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Oregon Obamacare Insurance

Oregon Obamacare and Affordable Care Act Health Insurance

Oregon Health Insurance Agent Portland Benefits Group

Obamacare is confusing and if you choose the wrong plan you could be overspending on your health insurance by thousands of dollars per year. We can help you understand all of your options under the new law, and assist you with the application process. 

David Taxer Licensed Agent NPN# 16520021 Will Answer Your Questions. Health and Life Licenses held for OR, WA, CA, AZ, TX, MI, OH, PA, VA, NC, and SC. 

503-828-1970

dtaxer@portlandbenefitsgroup.com

As a Licensed Agent certified with the Cover Oregon and the other health exchanges I can explain how  the ACA works and let you know if Tax Credits and Reduced premiums are available, and what Health Insurance will cost for you from the health exchange and on the private market circumventing the exchange. Buying off-exchange means you won’t get cost assistance, however you will have better networks and more plan varieties to choose from. 

All Information Submited on this website is Private and NOT Sold to Hundreds of Insurance Agents LIKE OTHER SITES. 

What is Oregon’s ObamaCare Health Insurance Exchange Marketplace?

Cover Oregon, Oregon’s ObamaCare Health Insurance Exchange Marketplace opened Oct 1st, 2013 with limited success. Despite having seemed fairly prepared and having ran a reasonably effective series of trainings and line of communication with health insurance agents like myself, the website in order to do business has been an absolute disaster, both on the client side and agent side and probably internally for those folks answering the phone at Cover Oregon. 

The system generally was presented to us agents as being similar to the software we ‘ve all been using for years, that quotes every single plan in a zip code and saves clients basic data so we can run quotes for a family at a moment’s notice. And from the limited working access I’ve had of the Cover Oregon agent system I can see that the buttons are all there for me to do just that. They just don’t function quite yet.

In the meantime, I can run quotes with Cover Oregon, review the plans, and assess your tax credit for you. The tax credit is applied directly to your monthly premium by Cover Oregon for you and is based on your MAGI, or Modified Adjusted Gross Income. If you over estimate your MAGI the difference is given back to you at the end of the year as a refund. If you under-report your income below what was on record, then the difference is applied to your taxes.

Many types of non-taxable income are still included in MAGI (Modified Adjusted Gross Income), such as child support and social security. An agent like myself can assist you with determining your eligibility.

If you made more than 400% of the Federal Poverty Level you will not be eligible for a premium subsidy and although you still have to purchase a qualified health plan to meet the Obamacare mandate, you do not have to purchase that insurance through the Health Exchange. You can purchase your insurance through an agent just likely you always have before. The plans are a little different now, and so are the laws, but you do not have to go through Cover Oregon’s intrusive application.

Essentially, there are two paths to buying health insurance and it depends on your eligibility for a subsidy on the Oregon health exchange.

I have included a chart on this page of the Federal Poverty Level Guidelines, or just call my office for a 15 minute consultation on your options.

-Dave Taxer 11/16/2013

503-828-1970

 

 

The Health Insurance Marketplace: What Every Oregonian Should Know

The health insurance marketplaces (also known as  exchanges) are estimated to provide up to 29 million people with affordable health insurance by 2019.

• Open enrollment for ObamaCare’s health insurance marketplace goes from Oct 1st, 2013 to March 31st, 2014.

• Coverage purchased on the marketplace starts January 1st, 2013.

• If you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage you don’t have to purchase by 2014 to avoid the fee.

• Exchanges are either State, Federal or join-run depending on your State.

•  Tens of millions of Americans who will qualify for cost-assistance offered exclusively through the marketplace!

• There are three types of cost assistance offered through the Health Insurance Marketplace tho those making under a certain amount of income who don’t have access to employer based insurance.

• Medicaid / CHIP for those making less than 138% of the Federal poverty level (FPL).

• Help with out-of-pocket costs for those making up to 250% of the FPL.

• Premium tax credits to reduce monthly premiums for those making up to 400% of the FPL.

• You may qualify for both premium and cost-sharing subsidies as they are not mutually exclusive.

Oregon Health Insurance Exchange: Cover Oregon

The Health Insurance Exchange implements State specific marketplaces for health insurance. Americans making under 400% of the Federal poverty level can use their State’s marketplace to buy Federally regulated, subsidized private health insurance from competing providers.

