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During the COVID-19 public health emergency (PHE), the federal government extended health coverage, services and supports for people with disabilities and older adults and provided extra food benefits. Some of these flexibilities and temporary programs will end as the federal COVID-19 PHE phases out.
Oregon is planning for how these changes will affect people, with a goal of keeping as many people as possible connected to benefits and covered by a health plan. You can play a critical role in helping your employees keep covered. Learn more below.
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.
**Employees who are offered employer-sponsored coverage likely are not eligible for financial assistance through HealthCare.gov.
If you are not currently offering health insurance, but want to get an estimate of what offering coverage through a Marketplace certified plan may cost, use our premium calculator. You can then use that information to use the tax credit estimator.
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 Marketplace website.
Learn more about health coverage options for small businesses.
A PHE doesn't typically affect eligibility for health coverage programs. However, the Families First Coronavirus Response Act mandates that any Medicaid agency (Oregon Health Plan, OHP, in Oregon) receiving certain federal funding must offer continuous coverage to all Medicaid enrollees. This means that people who are technically no longer eligible for OHP benefits due to a life change will not be disenrolled until after the continuous coverage provision ends. Certain verification factors can also be relaxed.
Under the 2023 omnibus bill, the federal government uncoupled the continuous coverage provision from the PHE. This means that OHP must begin the redetermination process no later than April 1, 2023, regardless of the status of the PHE. April 1 will mark the beginning of the “unwinding period."
During the unwinding period, Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS) will work together to redetermine clients' eligibility for state benefits, such as OHP.
Throughout the unwinding period, OHP will send notices to Oregonians who are enrolled in medical benefits. OHP enrollees will have 90 days to submit information to redetermine their eligibility for OHP.
People who are no longer eligible for OHP benefits will receive a 60-day closure notice. We estimate that around 300,000 Oregonians may no longer qualify for OHP benefits and will need to act elsewhere to enroll in health coverage. OHP will share data with the federal Marketplace and OHIM regarding enrollees who are no longer eligible for OHP benefits. The federal Marketplace and OHIM will contact individuals to advise of coverage options through the Marketplace.
If someone in your organization is losing OHP benefits, now is the time to help them find new coverage to ensure they do not have a gap in their health coverage and can take advantage of the important health benefits and services available by having health coverage.
Yes, and this may be the best and simplest way for your employee to maintain coverage. OHP will be redetermining eligibility and ending coverage for some members over a 14-month period, starting in April 2023. If your employee is determined no longer eligible for OHP benefits, the employee will receive notification indicating when their OHP benefits are ending. You will have a window of time to add your employee to coverage because loss of OHP benefits is a qualifying life event which triggers a special enrollment period. That allows eligible employees to request enrollment in your company's health plan within 60 days of the OHP benefits closure date.
No. You can follow your usual process when you add an employee or dependent to your company's plan. Contact your insurance agent/broker or whoever manages your company's health policy to add an employee.
Your employees could choose to shop through the Oregon Health Insurance Marketplace instead, but they won't qualify for financial assistance if the cost of your plan is considered affordable under federal standards. If the plan you offer is considered unaffordable, employees could potentially qualify for help paying for Marketplace coverage through HealthCare.gov. You or your employees can find out if the coverage you offer is considered affordable at orhim.info/ESItool.
It is very likely that your employer-sponsored coverage meets the standards for affordability. In 2023, an employer's plan is considered affordable if the employee's share of the monthly premium in the lowest-cost plan offered is less than 9.12 percent of the employee's household income. If you are unsure if the coverage you offer is considered affordable, the Oregon Health Insurance Marketplace has a tool to help you find out, which can be found at orhim.info/ESItool.
In our current competitive workforce environment, now is a great time to offer additional benefits for your employees, including health coverage. If your company has 50 or fewer employees, you can start at the Oregon Health Insurance Marketplace, which offers small businesses lower-cost plans and options to save money while providing plan choices to employees. You can also find a certified insurance agent/broker who can help you complete an application and pick a plan. Find out more about the Oregon Health Insurance Marketplace for employers at orhim.info/employers.
If you have more than 50 employees, an insurance agent/broker can help you establish a plan to meet your needs and the needs of your employees. You can make sure you're finding a licensed insurance agent/broker at OregonHealthCare.gov/GetHelp.
If you have an employee who needs health insurance, encourage the employee to consider coverage through the Oregon Health Insurance Marketplace. The Marketplace is the state's health insurance exchange, offering individuals and families a range of quality, private plans that meet state and federal standards for covered benefits and services. The Marketplace is also the only place people can get help paying for their health coverage. People who no longer qualify for OHP benefits will get information from the Marketplace. However, they can find information about transitioning to the Marketplace at orhim.info/transition, or call 833-699-6850 (toll-free, all relay calls accepted) to get help in any language.
Unfortunately, many websites that come up in search results are from companies that do not offer plans that meet state and federal standards. These products often don't cover basic services, including preventive care, procedures, or even emergency care. This means a policyholder is paying monthly premiums but may be stuck with medical bills for care.
The best way to make sure employees are choosing a high-value plan is through the Oregon Health Insurance Marketplace. All health plans meet state and federal standards and provide access to vital services. Plus, the Marketplace is the only place for Oregonians to access financial help for health coverage. Visit OregonHealthCare.gov to learn more.
Questions specific to transitioning to the Marketplace during the unwinding period may be emailed to email@example.com. You may also reach the Marketplace Transition Help Center by calling 833-699-6850 (toll-free, all relay calls accepted).
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