Health coverage options for employers and employee
The first step to considering whether to offer health coverage to your employees is to understand the health coverage options available in Oregon:
Employer-sponsored group coverage
- Small employers with 50 or fewer employees may be eligible for small group coverage.
- If you have fewer than 25 FTE (full-time equivalent), you may be eligible for the Small Business Health Care Tax Credit (see below).
- Large employers with more than 50 FTE must offer employer-sponsored health coverage to their employees that meets the employer shared responsibility provisions.
Individual health coverage
- Oregon Health Plan
- Individuals and families who work part time may qualify for Oregon's Medicaid program, also called Oregon Health Plan (OHP), which is free coverage for people in Oregon with low to moderate income.
- Private health insurance
- People who are not offered employer-sponsored health coverage, Oregon Health Plan, or Medicare can purchase health coverage through a health insurance company or through Explore Health.
- Financial help is available through Explore Health to reduce the monthly premium and out-of-pocket costs.
- American Indians and Alaskan Natives may qualify for additional savings and protections through Explore Health.
- Medicare
- Federal health coverage program through Social Security for people who are 65 or older, are on Social Security Disability for 24 months, or have end-stage renal disease (ESRD).
Association health plans
- Allow many small- to medium-sized companies the ability to come together under one health plan, potentially reducing costs and increasing benefit options.
- There are regulations around these entities and criteria to participate, but coverage is not regulated or guaranteed for essential health benefits or pre-existing conditions.
Health reimbursement arrangements
- HRAs allow employers to contribute pre-tax funds to help employees pay for medical expenses.
Small-group coverage
Small-group coverage is available year-round, unlike individual health insurance, which has a set enrollment window.
If you have at least one employee who receives a W2, you can purchase coverage for yourself and your workers at any time. Small businesses with one to 50 employees can purchase a plan from any insurer offering a small-group plan in Oregon.
If you need help getting more information about these plans or other available options, please contact a licensed agent. You can find a local agent through the Explore Health website.
Coverage for family members
Can your organization sponsor health coverage for additional family members? If not, the family may get a better deal through Explore Health (possibly getting financial assistance) or if they are eligible for the Oregon Health Plan, rather than being offered full-cost coverage through a family member's employer. Don't have employees?
An individual can apply for financial help and enroll in individual coverage through Explore Health:
- During open enrollment, Nov. 1 to Jan. 15.
- Year round through the Oregon Health Plan.
- During a special enrollment period. This is a 60-day period that can be triggered by certain life events, such as getting married, having a baby, or losing other health insurance coverage.
Small Business Health Care Tax Credit
Small businesses with fewer than 25 full-time employees may be eligible for the Small Business Health Care Tax Credit if they choose one of the small-group plans certified by Explore Health. If your business qualifies, the tax credit may cover up to 50 percent of the employer paid premiums. Learn more about the Small Business Health Care Tax Credit.
Resources for employers
If you have questions, please contact the Marketplace at 855-268-3767 (toll-free) or shop.marketplace@odhsoha.oregon.gov.