You can apply today to see if you qualify for subsidies! The marketplace opened up to individuals, families and small businesses on October 1st, 2013 and enrollment continues until March 31st, 2014. The insurance bought on the marketplace doesn’t kick-in until January 1st, 2014, but you can apply today to see your options and then enroll any time before March 31st, 2014.

Those who don’t obtain insurance, or an exemption, before the end of enrollment will be charged a fee on their 2014 income tax returns. Keep reading our unbiased breakdown of the exchanges and how the marketplaces works to get the inside scoop before you buy your health insurance.

In Oregon, the Health Insurance Exchange is called Cover Oregon. This online marketplace for Oregonians that qualify for tax creditsallows them to buy a private health insurance plan for themselves and their families. The plans which are sold in the Exchange, will also be available outside of the Exchange, without having to submit your information to the INS and IRS. You will also have more options outside of the Exchange. However, to receive a subsidy you will need to apply through Cover Oregon. Cover Oregon will help pay for premiums based on income. Below is the maximum monthly premium you would pay for a benchmark plan through Cover Oregon. Costs vary depending on the plan you choose and how many family members are on the plan. Families with income lower than these amounts will likely be eligible for no-cost coverage through Oregon Health Plan. There is no requirement that you must buy your insurance through Cover Oregon, just that you purchase a qualified health plan of some kind.

Most current individual plans (except for a few grandfathered plans) do not meet the requirements of the Affordable Care Act and will have to be replaced in 2014. Newly approved plans are currently scheduled to be available on 10/1/2013. Your current insurance company will transfer you to the closest new plan automatically. If you wish to apply for a subsidy, you will have to fill out a subsidy application and reapply for insurance.

If you apply for a subsidy, you will have to complete a Cover Oregon application annually. If your actual income exceeds your estimated income, you may receive a tax bill in April of the following year to recover any excess subsidy paid on your behalf. You are also signing the application under penalty of perjury and need to fill out the application accurately.

 

Household Size

100%

133%

150%

200%

300%

400%

1

$11,490

$15,282

$17,235

$22,980

$34,470

$45,960

2

15,510

20,628

23,265

  31,020

46,530

62,040

3

19,530

25,975

29,295

  39,060

58,590

78,120

4

23,550

31,322

35,325

  47,100

70,650

94,200

5

27,570

36,668

41,355

  55,140

82,710

110,280

6

31,590

42,015

47,385

  63,180

94,770

126,360

7

35,610

47,361

53,415

  71,220

106,830

142,440

8

39,630

52,708

59,445

  79,260

118,890

158,520

+1

$4,020

$5,347

$6,030

  $8,040

$12,060

$16,080

What You Pay
Individual (example costs)* Family of 4 (example costs)*
Annual IncomeMaximum amount you pay monthlyAnnual IncomeMaximum amount you pay monthly
$15,860-$17,253$57$32,499-$35,325$118
$17,253-$22,980$121$35,325-$47,100$247
$22,980-$28,725$193$47,100-$58,875$395
$28,725-$34,470$273$58,875-$70,650$559
$34,470-$45,960$364$70,650-$94,200$746
*Depending on your age, premiums may be significantly lower*Depending on your age, premiums may be significantly lower

Starting in 2014, all health plans will be required to cover essential health benefits

