As the old saying goes, “health is wealth.” This is especially true when it comes to the health of your family. In Oregon, having family health insurance is crucial for providing financial protection against medical expenses, ensuring that your loved ones receive the medical care they need, and maintaining peace of mind. Thankfully, there are numerous resources available to help when you’re looking for family health insurance in Oregon.
Why is family health insurance important?
Medical expenses can add up quickly, especially if you or a loved one requires a significant medical procedure. Without health insurance, these costs can be devastating, both financially and emotionally. Having health insurance provides a safety net against these unforeseen expenses.
Additionally, family health insurance can help you and your loved ones stay healthy by providing access to preventive care, such as annual check-ups, vaccinations, and regular screenings. These preventive measures can help catch potential health issues early before they become more serious and expensive to treat.
Who is eligible for family health insurance in Oregon?
In Oregon, individuals and families can purchase health insurance through the state’s health insurance marketplace—the Oregon Health Insurance Marketplace. To be eligible, individuals must be residents of Oregon and be either U.S. citizens, U.S. nationals, or lawfully present immigrants.
Additionally, certain individuals and families may be eligible for financial assistance to help pay for their health insurance premiums. This assistance is based on income and family size and is available through the Marketplace, the state’s Medicaid program, or the Advanced Premium Tax Credit.
What programs are available to help afford family health insurance?
In Oregon, there are several programs available to help individuals and families afford health insurance. These include:
Medicaid
Medicaid is a state and federal program that provides free or low-cost health insurance to eligible individuals and families with low incomes. In Oregon, the program is called the Oregon Health Plan (OHP). The plan covers medical, dental, and mental health care.
Advanced Premium Tax Credit
The Advanced Premium Tax Credit (APTC) is a federal subsidy that helps eligible individuals and families afford health insurance purchased through the Oregon Health Insurance Marketplace. The APTC is based on income and family size and can be applied to monthly insurance premiums.
Cost-Sharing Reduction
Cost-sharing reduction (CSR) is a federal subsidy that helps eligible individuals and families with low incomes afford out-of-pocket costs, such as deductibles, co-payments, and coinsurance. These subsidies are only available to individuals and families who purchase a silver-level health insurance plan through the Oregon Health Insurance Marketplace.
Medical cost-sharing plans as a viable alternative
In addition to traditional health insurance, there is another option for families looking for coverage against unexpected medical expenses—medical cost-sharing plans. These plans are not insurance, but rather a way for folks to share medical costs with a group of like-minded individuals.
Under a medical cost-sharing plan, individuals pay a monthly share amount, which is then used to pay for eligible medical expenses for other members of the plan. These plans can be a more affordable option for individuals and families who don’t qualify for Medicaid or subsidies through the Oregon Health Insurance Marketplace.
What is annual open enrollment and when is it?
Each year, there is a specific period of time when individuals and families can enroll in health insurance or make changes to their existing coverage. This period is called annual open enrollment.
In Oregon, annual open enrollment for health insurance typically begins on November 1st and ends on January 15th. During this time, individuals and families can compare plans, change plans, and enroll in new coverage through the Oregon Health Insurance Marketplace.
You must have a qualifying life event to enroll in coverage outside of this annual window. The events that would make you eligible for this special enrollment period include:
- You may be able to enroll in a new plan, or make changes to your current health plan within 60 days of getting married.
- If you have a baby, adopt a child, or have a child placed in your home, you may be able to add them to your health plan within 60 days of their birth, adoption, or placement.
- Losing employer-sponsored coverage due to no longer being eligible, quitting, or being laid off could make you eligible to enroll in an individual plan through the Marketplace within 60 days of your coverage ending or 60 days after your coverage ended.
- Moving—to Oregon from out-of-state, across town, or to a new city—could make you eligible for a special enrollment.
- Getting divorced, separating from your spouse, or a death in the family could qualify you to enroll in a new health plan.
- Becoming a US citizen, US national, or a legal resident may trigger a 60-day special enrollment period.
- Being released from jail or prison can make you eligible for a special enrollment period and open a 60-day window where you can enroll in a health plan.
Why is a broker a valuable resource when looking for health insurance?
Navigating the complex world of health insurance can be overwhelming, especially for those who are new to the process. That’s where a local health insurance broker comes in.
A health insurance broker is a licensed professional who can help individuals and families navigate the health insurance marketplace and find the best coverage for their needs and budget. They can provide personalized advice, answer questions, and help individuals and families understand the options available to them. Additionally, brokers can help individuals and families complete the enrollment process and make changes to their coverage as needed.
Brokers are paid by insurance companies, which means that their services are typically free to individuals and families. This makes them an incredibly valuable resource for anyone who is looking for health insurance in Oregon.
Family health insurance is essential for financial protection against unexpected medical expenses, access to regular preventive care, and peace of mind. In Oregon, individuals and families can purchase health insurance through the state’s health insurance marketplace, and may be eligible for financial assistance to help pay for their premiums. Additionally, medical cost sharing plans can be a cost-effective, viable alternative for those who do not qualify for traditional health insurance or subsidies.