Oregon is home to the Cascade Mountains, a breathtaking coastline, hot springs, waterfalls, and Mount Hood, an 11,239 foot dormant volcano. With many natural attractions, it is one of the most environmentally conscious states as well as a magnet for outdoor enthusiasts. There is a great abundance of state parks, trails, ski resorts, lakes, and beaches throughout the state, and even the largest cities, Eugene and Portland, are completely infiltrated by trees. Both major cities are known for their progressive, eco-friendly approach to city living, making room for an equal amount of bikes on the road as automobiles.
Residents of Oregon have many great health insurance companies to choose from for individual coverage. The carriers represented throughout the state are Health Net of Oregon, Kaiser Permanente, ODS, Pacific Source Health Plans, Providence Health Plans, and LifeWise Health Plans. View premium rates and plans available in your area by entering your zip code below for a comparative personal quote. If you have any questions regarding plan details in Oregon, please call one of our agents at 888 803 5917.
Oregonians have been increasingly healthier over the past seven years, currently ranked by UnitedHealth Foundation as the 14th most healthy state for two years in a row. For such a large state, this is a great accomplishment, though there are some drawbacks and areas where individuals could use improvement. Oregon has a very low prevalence of smoking in the state, and the population of smokers has decreased by 5% over the past decade. As expected from such a heavily wooded and nature-rich area, the air quality is one of the cleanest in the nation with very little pollution. Diabetes is also not very common among adults compared to other states, though the amount of people affected has increased over the last 5 five years.
In addition to every other state, Oregon’s adult residents with obesity are growing in number. In 2011, there were 818,000 reportedly obese residents over the age of 18 in the state. Other areas that need help are public health funding and the number of uninsured residents, which are both low in comparison to the rest of the country. Those statistics go hand-in-hand, which means the state needs a boost in their public health system, and also that more individuals who can afford insurance should consider getting a plan. As long as the rainy winters don’t get too depressing and Oregon residents stay active and eating organic, the future looks bright for Oregon’s health.
Health Insurance Plans
Health Net of Oregon
- PPO Basics plans come in deductible options of $2,500, $5,000, and $10,000 for individuals, offering in and out-of-network coverage. As soon as your plan begins, you receive preventive care for no charge with a network provider. Regardless of your deductible choice, all in-network physician and hospital care is covered at 60% after reaching the deductible amount. Out-of-network covered services are offered for 50% coinsurance, with emergency care for 40% coinsurance. These plans also cover prescription drugs with a separate $100 deductible, with generics and brand names covered at 50%. Additional benefits offered for 40% coinsurance include durable medical supplies, home health care, home infusion therapy, and diabetes management. PPO Basics plans only allow for one person on each plan, requiring each family member to apply for their own plan.
Kaiser Permanente of Oregon
- Copayment plans are EPO plans offered to residents of Oregon are available with no deductible and a variety of instantaneous benefits. Preventive care is covered in full from the day your plan begins, including immunizations, yearly routine physicals, well-woman visits, well-child care and more. These plans only cover in-network care, which is offered for predictable copays starting at $25 for physician’s office visits, prenatal care, lab work and X-rays, and vision exams. Hospital care is offered for copayments ranging from $100 to $500, based on the service. Prescription drugs are also covered for either a $15 copayment or 50% coinsurance, depending on the higher number.
- Deductible plans are also in-network-only plans, that offer care for deductibles ranging from $500 to $7,500. These Gold, Silver, and Bronze plans all offer first-dollar benefits for a copayment such as doctor’s office visits with a PCP, urgent care, and outpatient maternity care. Higher deductible plans cover specialists for a percentage of coinsurance after deductible, and do not include prescription drugs. Plans with deductibles between $500 and $2,500 offer prescription drug coverage for $15 copay or 50% coinsurance from the start date of your plan. After you meet the deductible, in-network hospital care is covered at 50%, 70%, or 80% on emergency room visits, inpatient stays, and more. Based on the deductible choice, these plans differ greatly, giving more options for customization and personal preference.
- HSA plan options from Kaiser Permanente have deductibles of either $2,000 or $3,000 for individuals, and double for families. Offering comprehensive care after you meet the deductible, HSA plans leave you responsible for out-of-pocket costs on all but preventive care before reaching the deductible amount. You also have the ability to connect your plan to a health savings account to help you reach your deductible while simultaneously receiving tax rewards. After the deductible is met, your plan covers 80% of in-network services such as physician office visits, prescriptions, and most types of inpatient and outpatient hospital care.