  • Prevention and wellness
  • Hospitalizations
  • Ambulatory services
  • Rehabilitative and habilitative services and devices
  • Emergency services
  • Prescription drugs
  • Laboratory services
  • Maternity and newborn care
  • Pediatric oral and vision care
  • Mental and behavioral health (substance use disorder services)
Cover Oregon / Silver Plan / Individual
Every carrier offering insurance plans through Cover Oregon must offer a standard silver plan. Individuals under certain income levels will be eligible for premium assistance; the amount of assistance will be based on the second-lowest cost silver plan. In addition, some individuals will receive help paying for co-pays and co-insurance if they buy a silver plan. Costs are estimated below.
Annual Income$15,856-$17,234$17,235- $22,979$22,980- $28,724$28,725- $45,960
Maximum Monthly Amount You Pay (Balance paid by federal tax credit; some plans may have lower premiums)$40 – $57$57 – $121$121 – $193$193 – $364
 Copays in grey sections are not subject to any deductible and count toward the annual out-of-pocket minimumBenefits in blue are covered after the combined deductible is met
Combined Deductible (Applies to Medical and Drug)$100$750$2,500$2,500
Preventive ServiceNo CostNo CostNo CostNo Cost
Primary Care Visit Copay (Applies to Physical, Speech & Occupational Therapy Visits and Pediatric Vision)$10$15$35$35
Specialty Care Visit Copay$20$30$70$70
Urgent Care Visit Copay$30$40$90$90
Inpatient/Outpatient Coinsurance10%10%30%30%
Emergency Room & Ambulance Coinsurance10%10%30%30%
Radiology (MRI, CT, Pet Scans) Coinsurance10%10%30%30%
Generic Drugs Copay$5$10$15$15
Preferred Brand Drugs Copay$10$25$50$50
Non-Preferred Brand and Specialty Drug Coinsurance25%50%50%50%
Maximum Out-of-Pocket$750$1,500$4,250$6,350
Cover Oregon / Silver Plan / Family of Four
Every carrier offering insurance plans through Cover Oregon must offer a standard silver plan. Families under certain income levels will be eligible for premium assistance; the amount of assistance will be based on the second-lowest cost silver plan. In addition, some families will receive help paying for co-pays and co-insurance if they buy a silver plan. Costs are estimated below, but they will vary depending on how many family members are enrolled in the plan.
Annual Income$32,499- $35,324$35,325- $47,099$47,100- $58,874$58,875- $94,200
Maximum Monthly Amount You Pay (Balance paid by federal tax credit; some plans may have lower premiums)$81 – $118$118 – $247$247 – $395$395 – $746
 Copays in grey sections are not subject to any deductible and count toward the annual out-of-pocket minimumBenefits in blue are covered after the combined deductible is met
Combined Deductible (Applies to Medical and Drug)$200$1,500$5,000$5,000
Preventive ServiceNo CostNo CostNo CostNo Cost
Primary Care Visit Copay (Applies to Physical, Speech & Occupational Therapy Visits and Pediatric Vision)$10$15$35$35
Specialty Care Visit Copay$20$30$70$70
Urgent Care Visit Copay$30$40$90$90
Inpatient/Outpatient Coinsurance10%10%30%30%
Emergency Room & Ambulance Coinsurance10%10%30%30%
Radiology (MRI, CT, Pet Scans) Coinsurance10%10%30%30%
Generic Drugs Copay$5$10$15$15
Preferred Brand Drugs Copay$10$25$50$50
Non-Preferred Brand and Specialty Drug Coinsurance25%50%50%50%
Maximum Out-of-Pocket$1,500$3,000$8,500$12,700

 

Number of Obamacare enrollments through Oregon’s state exchange: Zero. Still.

 

Yes, this is a deja vu headline.  The Associated Press in late October:

A month after Oregon’s problem-plagued online health insurance marketplace has failed to enroll a single person, concerns are mounting that some of the most vulnerable Oregonians may face a break in coverage if they don’t enroll within the next month and a half.

Oregonians were told state officials were making “significant progress.”  It’s now mid-November.  Back over to you, Associated Press:

With a reputation as a pacesetter in health care, Oregon laid out bold plans for complying with the federal overhaul. The state wouldn’t just create a health insurance exchange, a complicated undertaking in its own right. Oregon officials set out to build one of the biggest and best in the nation — a model that other states would want to copy. But more than a month after Cover Oregon’s online enrollment was supposed to launch, reality is lagging far behind Gov. John Kitzhaber’s grand ideas. The online system still doesn’t work, and the exchange has yet to enroll a single person in health insurance. Interviews with state officials and a review of public records by The Associated Press suggest Cover Oregon officials bit off more than they could chew and clung to their ambitious vision even when their risk management consultants raised alarms.

A few thoughts: (1) Just how proud should Oregon be of its healthcare “pacesetter” reputation?  (2) The magnitude of Cover Oregon’s failure is extraordinary.  Its website is under-performing Healthcare.gov, having signed up precisely zero people for coverage in six weeks.  Oregon is governed by Democrats.  They heartily embraced their Obamacare charge from day one, and they’ve failed.  These facts blow a giant hole in the Left’s reactionary, ‘it’s Republicans’ fault!’ blamestorming premise.  (3) Oregon is something of a case study: Its Democrats “bit off more than they could chew,” then “clung” to their big government ambitions, ignoring multiple warning flares.  The governor’s “grand ideas” and the president’s big promises have given way to pathetic results and countless betrayals.  This is the liberal project at work, America.  Cold, hard reality has punctured the feel-good bubble.  Leftism should be judged by its results, not its ostensibly lofty intentions or manipulative rhetoric. (4) Incredibly, Barack Obama has touted Oregon as one of Obamacare’s exemplars of success.  Why?  They’ve placed a bunch of new people into their empirically failing Medicaid system, a nationwide trend that threatens to crash the financial model of the entire law.  And these numbers are cited as good news.  Keep that in mind when the administration releases its intentionally nonspecific Obamacare enrollment figures this week.  But who cares about these buzz-kill facts and figures, really?  Think happy, crunchy thoughts:

