Oregon Health Insurance Marketplace

In Oregon, the federal government operates the health insurance Marketplace.

Oregon now has its own Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone.

Oregon Plans, Benefits, and Costs


Oregon, Portland 2015 2016
Monthly Silver Premiums for a 40 Year Old Non-Smoker $213 $261
Average Tax Credit Amount as of March 31, 2016: $197 $253

Last year average total cost for Health Insurance for a 40 Year Old Non-Smoker in your state was $16 per month after tax subsidies. See if you qualify for a free or low cost plan.

Companies can offer four types of plans: bronze, silver, gold, and platinum. These “metal level” plans all cover the same benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers.

Tobacco Surcharge: Oregon allows insurance companies to charge tobacco users 15% more than non-tobacco users.

Who Is Selling Insurance in the Oregon Marketplace?

On exchange plans in Oregon

Off exchange plans in Oregon

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What's Covered:

All approved plans in the state must cover the same package of benefits, called essential health benefits. In Oregon, the benefits include:

  1. Outpatient services, such as doctor visits or tests done outside a hospital
  2. Emergency services
  3. Hospital stays
  4. Pregnancy and baby care
  5. Mental health and substance abuse services, including behavioral health treatment
  6. Prescription drugs, including most generic drugs and certain brand-name drugs
  7. Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues
  8. Lab tests
  9. Preventive and wellness services, along with those that help people manage chronic conditions
  10. Services for children, including dental and eye care

Some services not included: infertility treatment, long-term care, weight loss surgery and programs, acupuncture, and visits to a chiropractor.

Will These Benefits Be in All Plans?

Although all health insurance policies have to include these benefits, some states may allow insurance companies to substitute a service that has the same value. For example, one type of lab test may be substituted for another. Make sure to read the summary of benefits of the plans you are considering to see if they include the coverage you need.

Financial Aid

You may be eligible for financial aid to help pay for insurance. Not all states will offer all types of aid. Here’s what Oregon will offer:

Medicaid Expansion: Some states, including Oregon, are expanding Medicaid so more people can get health insurance coverage. You may be eligible if your yearly gross income is below $16,243 for one person or $33,465 for a family of four.

Premium Subsidies (also known as Tax Credits ): You may qualify for a federal subsidy to help lower your monthly premium. The subsidy is available only if you buy your insurance in the Marketplace. In general, you'll be eligible if you're single and make between $11,770 and $47,080 a year, or if you have a family of four and make between $24,250 and $97,000 a year. Subsidies are based on your estimated household income for 2016 and the cost of the health plans in your area. The lower your income, the more assistance you will receive. You can use your 2015 tax return to estimate your 2016 income. When you file taxes for 2016, the IRS will adjust your subsidy based on your actual income.

Cost-sharing subsidies: Depending on your income, you may also qualify for cost-sharing subsidies that will reduce your costs when you receive medical care. Cost-sharing subsidies are available only with silver-level plans.

Calculator: You can also use our calculator to learn about costs and whether you'll qualify for subsidies or other financial aid.

CHIP: The Children’s Health Insurance Program, called Healthy Kids in Oregon, provides coverage for children of some families who have a low income but are not eligible for Medicaid.

 

Ready to obtain the right health insurance? Check your eligibility for free or low cost health insurance through the marketplace in 4 simple steps...