Oregon Health Insurance Consumer Guide

You can buy a health plan through the Oregon exchange if:⁶

• You reside in Oregon.
• You are a U.S. citizen or national.
• You are not incarcerated.
• You are not already enrolled in Medicare.

To qualify for financial assistance (premium subsidies and cost-sharing reductions), you must meet additional requirements: 

• Your eligibility for premium subsidies depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area. The cost of that Silver plan varies based on your age and location. 
• You must not have access to affordable health coverage offered by an employer. If your employer offers health insurance, but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace. 
• You must not be eligible for Medicaid or CHIP.
• You must not be eligible for premium-free Medicare Part A.⁷
• No one else can be able to claim you as a tax dependent.⁸
• If you’re married, you must file a joint tax return with your spouse.⁹ (with very limited exceptions)¹⁰

In Oregon, open enrollment for ACA Marketplace/exchange individual and family health coverage runs from November 1 through January 15. 

OHP Bridge enrollment and Medicaid enrollment are both open year-round.

Enrolling in an exchange plan or changing your coverage outside of the open enrollment period is possible if you meet the criteria for a Special Enrollment Period (SEP).¹¹ This typically means you must have a qualifying life event, such as losing your health insurance, getting married, or having a baby, although some SEPs aren’t dependent on a specific qualifying life event. For example:

• Your income falls at or below 150% of the poverty level, and you’re eligible for premium tax credits. In this scenario, you can enroll anytime. However, Oregon will no longer be using the HealthCare.gov enrollment platform after 2026. This means the state will have some flexibility to set its own SEP rules,¹² and will be able to decide whether to continue to offer this SEP.
• Native Americans can enroll or switch plans year-round (this SEP is available nationwide, regardless of whether a state uses HealthCare.gov or runs its own exchange platform).

For people who lose Oregon Health Plan (Medicaid or CHIP) coverage between March 31, 2023, and November 30, 2024, there’s an extended SEP available for enrollment.¹³

Oregon also received federal approval to not disenroll people from Medicaid if their income wasn’t more than 200% of the poverty level (the normal limit is 138%), while the state waited to implement a Basic Health Program (OHP Bridge) that became operational as of July 2024.¹⁴ So some people were able to remain on Medicaid in Oregon during the “unwinding” process even though they would have been disenrolled in most other states. And as of July 2024, these individuals transitioned to OHP Bridge coverage.

Here are the main ways to enroll in a Marketplace health plan in Oregon:

• Online: You can visit OregonHealthCare.gov to learn more about health insurance plans and eligibility.¹⁵ When it’s time to apply and enroll, you’ll be redirected to the federal Marketplace website, HealthCare.gov. (Oregon’s new state-run Marketplace platform is expected to debut in the fall of 2026.)
• By Phone: Dial 1-800-318-2596 (TTY: 1-855-889-4325) to enroll with a Marketplace representative. The call center is available 24 hours a day, seven days a week, but it’s closed on holidays.
  
• In-person: Enrollment assistance is also available from trained Navigators and assisters who can answer your questions. Go to localhelp.HealthCare.gov or OregonHealthCare.gov/GetHelp to find local help in your area.¹⁶

Assistance is available from local Navigators and brokers. Enrollments can also be completed via an approved enhanced direct enrollment (EDE) entity, using the EDE’s website.¹⁷

Oregon’s ACA Marketplace (HealthCare.gov) is a one-stop shop where individuals and families can find affordable health insurance coverage in Oregon. There are two types of financial assistance available through the Marketplace:

• Premium subsidies: You may qualify for income-based subsidies known as Advance Premium Tax Credits (APTC) that help lower your monthly premiums through the ACA Marketplace. About eight out of 10 Oregon exchange enrollees qualified for premium subsidies in 2024, saving around $524 monthly. People who receive these subsidies pay an average monthly premium of $164 in 20243.¹⁸

Source: CMS.gov¹⁹

• Cost-sharing reductions: You may be eligible for cost-sharing reductions (CSR) if your income is no more than 250% of the federal poverty level,²⁰ and you enroll in a Silver-level plan through the Oregon Marketplace. CSRs help lower your out-of-pocket costs, making coverage more affordable.²¹

Oregon implemented a reinsurance program starting in 2018, using a 1332 waiver that allows the state to capture federal savings generated by the program.²² Reinsurance is designed to keep unsubsidized (full-price) premiums lower than they would otherwise be. Although most enrollees do qualify for premium subsidies, the reinsurance program helps to minimize premiums for those who don’t.

