Frequently asked questions about health insurance
coverage options in Oregon
Oregon has a state-run health insurance marketplace (exchange) that uses the HealthCare.gov enrollment platform. The Cover Oregon website – which was used in late 2013 and 2014 as the state’s health insurance exchange platform – is no longer operational.
Consumers can use OregonHealthcare.gov to learn about the state’s health insurance marketplace health insurance plans and eligibility; when they are ready to apply and enroll, they are taken to the federal marketplace website at HealthCare.gov.
The marketplace is used by individuals and families who buy their own health insurance coverage. This includes people who retired (and lost their employer-sponsored coverage) prior to age 65, people who are self-employed, and people who are employed in a small business that doesn’t offer health benefits to workers.
Enrolling through the marketplace (HealthCare.gov) is the only way that Oregon residents can obtain income-based premium subsidies and cost-sharing reductions, which serve to reduce monthly premium costs and out-of-pocket costs for eligible enrollees.
Open enrollment in Oregon for 2021 health insurance plans ended on December 15, 2020. Outside of open enrollment, residents normally need a qualifying event in order to enroll or make changes to their coverage, but a one-time COVID-related enrollment window has been opened in early 2021, continuing through August 15, 2021.
During this window, people can newly enroll in a plan through HealthCare.gov, or make a plan change if they’re already enrolled. This window is a good opportunity for Oregon residents to enroll or make a plan change in order to best take advantage of the enhanced premium tax credits provided by the American Rescue Plan.
After August 15, a qualifying event will again be necessary in order to enroll or make a plan change outside of the annual open enrollment period in the fall.
The fall open enrollment period, which begins each year on November 1, is an opportunity for enrollees to change or renew their coverage for the coming year, and to update the financial information that the exchange has on file. It’s also an opportunity for people to newly enroll in individual market coverage.
The open enrollment period applies both on-exchange and off-exchange (ie, even outside the exchange, open enrollment is the only time that a person can sign up for individual market health insurance without a qualifying event).
Enrollment in private health insurance plans for 2021 through Oregon’s health insurance marketplace reached 141,089 people during the open enrollment period that ran through December 15, 2020. That was the third year in a row with declining enrollment.
But enrollment in Medicaid has increased significantly during the COVID pandemic, as people transitioned away from private health insurance (both employer-sponsored coverage and individual/family coverage) and gained coverage under Medicaid instead, due to loss of jobs and income.
And enrollment in private plans through the marketplace is growing in 2021 due to the COVID/American Rescue Plan enrollment window, which is allowing people to sign up for coverage even if they don’t have a qualifying life event. During the first several weeks of this window, nearly 5,500 Oregon residents enrolled in coverage.
For 2022, the state’s six individual market insurers have proposed an average rate increase of 1.8%. And PacificSource, which currently offers plans in 13 of the state’s 36 counties, will expand to offer coverage statewide. Three insurers already offer marketplace plans statewide, and four of the six will do so in 2022.
Rate changes for 2021 varied from an average decrease of 3.5% to an increase of 11.1%. The overall average was an increase of 2.1%.
As is always the case, rate changes apply to full-price premiums; rate changes for people who receive premium subsidies can be quite different, depending on fluctuations in the price of the benchmark plan in each area.
Six insurers are offering coverage for 2021 through the Oregon health insurance marketplace, including Regence, which previously only offered plans outside the marketplace.
For 2021 individual market coverage, policies are available in Oregon’s marketplace from BridgeSpan, Moda, PacificSource, Regence, Providence, and Kaiser.
Oregon started with two CO-OPs under the ACA but currently has no CO-OPs following the July 2016 closure of Oregon Health CO-OP and the 2015 closure of Health Republic Insurance.
In 2013, about 14.7% of Oregon residents did not have medical insurance – a little higher than the national average.
Despite the troubles Oregon’s health insurance marketplace experienced before switching to the HealthCare.gov enrollment platform, the state’s supportive approach to the ACA, including expanding Medicaid, resulted in a significant decrease in the percentage of residents who have no health insurance coverage. By 2018, the uninsured rate stood at 7.1% — less than half of what it had been pre-ACA. It climbed slightly, to 7.2%, as of 2019.