LifeWise Health Plan of Oregon
- WiseValue Plus plans are money-saving PPO plans with deductibles from $1,000 to $7,500. These plans are available with or without pharmacy benefits, and cover either 70 or 65% of in-network major medical care after you meet the deductible. Immediate benefits include preventive care for no charge, and the first three to four doctor’s office visits for a copay of either $20 or $35 for primary care. These plans also cover maternity care for pre and postnatal office visits, as well as labor and delivery for a percentage of coinsurance. Out-of-network care is provided with these plans, requiring you to pay 50% coinsurance on covered services after deductible.
- WiseOptimum plans come in individual deductibles of $1,000, $2,500, and $5,000. These plans offer the first four primary care physician office visits for a $10 copay, and cover hospital services at 80% after deductible. Included in the set of covered benefits are preventive care, prescription drugs, chiropractic care as soon as your plan starts for a copay. Other services, such as surgery, maternity care, and hospitalization are included in the deductible. After meeting the deductible, services received through non-network providers will be covered at 50% with an out-of-network deductible twice the individual in-network deductible.
- WiseHSA plans are high deductible health plans qualified for use with a health savings account. These plans are offered for deductibles of $3,000 and $5,950 for individuals, and double the price for families. With 100% coverage after deductible on all types of covered in-network care, these plans have a great deal of benefits. Once your deductible is reached, you can visit a primary care doctor or specialist, use hospital services and receive prescriptions for no charge in-network. Using funds from an HSA to pay for your care can be highly rewarding, with tax benefits on annual federal and state taxes.
ODS Health Plan
- Beneficial plans come in two types in Oregon, including Beneficial Rx and Beneficial Value. Value plans do not include pharmacy coverage, while they do cover maternity benefits. Value plans offer doctor’s office visits for a copay of $25 as soon as your plan starts. For a slightly higher premium, Rx plans cover primary care visits for $15 in addition to generic and brand name medications immediately, with a “value tier” option for $2. All ODS plans are PPOs, allowing members to use in or out-of-network doctors and hospitals. Both types of Beneficial plans come in deductibles of $1,000, $2,500, or $5,000.
- Maximizer plans are traditional PPO plans with a variety of coverage options. Deductibles for individuals are $1,000, $2,500, or $5,000, which covers the whole gamut of care, including benefits as soon as your coverage starts. Office visits for both primary care and specialist physicians are offered for a $20 copay, and generics and brand name prescriptions are also available without having to meet the deductible. After deductible, Maximizer plans cover 70% of all hospital services.
- HSA plans come in HSA Value and HSA 3000 options, both providing comprehensive coverage and the choice of opening a health savings account in conjunction with your plan. HSA Value plans have a $2,800 deductible and for two hundred more dollars per year, you can get the HSA 3000 plan. Value plans have a significantly lower monthly premium, though they only cover 50% of in-network health care services after deductible. HSA 3000 plans cover the total cost of all types of covered care in addition to having a connected set of funds for medical use.
PacificSource Health Plans
- Elect Preferred plans are PPOs with individual deductibles ranging from $1,000 to $10,000. These plans cover prescription drugs, starting at $4 for incentive drugs, and covering generics and brand names at 50% before the deductible. Offering traditional PPO coverage, Preferred plans cover doctor’s office visits for a $30 copayment for primary care physicians and specialists. Once the deductible is met, member receive in-network hospital care for 30% coinsurance.
- Elect Premiere plans are benefit-rich plans with PCP and specialist office visits for a $25 copay as soon as your plan becomes effective. Prescription drugs are covered for a $4 copay for incentives, $10 for generics, and 50% coinsurance for brand names not subject to the deductible. When the deductible has been reached, all in-network major medical care is covered at 80%. Non-network care is available for 40% coinsurance after deductible on the same covered services as in-network. Deductibles range from $1,000 to $10,000 for individuals, and double for additional members.
- Elect Value Option plans offer a lower monthly premium rate and higher cost sharing, with services covered at 60% after deductible. Value Option plans are available in deductible choices ranging from $2,500 to $10,000, with premiums varying based on which level you choose. Each of these plans covers prescription drugs for 50% coinsurance after deductible. Preventive care is covered from the start date of your plan, while non-preventive doctor’s office visits are covered with hospital care after meeting the deductible.
- Elect HSA plans are offered in deductible options between $1,500 and $5,000, and give members the choice of opening a health savings account to supplement their plan. Depending on which deductible you select, HSA plans will cover 50% or 100% of in-network care once you have paid up to the deductible amount in out-of-pocket costs. Covered services include physician care, surgery, hospital care, chiropractic and more. Preventive care is offered to members when the plan starts, including maternity care, well-child care, and immunizations.
Providence Health Plans
- Optimum plans are offered in the widest range of deductibles, from $1,000 to $10,000. These PPOs give the immediate benefits of doctor’s office visits for a $20 copayment and prescription discounts to plan members. Once the deductible has been met, Providence covers 80% of all in-network costs including hospitalization, surgery, maternity care, mental health care and diagnostic lab work. From the start date of your plan, preventive care is available for no cost when using a provider from the network.