Oregon also requires all state-regulated health plans, including Marketplace plans, to cover both female and male contraception (including vasectomies), as well as abortion, all without out-of-pocket costs.²³

Medicaid: Oregon residents may qualify for Medicaid coverage if eligible based on income. Medicaid in Oregon is called Oregon Health Plan, and has no monthly premiums.²⁴

Basic Health Program: Oregon has created a Basic Health Program — OHP Bridge —that became operational in July 2024.² Federal approval for OHP Bridge was granted in June 2024.²⁵

Coverage under OHP Bridge is available to Oregon adults (under age 65) with income above 138% of the poverty level but not above 200% of the poverty level.¹⁴ (Children at this income level were already eligible for OHP coverage, so OHP Bridge does not need to cover children.)

Short-term health insurance: If you’re not eligible for subsidies, Medicare, or Medicaid, short-term health insurance, available in Oregon with terms of up to three months, might be an affordable temporary solution.

Six insurers offer plans through Oregon’s exchange²⁶

All six will continue to offer coverage in 2025. And five of them will offer plans statewide in 2025,¹ up from four that do so in 2024.²⁷

The following average rate changes have been approved for 2025 for Oregon’s individual/family market health insurers, amounting to an overall average proposed rate increase of 8.3%. The overall average increase was slightly lower than insurers had initially proposed.¹

Source: Oregon Division of Financial Regulation¹

Average approved rate changes apply to full-price premiums. However, about 81% of Oregonians who enrolled in ACA plans received subsidies in 2024 – which means they did not pay the full rate.²⁸

In addition, subsidy amounts are adjusted each year based on the cost of the second-lowest-priced Silver plan. So, as coverage costs increase, subsidies may also grow to offset part of the change.

If your plan’s rates are increasing next year, consider exploring other options on the ACA Marketplace. You may find a more affordable plan that still meets your coverage needs.

For perspective, here’s a summary of how average full-price (unsubsidized) premiums have changed in Oregon’s individual market over the years:

• 2015: Average decrease of 5%.²⁹
• 2016: Average increase of 24.2%.³⁰
• 2017: Average increase of 26.5%.³¹
• 2018: Average increase of 15.7%.³² (reinsurance took effect;²² Federal CSR funding eliminated³³)
• 2019: Average increase of 7.3%³⁴
• 2020: Average increase of 1.5%.³⁵
• 2021: Average increase of 2.1%.³⁶
• 2022: Average increase of 1.5%.³⁷
• 2023: Average increase of 6.7%.³⁸
• 2024: Average increase of 6.2%.³⁹

During the 2024 open enrollment period, 145,509 people signed up for individual/family health coverage through the Oregon Marketplace/exchange.¹⁸

Although nationwide Marketplace enrollment has grown to significant record highs in recent years, Oregon’s enrollment has hovered around the same level for many years. 

Source: 2014,⁴⁰ 2015,⁴¹ 2016,⁴² 2017,⁴³ 2018,⁴⁴ 2019,⁴⁵ 2020,⁴⁶ 2021,⁴⁷ 2022,⁴⁸ 2023,⁴⁹ 2024⁵⁰

OregonHealthCare.gov
A state-run service that connects Oregon residents with health coverage options.

HealthCare.gov
The Marketplace for individuals and families buying their own health coverage; premium subsidies and cost-sharing reductions are available for eligible enrollees who use the Marketplace.

Oregon Division of Financial Regulation
Licenses and regulates health insurance companies in Oregon, as well as agents and brokers. Can address consumer questions and complaints about regulated entities.

Medicare Rights Center
A nationwide resource that can answer questions about Medicare and provide information that beneficiaries need.

Oregon Senior Health Insurance Benefits Assistance
A local service that can provide assistance, information, and enrollment counseling to Medicare beneficiaries and their caregivers.