By Lynne Terry/Oregon Capital Chronicle
The tens of thousands of Oregonians who buy their own health insurance can now start shopping for the best plan for next year.
Open enrollment on the federal online marketplace, which Oregon will continue to use for the next few years, runs this year from Nov. 1 through Jan. 16. Those who enroll by Dec. 15 will be covered starting Jan. 1, and those who sign up after that will be covered starting Feb. 1.
Premiums will increase 6% next year on average but individuals can obtain subsidies through the marketplace to reduce costs. The subsidies come in the form of tax credits that can be used throughout the year or at tax time. In the past, around 70% of those who applied obtained financial help. That jumped to 80% last year, according to Amy Coven at the Oregon Health Authority, which oversees health insurance enrollment.
“Premiums can start as low as a dollar, sometimes even less with the financial help, and they go up from there,” Coven said.
The average tax credit last year was around $500 per person a month, Coven said. That translated to an out-of-pocket premium cost per person of about $225.
Subsidies are based on the marketplace’s silver, or mid-range plans, and there’s no upper income limit to qualify for financial help. Individuals can also sign up for a bronze plan, which has the least expensive premium but costs more out-of-pocket for services, or gold plans, which have the highest premiums but lowest out-of-pocket costs.
All plans include 10 essential benefits, which include emergency care and hospitalization, prescriptions, mental health and addiction services, lab services and maternity and pediatric care. The plans also include free preventive care, which is mandated by the Affordable Care Act. All Oregon plans also offer coverage for abortions, acupuncture and chiropractic care and the first three primary care or mental health care visits cost $5 even before the deductible kicks in.
“The coverage is very robust,” Coven said.
The state offers catastrophic coverage, which is designed to cover unexpected medical costs. These plans are available to Oregonians younger than 30 or people who qualify for a hardship or affordability exemption. The marketplace shows those who are eligible for a catastrophic plan the available choices.
Enrollment on the marketplace increased in recent year, hitting nearly 147,000 in 2022 and nearly 142,000 last year. Coven expects 2024 enrollment figures to increase over this year’s as a result of the thousands of people who are being bumped off Medicaid because they no longer qualify. Since April, state officials have been auditing the nearly 1.5 million Oregonians on Medicaid to see whether they still meet the income and other qualifications as part of the end of extra Medicaid benefits during the pandemic.
Although a majority of people on Medicaid have retained coverage, the health authority’s dashboard shows that more than 62,000 have lost the free medical and dental coverage.
“We’re doing everything we can to make sure that folks understand what other coverage options are available and provide direct assistance for enrollment,” Coven said.
She said officials have sent out 50,000 letters to those who’ve lost Medicaid coverage. It’s not yet clear how many will remain insured by buying health insurance. The state increased the percentage of those who have health insurance during the pandemic thanks to federal and state programs. The state’s insured rate stands at 96%, though that could fall if a lot of people who lose Medicaid do not buy coverage.
This story first appeared in the Oregon Capital Chronicle.
