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Short-term health insurance in Oregon

Oregon law limits short-term plans to three months, including renewal

Short-term health plans in Oregon

 Oregon’s short-term health insurance regulations

The Trump Administration’s regulations that took effect in 2018, which allow for longer short-term healthcare plans, do not apply in Oregon. The federal rules are clear in noting that a state can impose stricter guidelines, and the Oregon Department of Financial Regulation has published guidance relating to short-term health insurance, clarifying that the state’s rules remain in force.

Short-term plans duration 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(16)(b)(H).]

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.

Which insurers offer short-term plans in Oregon?

As of 2020, at least three insurers offer short-term health insurance plans in Oregon:

  • Companion Life
  • Everest Reinsurance
  • LifeMap
  • National General

The availability of short-term health insurance options has decreased in Oregon over the last couple of years, with fewer insurers offering plans as of mid-late 2020 than there were in early 2021.

Other insurers, such as United Healthcare (Golden Rule), offer other types of non-ACA-compliant healthcare coverage in Oregon, such as fixed indemnity plans. Some people use fixed indemnity plans as a supplement to ACA-compliant coverage with higher deductibles, or to supplement other types of non-ACA-compliant coverage such as health care sharing ministry plans and direct primary care plans.

Who can get short-term health insurance in Oregon

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 of insurers. This usually means being under 65 years old and in fairly good health.

Short-term health medical insurance plans typically include blanket exclusions for pre-existing conditions, so these types of plans are not adequate for someone in the Beaver State who needs medical care for ongoing or pre-existing conditions. And since short term medical plans do not have to cover the ACA’s essential health benefits, they often have significant benefit limitations and gaps in the coverage they provide. The most commonly excluded benefits are maternity care, mental health/substance abuse treatment, and prescription drugs. 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, 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’re in need of health insurance coverage in Oregon, first check if you’re eligible for a special enrollment period that would allow you to enroll in an ACA-compliant individual major medical plan through Oregon’s marketplace (Obamacare). There are multiple qualifying life events that 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 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.

When should I consider short-term health insurance in Oregon?

From Eugene to Pendleton, there are times when a short-term health coverage might be the only realistic option, such as if:

  • You missed open enrollment for individual ACA-compliant coverage and do not have a qualifying event that would trigger a special enrollment period.
  • You’ll soon be enrolling in Medicare, the open enrollment window for ACA-compliant plans has closed for the year, and you don’t have access to any other type of coverage.
  • You’re newly employed and your employer will provide health coverage, but you’re in a waiting period that can last up to three months.
  • You’re not eligible for Medicaid or a premium subsidy for an ACA-compliant plan in the exchange. People ineligible for premium subsidies include:
    • Oregonians who earn more than 400% of the poverty level. (For 2021 coverage, that is $51,040 for a single person. If your ACA-specific modified adjusted gross income peaks just a little above the subsidy-eligible threshold, there are steps you can take to reduce it).
    • People caught by the ACA’s family glitch.
    • People who can’t enroll in a plan through the exchang/marketplace because of their immigration status (a valid lawfully present immigration status is required in order to enroll in a plan through the exchange, and premium subsidies are only available if you get your plan through the exchange).

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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