance markets nationwide, despite the market stabilization rule that CMS finalized in April 2017. There was ongoing uncertainty around funding for the ACA’s cost-sharing reductions (CSR), and insurers generally expected enforcement of the individual mandate to be less robust in 2018. The 2018 rates that were finalized in August 2017 were, in most cases, lower than the insurers had proposed. Oregon regulators noted in their final rate decision announcement that the state’s new reinsurance program shaved six percentage points off the average individual market rate increases for 2018, although it added 1.5 percentage points to the small group rate increases (the reinsurance program took effect in January 2018). For the five on-exchange insurers in Oregon, average approved rate changes for 2018 initially ranged from a 1.6% decrease for BridgeSpan to a 14.8% increase for Kaiser Foundation Health Plan of the Northwest. Those average rates increases, however, were approved before the Trump Administration eliminated funding for cost-sharing reductions (CSR) in October 2017. When that happened, the Oregon Division of Financial Regulation ordered individual market insurers to increase premiums for their Silver-level plans by an additional 7.1%, on top of the rate changes that had already been approved for 2018. Notably, this increase applied both on and off the exchange, including Silver plans offered only off-exchange by Regence and Health Net. This chart shows the impact of the additional premium increase on Silver plans.
• 2019: Average increase of 7.3%. In addition to normal health care inflation, most of the carriers cited the elimination of the mandate penalty and the fact that the exchange fee increased from 2% of premiums to 3% of premiums as factors driving the rates higher for 2019 (as described above, Oregon has its own exchange, but uses the HealthCare.gov enrollment platform; the fee for using the enrollment platform was 1.5% of premiums in 2017, increased to 2% in 2018, and increased to 3% in 2019, although it dropped to 2.5% for 2020). The cost of cost-sharing reductions (CSR) continued to be added to Silver plan rates in 2019, just as it was in 2018. In July 2018, the Oregon Division of Financial Regulation finalized the approved rate changes. At ACA Signups, Charles Gaba calculated a weighted average rate increase of 7.3% in Oregon’s individual market for 2019, but noted that it would have been significantly smaller if the individual mandate penalty hadn’t been eliminated at the end of 2018.
   
• 2020: Average increase of 1.5%. In July 2019, the Oregon Division of Financial Regulation published the approved rate changes for 2020 health plans in the individual and small group markets. They also published a list of counties where each insurer is offering plans for 2020, including service area expansion by BridgeSpan and PacificSource in the exchange, and Regence outside the exchange. Average premiums in the individual market increased by 1.5% in 2020 (down from the 3.3% average increase that insurers had initially proposed). Regence (5.5% average rate increase) and Health Net (8.9% average rate increase) continued to offer plans only outside the exchange for 2020. Their rate increases were among the most significant in the state’s market (on a percentage basis), leaving the on-exchange insurers with a slightly smaller overall weighted average increase.
• 2021: Average rate increase of 2.1%. Six insurers offered coverage in Oregon’s exchange for 2021, up from five in 2020 (Regence joined the exchange as of 2021). And three of them — BridgeSpan, Providence, and Regence – offered coverage state-wide. The average rate changes for Oregon’s exchange in 2021 varied from a 3.5% decrease to an 11% increase.
• 2022: Average rate increase of 1.5%. For the state’s individual market insurers, the weighted average rate change for 2022 was a 1.5% increase. 

• 2023: Average rate increase of 6.7%. Across Oregon’s individual market insurers, the weighted average rate change for 2023 was a 6.7% increase.

141,963 people enrolled in coverage through Oregon’s exchange during the open enrollment period for 2023 coverage. This was a little lower than the year before, despite the fact that nationwide exchange enrollment hit a record high in 2023. 

Here’s a look at enrollment numbers over the years in Oregon’s exchange:

• 2014: 68,308 people enrolled. Oregon’s exchange platform did not function well at all during the first open enrollment period, which resulted in much lower than expected enrollment.
• 2015: 112,024 people enrolled. All of them had to re-enroll, even if they had exchange coverage in 2014, because Oregon transitioned from using the Cover Oregon platform to HealthCare.gov.
• 2016: 147,109 people enrolled.
• 2017: 155,430 people enrolled.
• 2018: 156,105 people enrolled.
• 2019: 148,180 people enrolled
• 2020: 145,264 people enrolled
• 2021: 141,089 people enrolled (the exchange noted that enrollment was down due to migration to Medicaid during the pandemic, and the federal rule that prevents states from transitioning people off Medicaid during the pandemic, unless the member requests it or moves out of state)
• 2022: 146,602 people enrolled (nationwide, enrollment hit a record high in 2022, thanks to the American Rescue Plan’s subsidy enhancements that made coverage more affordable than it had been in previous years) 
• 2023: 141,963 people enrolled (nationwide there was another record high enrollment in 2023, but enrollment in Oregon declined slightly from 2022 to 2023)