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Health Care Reform:

Health Insurance & Affordable Care Act

Cover Oregon

Who Is the Marketplace for?

The Oregon health insurance Marketplace is where eligible residents can shop for and buy insurance in person, online, or by phone. Last year in Oregon the Marketplace was run by the state, but beginning this year, the Marketplace is run by the federal government. The Marketplace, also called an Exchange, is mainly for people who:

  • Don’t have insurance
  • Aren’t insured by their employer
  • Don’t have Medicare
  • Aren’t included in their spouse’s employer insurance
  • Have pre-existing conditions and may have had trouble getting insurance before
  • Have private insurance but want to look at other options
  • Own a small business

The Affordable Care Act required most Americans to sign up for health insurance in 2014. Generally, you don't need to buy insurance through the Marketplace if you are covered by Medicaid, Medicare, TRICARE, or an employer-sponsored plan.

When You Can Enroll:  The next open enrollment period is Nov. 15, 2014, to Feb. 15, 2015. Enroll online at HealthCare.gov or call 800-318-2596. You can also download an enrollment application at HealthCare.gov, or insurance agents can help you enroll.

If you have a life-changing event -- such as the birth of a child, losing your job, or moving to a new state -- you don't have to wait for the next enrollment period. You can sign up or change coverage within 60 days of the event.

Plans and Costs

Benefits

What’s Covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. They 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 generic and certain brand-name drugs
  7. Lab tests
  8. Rehabilitative services, such as those that help people recover from an accident or injury, and habilitative services, which help people with developmental issues.
  9. Preventive and wellness services, along with those that help people manage chronic conditions; these are covered at no additional cost.
  10. Services for children, including dental and eye care

 

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