Oregon Health Insurance
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Facts and Figures
-
Place in State
Health Report Card 14th - Insured 3,172,094
- Uninsured 649,400
-
Insurance
Carriers 10 -
Number of
Primary Care Physicians 8190 -
Number of
Hospitals 58 -
Average Cost of
Health Insurance* $612
Breakdown of Insureds
- Employer-sponsored health insurance 63%
- Private plans 5%
- Medicaid 15%
- Medicare 17%
Insurance Carriers
- Assurant Health
- Great American Health Insurance Company
- Health Net of Oregon
- John Alden Life Insurance
- LifeWise Health Plan of Oregon Health Insurance
- ODS Health Plans Health Insurance
- PacificSource Health Plans Health Insurance
- Providence Health Insurance
- Regence Blue Cross and Blue Shield of Oregon Health Insurance
- Time Insurance Health Insurance
State Health Report Card
There are 448,000 adult residents who smoke. But the percentage has decreased from 20.7 percent to 15.1 percent in ten years. The rate of preventable hospitalizations also decreased from 46.1 to 42.0 discharges in the past ten years. The rate of obesity among adults increased from 23.6 percent to 27.6 percent in the past year.213,000 adults in Oregon have diabetes.Diabetes increased from 6.7 percent to 7.2 percent in the past year.The rate of uninsured population increased from 12.7 percent to 16.8 percent in the past ten years.
Oregon Health Insurance Laws and Regulations
Oregon state laws do not require health insurers to guarantee renewal of policies. But insurers are prohibited from cancelling your policy if you’re sick. When creating new Oregon health insurance plans, insurers can exclude coverage for a pre-existing condition. The look back period is six months. The exclusion period is also six months.If you were able to go through an exclusion period and you want to change to another insurer, you no longer need to go through another 6 month exclusion period.Oregon health insurance companies set their premium rates based on determining factors like age and health condition. Insurers may deny you coverage due to your health condition. Small businesses can apply for any small business group plan for as long as you are able to comply with the requirements they set. Oregon health insurance quotes for group coverage can vary according to the risk factors of the applicants. But they are also influenced by determining factors. Self-employed individuals without employees on payroll are not allowed to purchase small business group plans.
Individual Health Insurance in Oregon (OR) Individual health insurance companies are allowed to turn you down due to a health problem. If you have been rejected, the Oregon Medical Insurance Pool will provide you with insurance. Insurers are allowed to impose a waiting period of 90 days for coverage. Insurers are further allowed to study the last six months of your medical history before coverage for pre-existing conditions. Pregnancy can be considered a pre-existing condition, but genetic information cannot. If you have had no lapses of 63 days or more in your coverage, you can get credit toward any exclusion periods. The costs of individual policies are determined using modified community rating. Due to your illness, your insurance cannot be cancelled. Group Health Insurance in Oregon (OR) Group health insurance regulations in Oregon provide that you cannot be denied or charged more for group coverage because of a medical condition, provided you qualify. A new employer may wait to offer group coverage and a new HMO may impose an affiliation period until coverage actually begins. There are several life changes relating to marriage, children, family problems, or job loss which could entitle you to special opportunities for group insurance. Newborns and adopted children are covered for their first 31 days, provided you have dependent coverage. Group health plans are allowed to look back at your medical records for the six months prior to coverage for pre-existing conditions. The maximum time that a condition can be excluded from initial coverage is six months for a fully insured group, although late enrollment may lengthen the time limit. If you have maintained continuous coverage, with no break longer than 63 days, you can count it toward the exclusion period. Small Business Health Insurance in Oregon (OR) Small businesses with two to 50 employees cannot be denied small group health insurance and they cannot have it cancelled due to health issues within the employee group. The insurance companies must offer a standardized plan. If you have two to 25 employees, your premium cost will be determined according to modified community rating. With employee groups of over 25, the premium can change due to the health status of the employees. A small business with two to 50 employees is allowed to join an approved statewide association or alliance which can offer group health insurance to its members. It is recommended that you contact your Oregon Division of Insurance for regulations governing associations with group health insurance availability.
Heath Care Reform
Young adults in Oregon can now stay under their parent’s policy. The new health law mandates
health insurance companies to allow parents to keep their children in their
policy until age 34,532 young adults in
Oregon have benefited from this plan (as of June 2011).
