Who Is the Marketplace for?
Cover Oregon is the state's Marketplace for health insurance, where you can shop for and buy insurance in person, online, or by phone. Cover Oregon is run by the state. The Marketplace, also called an Exchange, is mainly for people who:
- Don’t have insurance
- Aren’t insured by their employer
- 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 something less expensive
- Own a small business
The Affordable Care Act requires that most Americans have health insurance starting in 2014. Generally, you don't need to buy insurance through the Marketplace if you are currently covered by Medicaid, Medicare, TRICARE, or an employer-sponsored plan.
When You Can Enroll: The next open enrollment period will be from Nov. 15, 2014, to Feb. 15, 2015.
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
Companies can offer four levels of plans in the Marketplace: bronze, silver, gold, and platinum. These “metal level” plans all cover the essential health benefits in your state. What differs is how much they pay on average toward the costs of the services the plan covers. Here’s how it works:
- Bronze Plan: You pay 40% and the plan pays 60%.
- Silver Plan: You pay 30% and the plan pays 70%.
- Gold Plan: You pay 20% and the plan pays 80%.
- Platinum Plan: You pay 10% and the plan pays 90%.
Low cost – or catastrophic – plans are available, especially for people who are under 30 and are healthy. These plans cost less up front, but they don’t give you as much coverage. They generally require you to pay more out-of-pocket costs.
Costs: Companies on the Marketplace can vary costs based on your age, where you live in the state, and your tobacco use. They cannot charge you more because of your sex or your health condition.
You can see the proposed rates . Here are some examples of premiums:
- A single, 21-year-old nonsmoker in Portland could choose a silver plan (which pays 70% of medical costs) that ranges from $168 to $257 a month.
- A single, 40-year-old nonsmoker in Portland could choose a silver plan that costs from $215 to $329 a month.
- A single, 21-year-old nonsmoker in the Bend area could choose a silver plan that costs from $173 to $265 a month.
- A single, 40-year-old nonsmoker in the Bend area could choose a silver plan that costs from $221 to $339 a month.
Tobacco Surcharge: Oregon allows companies in the Marketplace to charge tobacco users 15% more than non-tobacco users.
Who Will Sell Insurance in the Oregon Marketplace? Cover Oregon expects to have 10 companies and 2 co-ops offering insurance.