Even though open enrollment hasn't started, you can still take action to prepare to enroll. We recommend the five steps below to help make your application and enrollment process quicker and easier.
1) Figure out what benefit you may qualify for and how to apply.
In Oregon, there are different programs depending on your family's situation. You may qualify for the Oregon Health Plan, which is Oregon's Medicaid program. This program is available to low-income children, teens, and adults. If you don't qualify, you may be able to shop through the Marketplace. Shopping through the Marketplace means you have access to financial help for both monthly premiums and out-of-pocket costs.
Wading through these options can be complicated. That's why we have created a tool to help you figure out what program and savings you may qualify for. Just answer a few quick questions to get a good estimate of the cost and savings you can expect. Visit OregonHealthCare.gov/WindowShop to take a test drive.
2) Compare plan options, even if you like your current plan.
Once you've figured out what program and savings you can get, we recommend narrowing down your plan options. A few things to keep in mind:
- Plans with lower premiums may have higher out-of-pocket costs. Pay special attention to the costs for doctors visits and to fill a prescription as these can add up quick. For many people, plans with slightly higher monthly costs will be less expensive if you need to use the coverage.
- Extra savings called cost-sharing reductions are available only on Silver level plans for most people. If you are eligible for these savings, you will likely see much reduced costs for things like deductibles, co-pays, and co-insurance than you would see on Bronze plans, which have lower monthly premiums.
- If you have an upcoming procedure, make sure it is covered by the new plan. It is also important to consider whether you will need to get a new referral to visit a specialist you have already been seeing.
- Check coverage for specialty care such as acupuncture, chiropractic care, vision, and dental. Some plans include these benefits, but many do not. If these are important to you, they are important to consider.
3) Look over your estimated yearly costs.
The window shopping tool on OregonHealthCare.gov will help you determine the estimated annual costs for each plan. The tool uses a “bad year," “average year," and “good year" ranking to make these estimates. Each estimate includes the monthly premium and estimated out-of-pocket costs you may experience.
- Good year: An estimated yearly cost if your health coverage is low.
- Average year: An estimated yearly cost for an average person who may visit the doctor a few times and receive wellness care.
- Bad year: An estimated yearly cost with an increased likelihood that someone covered by the plan will experience an expensive year based on health status and any anticipated medical procedures.
It is important to not focus on the premium and deductible of each plan. With some plans, you will never pay towards your deductible if you are seeking only preventive care services or visit the doctor when you are sick. It is easy to get sticker shock when comparing plan deductibles, but looking at the plan's Summary of Benefits and Coverage document will help you get the real picture of how much you can expect to pay for routine care and standard services.
4) Consider how much health care you need.
Plans through the Marketplace come in four tiers: Bronze, Silver, Gold, and Catastrophic. These tiers have nothing to do with the quality of care or the amount of care you receive. The tiers correlate with the cost of the premiums and out-of-pocket costs that you will pay throughout the year.
- Bronze plans: Low monthly premium, but higher out-of-pocket costs. You can not use cost-sharing reductions or “extra savings" on these plans.
- Silver plans: Moderate premium and moderate out-of-pocket costs. You can use cost-sharing reductions on these plans, which can substantially lower your out-of-pocket costs.
- Gold plans: Higher premium and lower out-of-pocket costs. You can not use cost-sharing reductions on these plans.
- Catastrophic plans: Very low premiums, but high out-of-pocket costs. You cannot use any financial assistance on these plans. Although they include basic preventive care, you will need to pay for most services in full until you meet your deductible. These plans are available only to people younger than 30 or who qualify for a hardship exemption (not common in Oregon). The plans are available in limited areas in Oregon and premiums may be similar to bronze plans.
If you are eligible, you can use premium tax credits on any plan through the Marketplace, except Catastrophic plans.
5) Get help from an expert.
Health insurance can be confusing. With at least nine plan options available to every Oregonian, wading through the options alone can be daunting. That's one reason why we partner with organizations and insurance agents throughout the state to provide free, local one-on-one assistance. These experts are familiar with networks, providers and pharmacies in the area, and plan choices. They are also well versed in the Marketplace application and are able to help you accurately answer all of the questions. To find local help, visit our search tool. Help is also available for the Oregon Health Plan, the COFA Premium Assistance Program, and Medicare.
When in doubt, give us a call at 855-268-3767 (toll-free). We are happy to point you in the right direction.