- Prime plans have a 10,000 deductible and cover 50% of all physician visits for illness or injury as well as hospital services received in-network after deductible. Preventive care such as immunizations, well-baby care, and screenings for various cancers is offered as soon as your plan begins, free of charge with in-network providers. These Plans do not cover prescriptions of any sort, though due to the high deductible, monthly premiums will be very low.
- Value plans have deductible options between $1,000 and $7,500 for individuals. These plans offer the lowest premiums of any Providence plan, while still offering upfront benefits. Doctor’s office visits with a primary care physician for non-preventive care such as illness or injury are a $30 copay from the time your plan begins. Another immediate benefit is generic and brand name prescription drugs for 50% coinsurance. Once the deductible is met, hospital care is covered by the Value plan at 70%.
- HSA plans are offered in two types, with a $2,500 deductible or a $3,500 deductible. HSA 2500 plans offer a wider array of benefits for a higher monthly rate and less cost sharing. After deductible, these plans cover 80% of major medical services and a $20 copay for office visits. HSA 3500 plans cover 50% of all covered services after reaching the deductible amount. Both plans cover prescriptions for 50% coinsurance, included in the annual deductible. This type of plan allows members the ability to open a health savings account for greater control over medical expenses with added tax advantages.
Public Health Options
The State of Oregon has various programs in place to assist its uninsured residents with getting coverage or receiving health care. Though as mentioned above, the funding for such programs is considerably low in the state, they are still in existence. Enrollment may be closed on some programs due to lack of funding, but please try if you are eligible to apply for Medicaid, PCIP, CHIP, or any other state-run assistance program. Children and families with a low income and no health coverage as well as pregnant women and disabled persons are eligible for Oregon Health Plan. To see more qualifications for this program, refer to our Medicaid Eligibility by State article. More programs and services are offered to individuals with specific diseases and conditions. For a complete list of services and eligibility criteria, visit the Oregon Health Authority Public Health Division.
- Oregon Health Plan: medical insurance plans for low-income residents of Oregon who meet the qualifications for acceptance.
- Oregon Healthy Kids: the Children’s Health Insurance Program for uninsured residents of Oregon under age 19 who do not qualify for Medicaid.
- Oregon Medical Insurance Pool: health insurance coverage for those who otherwise would be rejected due to current or past medical conditions in Oregon.
- CAREAssist ADAP: Oregon’s AIDS Drug Assistance Program, helping those with HIV/AIDS pay for medications to promote longevity and health.
Health Insurance Laws
Oregon health insurance regulations specifically regard how private insurance companies in the state treat individuals who are applying for a plan, and also how they can treat those they insure. Oregon is much more accepting than other states when it comes to pre-exisitng condition laws. The definition of such a condition is based on what health care they have received in the six months prior to applying for health insurance. They still always have the right to decline any adult for coverage for a severe enough condition, but if they accept an individual they can issue an exclusion period for no more than six months. Exclusion periods allow health insurance companies to not pay for care related to the pre-existing condition for the stated length of time.
Elimination riders are not permitted in Oregon, which means an insurer can only refuse to pay for certain types of care for up to six months. Also, if an individual with a qualifying illness is changing from one carrier to another, they may receive a credit to pay for care during the exclusion period. Individuals who get denied a policy have the option of applying for the Pre-Existing Condition Insurance Plan, set up by the Affordable Care Act. PCIPs allow adults age 19 – 64 to have an adequate health plan despite their health status or medical history. These plans are due for expiration in early 2014 when all insurers will be required to accept any adult regardless of their health.
The Affordable Care Act has changed many health insurance laws, and continues to do so. The individual market will soon see the introduction of state health exchanges as a state-run alternative to the plans offered in the state. Exchanges will offer subsidized plans with essential benefits in order to create competition and higher quality of care in the private market. Essential benefits will include those that are already accepted in health plans today as preventive care such as immunizations, maternity care, cancer screenings, well-child care, and additional benefits such as mental health care and substance abuse coverage.
Another key element of health insurance regulations is the guaranteed renewability provision. For anyone who has a private health plan, the insurance company must offer to renew their benefits for another year after their term is over. In an attempt to avoid coverage gaps, this law makes sure every carrier is proposing to renew a person’s plan as long as they have been paying their premiums and claims and have not infringed upon the policy’s terms in any way. The law also guarantees that an insured person can keep their coverage even if they become ill or have some kind of condition discovered after their plan has begun. Guaranteed renewability is part of the HIPAA law, therefore acting as a protector for those enrolled in health insurance.