Oregon Health Insurance: 2023 Coverage Guide

Oregon Affordable Healthcare Insurance

There are several choices of health insurance plans in Oregon and it’s important that you compare rates carefully. If you’re buying health coverage as an individual or as a family, you can get the coverage you need at the best prices by comparing your options with SmartFinancial. It’s important to remember to enroll in a health plan during open enrollment, unless you are eligible for the Special Enrollment Period due to a qualifying event. Otherwise, you may have to wait another year to buy health insurance.

When Is Open Enrollment in Oregon?

November 1, 2022 – January 15, 2023

How to Get Health Insurance in Oregon

While it may be tempting to buy the cheapest health plan available, it may not be the most economical, depending on how often you see your health care providers. This is why it’s always important to look at the previous year to determine what your costs will be the following year.

The easiest way to get the most competitive rates for the coverage you need is to compare health insurance companies and health insurance quotes with SmartFinancial. After you submit a brief form you’ll get several competing health insurance rates to choose from. We’ll even connect you with an agent in your area so you can buy the coverage or ask questions about the plan you’re considering.

What Types of Health Insurance Are Available in Oregon?

You’ll have options about how you want your health care managed. You can choose from these most common forms of health insurance: HMOs, EPOs, PPOs and POS plans are available in Oregon. You can also choose which level of coverage you want based on a tier system that ranges from platinum and gold to silver and bronze. Platinum plans cost more in premiums but cover about 90% of expenses whereas bronze plans typically cover about 60%.

Does Health Insurance Cover Pre-existing Conditions?

The Affordable Care Act made it illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

• Lost or quit a job. You may have lost a job, changed jobs or even started your own business. If you lost a job and with it your health insurance, you qualify for the special enrollment period. If you changed jobs and are not offered health insurance, you qualify to buy health insurance after the enrollment period.
• Turned 26. If you were on your parents’ health insurance plan but turned 26 after the enrollment period, you can enroll in an individual health plan.
• Moved to another state or out of an HMO coverage area. You may have had a health plan that was only valid in one state but you moved to another state after the enrollment period. You can sign up for a new health plan.
• Cobra coverage ended. If you extended your healthcare with Cobra and reached the deadline, you can enroll in a new health plan.
• Divorce. If you were married and shared a health plan coverage with your spouse but divorced, you still have time to enroll in a new health plan.
• Marriage. If you recently married, you may be able to get added onto your spouse’s policy or start an entirely new one together.
• Birth or adoption of a child. If your baby was born or brought home after the open enrollment date, you can still buy health insurance for that child.
• Death of spouse or partner. If you were covered under your spouse or partner’s health plan but that person passed away, you can take advantage of the special qualifying events exception to enroll in an individual plan.
• Spouse of partner loses coverage. If you previously had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in Oregon?

No, the only states in which there is a tax penalty for not having health insurance are California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in Oregon?

The average cost of health insurance in Oregon for a 40 year old is about $441 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in Oregon

The best way to save on health insurance in Oregon is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.

Medicare in Oregon

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Oregon?

20% of all Oregonians are on Medicare.

How Much Is Medicare in Oregon?

If you do not qualify for Medicare, you can buy it for $499 a month for Part A in 2022 and a standard monthly premium for Medicare Part B was $177.10, or even higher depending on income.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2022, it was $7,550 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Oregon

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Oregon?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

Oregon State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Oregon Health System are listed below:

• Oregon: Overall Ranking: 23 of 51
• Oregon: Overall Performance: Below U.S. Average
• Oregon: Access and Affordability: 27
• Oregon: Prevention and Treatment: 40
• Oregon: Avoidable Hospital Use and Cost: 2
• Oregon: Healthy Lives: 20
• Oregon: Health Care Disparities: 41

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Oregon Health Insurance Coverage

The people of Oregon have different kinds of health insurance while some Oregon residents are not insured at all. See the breakdown below:

• Private coverage: 49%
• Medicaid: 23%
• Medicare: 20%
• Uninsured: 8%

Report: America's Health Insurance Plans

Oregon Health Insurance Companies

• BridgeSpan Health Company
• Moda Health Plan, Inc.
• PacificSource Health Plans
• Providence Health Plan
• Kaiser Foundation Health Plan of the NW
• Regence BlueCross BlueShield of Oregon