Cover Oregon – Oregons Health Insurance Exchange

May 26, 2013 in Affordable Health Insurance, Dependants, Employee Benefits, Employer Sponsored Plans, Group Health Plans, Health Care Costs, Health Insurance Agent, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance

You will likely be impacted by Obamacare, which forces most individuals, families and many groups to change their health insurance benefits soon. According to Obamacare, over 50% of health plans on the market today which consumers often choose, don’t provide enough benefits. As a result, many will be forced onto new plans that meet Obamacare requirements and their old plans will be terminated. Most existing plans on the market today will go away and most of you will be forced to choose a new plan for 2014. If you do not choose a new plan in Oregon, your insurance provider will automatically enroll you into their least expensive health reform compliant plan.

One of the largest changes to the industry will be the health insurance exchanges. Coverage Point agents are in the process of becoming certified in multiple states, which will allow our agents to offer plans on the health insurance exchanges. We anticipate being able to assist you apply for plans both on and off the exchanges. Here is what to expect. All detail are not yet available, but this is our general understanding as of now.

Health Insurance Exchanges & New Health Care Reform Compliant Plans

Enrollment begins October 1, 2013. With these changes, there are many who will benefit from the services offered by Coverage Point. We are here to guide you, and those you know, through this new insurance market. It is estimated that there are nearly 30,000,000 people in the US, who have no health insurance. By 2014, these uninsured individuals, will be required to obtain health insurance, or face a penalty when they file their tax return. For many who can’t afford health insurance, there will be subsidies to make it more affordable for them. Unless prohibited by law, at this time we will give you a $50 Gift Certificate or $50 Gift Visa from us when you refer someone to us and they are issued a new, individual, family or group, health insurance policy, or elect to make us their agent of record on an existing health policy. Please keep your eyes and ears open for anyone who may benefit from our assistance and services. Those who will most likely benefit from our services are:

  • Those who think they can’t afford insurance
  • Those who think their group options are too expensive
  • Those who think their group plan costs too much to add their spouse and/or children to their plan
  • Employers of all sizes
  • Individuals and families of all sizes
  • Those who currently don’t have health insurance
  • Individuals and businesses who think they will qualify for a subsidy, or have questions about them
  • Those who are required to purchase health insurance on their own
  • The self employed

Changes to take place on or before January 1, 2013. Oregon has come up with some of its own ideas while implementing some of Massachusetts current health exchange, Health Connector. Massachusetts implemented many of their own health care reform rules and mandates back in 2006.

  • Similar to group insurance now, there will be open enrollment periods for individual health plans. Like group, there will only be certain times of the year, or certain life instances that you will be eligible to apply for, or switch plans. These enrollment periods will apply to plans both in and outside of the exchange.
  • You must enroll into a health plan or there will be a penalty when you file your taxes. There will be a special “Catastrophic” plan available only for those who are considered as exempt from the penalty, or under the age of 30. The following will expected to be exempt from the penalty:
    o Certain religious groups
    o Certain Native American Indian Tribes
    o Undocumented immigrants
    o Prisoners
    o Those whose premium after federal subsidies and employer contributions exceed 8% of family income
    o Those whose income is so low they are not required to file a tax return
  • New required benefits
    o A health plans max out of pocket cannot exceed around $6,000 per person and $12,000 per family. Small group deductibles cannot exceed $2,000 per person and $4,000 per family
    o Plans must cover clinical trials
    o Plans must cover essential benefits. Lifetime and annual limits for essential benefits will be eliminated. Essential benefits are:
     Outpatient services
     Emergency
     Hospitalization
     Maternity & Newborn Care
     Mental Health & Substance Abuse
     Prescription Drugs
     Rehabilitative and habilitative services and devices
     Laboratory Services
     Preventive, wellness and chronic disease management services
  • Cover Oregon, Oregon’s health exchange is available to every individual and small group beginning October 1, 2013. Health exchange plan effective dates will begin January 1, 2014.
    o Insurance companies will no longer be allowed to deny someone for a preexisting condition. Rates are based on where you live, age and tobacco use. New premium ratios based on age for the January 1, 2014 rate adjustment, will result in a higher rate for children, and less significant for those nearing age 65.
    o Tax subsidy will be available to individuals and families who make up to 400% of poverty level. That means a family of 4 can make around $92,000 a year and still be eligible for a subsidy. A single person can make around $45,000 a year and still be eligible for a subsidy. The amount of the subsidy will be based on family income. The lower the family income, the higher the subsidy. Subsidies will only be available through the exchange. Here is an individual and family health insurance Subsidy Calculator.
    o Employers with 50 employees or fewer will have access to the exchange beginning 2014. Employers with up to 25 employees and an average wage less than $50,000, can receive a tax credit up to 50% the premium paid by the employer. These subsidies will be only available to plans purchased through the exchange. Here is the small group employer Subsidy Calculator.
    o The application process will be much simpler than it has been. Questions pertaining to health history will no longer be asked on the application. If you choose, the exchanges will give you the option to apply on your own and it will also allow you to choose us as your agent, or another agent. You will be able to give credit to the agent who assisted you, if you choose to apply on your own. The advice of an experienced agent is important to seek, prior to applying for any of these new plans that you are most likely unfamiliar with. There are important changes, details, knowledge and feedback about the exchanges, each plan and each company, which us agents have the knowledge or experience to guide you. Input that you will not get from an exchange or a brochure. Our agents are also brokers…we are not loyal to any one plan, one company, or the exchanges. Our assistance is still at no addition cost to you, like it always has been.
  • There will be 5 plan designs. Each insurance company will have comparable plans for each category below. Plans in the same category can somewhat differ from each other. There will be standardized Bronze, Silver and Gold plans, which will have identical benefits, no matter the insurer who offers them. Insurers are required to offer at least the standardized Bronze and Silver plan. Insurer who participate within the exchange are also required to offer a Gold option, though they are not required to offer the standardized Gold Plan. The most noticeable differences in the standardize plans are expected to be the premium you pay, provider networks and customer service received from the company.
    o Platinum – Covers on average 90%
    o Gold – Coverage on average 80%.
    o Silver – Covers on average 70%
    o Bronze – Covers on average 60%
    o Catastrophic – Covers on average 60%. This plan is for those who will be classified as exempt. Those who will be eligible for this plan are those who are under the age of 30, or those mentioned above.
  •  Employers with more than 50 employees will be required to offer insurance to their employees or face a penalty.

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