Frequently asked questions about
short-term health insurance in Oregon
Yes. As of 2021, there were at least four insurers offering short-term health insurance in Oregon.
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 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 (November 1 to January 15) to purchase health coverage.
- Companion Life
- Everest Reinsurance
- National General
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 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 (November 1 to January 15), 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). 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 (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).
The American Rescue Plan has made premium subsidies larger and more widely available, so it’s worth checking your options in Oregon’s marketplace if you haven’t done so recently.
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 too much to qualify for a subsidy. This is much less common than it was prior to the American Rescue Plan. And the Build Back Better Act might extend these subsidy enhancements through 2025.
- People caught by the ACA’s family glitch.
- People who can’t enroll in a plan through the exchange/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).
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.