 

How Much Will Health Insurance Cost Under Obamacare in Oregon? – Affordable Care Act Oregon Costs

One of the big questions people in Oregon are asking is about the cost of health insurance after “Obamacare” Oregon (the Affordable Care Act) takes full effect January 1st, 2014.

First, if you’re not familiar with the different types of Cover Oregon Plans… check out our post on that.  That’ll show you the different levels of coverage options that will be available once Cover Oregon opens up October 1st, 2013.

[NOTE: Cover Oregon is the new health insurance marketplace set up for Obamacare (the Affordable Care Act) here in Oregon. Learn more about Cover Oregon. ]

Here’s a quick short video with our take… and more info below the video to spell it out a bit.

 
See this video on YouTube, click here:  http://www.youtube.com/watch?v=qiot0RrUdqU

How Much Will Your Health Insurance Cost?

There’s speculation and even some data that suggests that health insurance premiums will go up as a result of the Obamacare requirement that everyone have at least the bare minimum health insurance coverage. Plus, preventing insurance companies from denying coverage to someone because of a pre-existing condition may raise premiums for everyone.

But, all of this right now is just a guessing game and we won’t know the impact of Obamacare on our health insurance costs here in Oregon for a little while.

The aim with creating the health insurance marketplaces in each state (Oregons is called Cover Oregon and it opens for business October 1st, 2013. Get on our Email or Text Notification List to get a reminder sent to you when you can apply for insurance.) is to create competition between the insurance companies.

Since health insurance companies who choose to offer insurance plans through Cover Oregon are required to offer “standard plans” (Bronze, Silver, Gold, and Platinum)… it’s meant to make it easier for you to compare plans… since they’ll be very similar… and meant to create competition to keep prices down.

Will You Qualify For Payment Assistance?

The majority of families will quality for some sort of government payment assistance for your health insurance.  People with incomes low enough may qualify for all or a large part of their premiums to be paid for by the government. A family of 4 who doesn’t smoke with a household income of up to about $94,000 will qualify for some payment assistance.

That is, however, only part of the story from Oregon. When it comes to private insurance, spokeswoman Amy Fauver said that it has not yet had any sign-ups.

“While we wish we were in a different place with our technology, we’re implementing the contingencies we need to make sure no Oregonians get left behind,” she said.

Cover Oregon decided Sept. 30, the day before the marketplace went live, that the software it uses to determine who qualifies for financial aid was coming up with too many errors to go live. It decided instead that it would process applications manually. Those applications have begun filtering in and determinations will likely go out later this month.

“They’ll start hearing from us in the next week or two what about what their next step is,” Fauver said. “We have staff trained to do that determination.”

However, Fauver said that no Oregon health plan has received an enrollment through the marketplace. She declined to comment on the number of applications submitted to the marketplace, saying her department is “still working through the data to to arrive at a number we can stand by.” It’s possible that some of the applications could be incomplete, or represent multiple people. Cover Oregon doesn’t know because they’re still pending manual processing.

Oregon initially projected that 7,000 people would sign up for private coverage this month. Fauver wouldn’t say whether that number still seems reasonable, with 12 days left to go in the month.

“It’s too soon to say,” she said. “We’re working with our developers around the clock to get this fixed. We’re not where we want to be, but we think we’ll be able to get there soon.”

How could so many people sign up for the Medicaid expansion, and not a single person enroll in private insurance? It mostly has to do with how simple the Medicaid sign-up was: The state sent out notices to about 260,000 people who already receive public benefits and were below 138 percent of the federal poverty line, the cut-off for the Medicaid expansion.

To enroll, they simply had to call a phone number or return a form to the state.

“It simplified the process and that made a huge dent,” Fauver said. “We’re extremely thrilled about that, and expect the number to go up in coming weeks.”

 

 

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