Because of the new law, Medicare members no longer need to
worry about their extra prescription cost. Once they reach the donut hole in
2010, they are sent a check for a $250 rebate. 49,828 seniors in Oregon have
received the rebate to offset the cost of
their prescription drugs. A 50 percent discount was also given for brand name
drugs once they’ve hit the donut hole. This resulted to an average savings of
$23,505,132 for Oregon Medicare members.
The Affordable Care Act aims to close the donut hole by 2020.
One of the provisions of the health care reform is to
provide preventive care services free of
charge for Medicare members and free from cost-sharing for those enrolled under
private plans. In 2011, 388,823 Medicare
members and 692,000 private plan members in Oregon have received free
preventive care services like colonoscopies and mammograms.
When looking at Oregon health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements and no more than 20 percent on administrative costs. 1,084,000 Oregon residents are now able to maximize their premium.
The new health law requires Oregon health insurance
companies who want to raise their rates by at least 10 percent to make public
the details as to why there is a need for rate increase. A $1 million fund was
given to Oregon to defend and implement this provision.
Insurers are no longer allowed to impose a lifetime limit on
their members’ benefits. 1,356,000 Oregon residents are now free from having
lifetime limits on their coverage. Patients with chronic diseases don’t have to
worry about maximizing their limit because of their accumulating medical costs.
Through the Pre-Existing Condition Insurance Plan, Oregon
residents who have pre-existing condition can now have affordable coverage. As
of 2011, 187residents now have a Oregon insurance. Without this provision, they
would still remain uninsured.
Oregon has received a $10.9 million grant to develop more
health programs and policies. They have also received $56 million to create
more health centers and to improve existing centers and the quality of health
care delivered.
Because of the new law, Medicare members no longer need to worry about their extra prescription cost. Once they reach the donut hole in 2010, they are sent a check for a $250 rebate. 49,828 seniors in Oregon have received the rebate to offset the cost of their prescription drugs. A 50 percent discount was also given for brand name drugs once they’ve hit the donut hole. This resulted to an average savings of $23,505,132 for Oregon Medicare members. The Affordable Care Act aims to close the donut hole by 2020.
One of the provisions of the health care reform is to provide preventive care services free of charge for Medicare members and free from cost-sharing for those enrolled under private plans. In 2011, 388,823 Medicare members and 692,000 private plan members in Oregon have received free preventive care services like colonoscopies and mammograms.
The new health law protects consumers’ money through the medical loss ratio which mandates insurers to spend 80 percent of their premium dollars on medical care and only 20 percent on administrative costs. 1,084,000 Oregon residents are now able to maximize their premium.
The new health law requires Oregon health insurance companies who want to raise their rates by at least 10 percent to make public the details as to why there is a need for rate increase. A $1 million fund was given to Oregon to defend and implement this provision.
Insurers are no longer allowed to impose a lifetime limit on their members’ benefits. 1,356,000 Oregon residents are now free from having lifetime limits on their coverage. Patients with chronic diseases don’t have to worry about maximizing their limit because of their accumulating medical costs.
Through the Pre-Existing Condition Insurance Plan, Oregon residents who have pre-existing condition can now have affordable coverage. As of 2011, 187residents now have a Oregon insurance. Without this provision, they would still remain uninsured.
Oregon has received a $10.9 million grant to develop more health programs and policies. They have also received $56 million to create more health centers and to improve existing centers and the quality of health care delivered.
State Government Insurance Programs Offered
Oregon Medical Insurance Pool (OMIP) www.omip.state.or.us Federal Medical Insurance Pool (FMIP) Federal program run by OMIP 503-225-6620 800-848-7280 www.PCIP.gov www.oregon.gov (Search: FMIP)
503-225-6620
800-848-7280
OMIP: Max lifetime benefit is $2 million per covered person. Choose from 4 policy options. In some cases benefits will not be provided during the first six months of enrollment for expenses resulting from a pre- existing condition. FMIP: Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. Eligibility: OMIP: Must be an Oregon resident and have a qualifying medical condition, or denied coverage due to pre-existing conditions, or offered coverage with substantially reduced benefits (e.g. elimination rider). May be eligible if previous coverage was terminated for reasons other than non- payment of premium or fraud. Cannot be eligible for COBRA, or government programs. FMIP: Must be a U.S. citizen or lawfully present in the U.S. Must have been uninsured for at least 6 months prior to applying. Must have had a problem getting insurance due to a pre-existing condition.
