Availability of short-term health insurance in Oregon

Short-term health insurance in Oregon is limited to a duration of no more than three months, including renewal periods. (See ORS 743B.005(25)(a).)

The state statute (ORS 743B.005(16)(c)) also clarifies that “renewal” includes a scenario in which a person buys another short-term health plan from the same insurer within 60 days of the termination of a previous short-term health plan.

As long as a short-term plan doesn’t have a total duration of more than three months, and there’s at least a 60-day gap before the insurer issues an additional policy to the same person, the short-term plans are exempt from Oregon’s definition of “health benefit plan” and the associated state regulations.

In 2021, Oregon enacted HB2046. It requires short-term health plans to provide a disclosure to enrollees informing them, among other things, that the plan is not regulated by the ACA, and that when it expires the person may have to wait until the next annual open enrollment period for ACA-compliant plans to purchase health coverage.

The Oregon Division of Financial Regulation has a list of 11 questions that they advise people to ask before enrolling in a short-term health insurance plan. They provide specific information for each question to help consumers understand the limitations of short-term plans and the availability of other coverage options.

Short-term health insurance in Oregon can be purchased by residents who can meet the underwriting guidelines the insurers use.

In most cases, this means being under 65 years old and not having a medical condition that will result in a declined application.² But the specific underwriting rules are set by the insurance companies that offer short-term coverage.

Short-term health insurance plans typically exclude all pre-existing conditions, and they often use post-claims underwriting. This means that if a claim is filed, the insurer can go through the person’s medical records to make sure the claim isn’t related to a pre-existing medical condition.³.

Short-term health plans often exclude coverage for some of the ACA’s essential health benefits (most commonly, maternity care, prescription drugs, and mental health care),² and impose dollar limits on the coverage they do provide.

But short-term health plans can vary considerably from one plan to another, so it’s important to carefully understand what’s covered and what’s not covered before you purchase a policy; you don’t want to find out that a particular service is not covered after you need it.

If you need to purchase health insurance coverage in Oregon outside of the annual open enrollment period for individual-market coverage, first check to see if you’re eligible for a special enrollment period. If so, that would allow you to enroll in an ACA-compliant individual major medical plan through Oregon’s Marketplace (Obamacare). Multiple qualifying life events can trigger a special enrollment period and allow you to buy an ACA-compliant plan.

ACA-compliant healthcare plans are purchased on a month-to-month basis; you won’t have to enroll for the entire year. So you can purchase one (during open enrollment or a special enrollment period) even if you only need a few months of coverage before another policy takes effect. For example, if you’ll soon be eligible for Medicare or a plan offered by a new employer, you’ll be able to cancel the ACA-compliant plan when your new coverage takes effect.

And if your total annual household income makes you eligible for a premium tax credit (premium subsidy), you can get that benefit even if you only need the plan for a short while (note that your household income will be based on your income for the full year, and reconciled on your tax return using that amount, even if you only need coverage for a few months).

Depending on your household income, you may find that you’re eligible for Medicaid in Oregon, or for OHP Bridge, which is Oregon’s Basic Health Program.