As of early 2021, there were more than 141,000 Oregon residents with coverage obtained through the Oregon health insurance marketplace, all of whom had coverage for the ACA’s essential health benefits. About 70% of them were also receiving subsidies that reduce their monthly premium costs, and that was before the American Rescue Plan made subsidies larger and more widely available.
In 2010, both of Oregon’s U.S. Senators – Jeff Merkley and Ron Wyden – voted yes on the Affordable Care Act. In the U.S. House, four of the five Oregon Representatives were Democrats and voted in favor of the law; Greg Walden, a Republican, cast the only no vote, and is still the only Republican in Oregon’s congressional delegation.
Under the leadership of former Gov. John Kitzhaber, a former physician who made healthcare and healthcare reform priorities throughout his years in public service, Oregon opted to expand Medicaid and run its own exchange, known as Cover Oregon.
Medicaid expansion was a success in Oregon, but unfortunately, the state’s initial exchange rollout did not go well. The online enrollment system was inoperable for months, and the exchange had to process thousands of paper applications.
In late April 2014, the Oregon health insurance marketplace board voted to use HealthCare.gov instead of continuing to try to fix the broken website, and Oregon residents started using HealthCare.gov during 2015 open enrollment. They have continued to do so ever since, although the state is considering the possibility of eventually switching back to a state-run exchange platform.
Utilizing federal funds to expand Medicaid coverage eligibility to 138 percent of the poverty level has played a significant role reducing the uninsured rate in Oregon.
Oregon has seen some of the nation’s most dramatic jumps in Medicaid plan enrollment under the ACA. From 2013 to November 2020, the average monthly enrollment in Oregon Medicaid plans grew 79% – the sixth-highest increase of all states. As of November 2020, there were more than 1.1 million Oregonians covered by Medicaid/CHIP.
Oregon’s “Cover All Kids” law took effect in January 2018, ensuring that all children under age 19 with household income up to 305 percent of the poverty level have access to Oregon Health Plan coverage, regardless of immigration status.
Read more about Medicaid eligibility expansion in Oregon.
New federal regulations expanded access to short-term health insurance coverage and association health insurance plans in 2018, but the effects of those regulations were muted in Oregon. Oregon limits short-term health insurance plans to three months in duration, so the federal rules do not apply.
Read more about short-term health insurance coverage in Oregon.
As of December 2020, there were 891,826 Oregon residents enrolled in Medicare plans. Most are eligible due to their age, but 13% are under the age of 65 and eligible for Medicare due to a long-term disability, ALS, or end-stage renal disease.
Read more about Medicare enrollment in Oregon.
Oregon has significant protections for Medigap enrollees, including an annual “birthday rule” enrollment period, during which a Medigap enrollee can switch to any Medigap plan with equal or lesser benefits, without medical underwriting. The state also guarantees access to Medigap plans for Medicare enrollees who are under age 65 (federal law only guarantees access when enrollees are 65).
- 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.
Gov. Brown signed OR SB1 into law March 6, 2015, which resulted in the dissolution of Cover Oregon and its board of directors. The remaining responsibilities were transferred to the Oregon Department of Consumer and Business Services. Though the act was effective immediately, the full transfer was not complete until June 2015.
Oregon HB2342 was signed into law in August 2017, granting the state the authority to take a variety of actions to stabilize the individual market, if and when federal changes are made to the ACA.
SB558 was also signed into law by Gov. Brown in August 2017, ensuring access to Oregon Health Plan (Medicaid) coverage for all children with household income up to 305 percent of the poverty level, regardless of immigration status.
SB250, enacted in 2019, codifies various ACA consumer protections into state law.
Before the ACA was implemented, individual health insurance was medically underwritten in Oregon, as it was in nearly all states. Because medical history was a factor in eligibility for coverage, people with serious pre-existing conditions were often unable to purchase a policy in the private market, or if they received an offer of coverage, it often included a substantial rate increase or a pre-existing condition exclusion rider.
In order to address this issue, the state created the Oregon Medical Insurance Pool (OMIP) in 1990 to provide an alternative for people who were unable to get private individual health insurance.
Now that medical underwriting is no longer used in the individual market – thanks to the ACA – there is no longer a need for state-run high-risk pools. Oregon had intended to shutter OMIP at the end of 2013, but the technical problems with the exchange made it difficult for OMIP members to transition to a new plan. So Oregon created a temporary pool that provided coverage for OMIP members for the first three months of 2014. That coverage ended on March 31, 2014.