Oregon Health Plan (OHP) www.oregon.gov (Search: OHP) Programs: OHP Standard, OHP Plus, OHP with Limited Drug Benefit.
503-945-5772
800-527-5772
TTY: 800-375-2863
Coverage: OHP Standard: Acupuncture, Chemical dependency, Dental, Emergency/ urgent hospital care, Hospice and hospital care, Immunizations, Labor and delivery, Laboratory and x-ray, medical equipment and supplies, Medical transportation, Mental health, Physician care, Podiatry, Prescription drugs, Vision care. OHP Plus: Includes OHP Standard benefits, plus hearing aids and hearing aid exams, home health, naturopathy, therapy (occupational, physical and speech) and private duty nursing. OHP with Limited Drug: Same benefits as OHP Plus, but no coverage for prescription drugs that Medicare Part D covers. Eligibility: Must be an Oregon resident and a U.S. citizen or a qualified non- citizen. OHP Standard: Must be parents and childless adults 19 years or older with asset limit of $2,000, earning up to 100% FPL, and not getting Medicare. Must be uninsured for 6 months prior to enrollment (the six- month waiting period is waived in some cases), and paid all previously billed OHP premiums. OHP Plus: Aged and disabled singles earning 75% FPL, blind singles earning 78% FPL. Aged and disabled couples earning 83% FPL, blind couples earning 85% FPL. Asset limit for aged, blind and disabled singles is $4,000, and for couples $6,000. Pregnant women earning 185% FPL. Patients receiving TANF or Extended Medical Assistance. For children under 19, see “Healthy Kids” in the next column. OHP with Limited Drug Benefit: Must be eligible for both Medicaid and Medicare Part D.
Oregon Health Plan Plus (OHP Plus) www.oregon.gov (Search: OHP) OHP Plus includes the no-cost option of Healthy Kids Healthy Kids 503-378-2666 800-359-9517 www.oregonhealthykids.gov Women-Infant-Children (WIC) 971-673-0040 www.oregon.gov (Search: WIC)
503-378-2666
Coverage: OHP Plus/Healthy Kids: Acupuncture, Chemical dependency, Dental, Emergency/urgent hospital care, Hospice and hospital care, Immunizations, Labor and delivery, Laboratory and x-ray, Medical equipment and supplies, Medical transportation, Mental health, Physician care, Podiatry prescription drugs, Vision care, Hearing aids and Hearing aid exams, Home health, Naturopathy, Occupational therapy, physical therapy, Private duty nursing, and speech therapy. WIC: Nutrition education and services, breastfeeding promotion and education, monthly food prescription of nutritious foods, and maternal, prenatal and pediatric health-care services. Eligibility: OHP Plus/Healthy Kids: Must be an Oregon resident and a U.S. citizen or qualified non-citizen, and 0–18 years old. Must have been uninsured for 2 months (though there are exceptions to this rule for special circumstances, like a parent’s job loss or a child’s serious medical need). OHP Plus pays for the full premiums for enrollees whose families earn to 200% FPL. Otherwise, those earning 201%–300% FPL will have their premiums subsidized, and those earning 301% FPL or more must pay for the full premium. WIC: Must reside in Oregon. Must be a pregnant or recently pregnant woman, or child up to age 5, and determined to be at nutritional risk. Income must be at or below 185% FPL.
Family Health Insurance Assistance Program (FHIAP) www.fhiap.oregon.gov Program is full for adults, due to budget. Reservation list remains open.
503-373-1692
888-564-9669
Use FHIAP to buy the private health insurance plan you choose. If an employer-sponsored plan is available then you must use FHIAP assistance to enroll in that plan. Applicants have 75 days to fill out the forms and return them with supporting documents. Must be an Oregon resident and U.S. citizen or legal immigrant, uninsured for at least 2 months (unless coming off OHP/Medicaid), and have investments and savings less than $10,000 (including rental property). Income limit is 200% FPL. Must not be eligible for or receiving Medicare.