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Health Care Reform:

Health Insurance & Affordable Care Act

Cover Oregon

Benefits

What's covered: All approved plans in the state must cover the same package of benefits, called essential health benefits. In Oregon, the benefits 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 most generic drugs and certain brand-name drugs
    7. Rehab and habilitative services, those that help people recover from an accident or injury and those that help people with developmental issues
    8. Lab tests
    9. Preventive and wellness services, along with those that help people manage chronic conditions
    10. Services for children, including dental and eye care

Some services not included: infertility treatment, long-term care, weight loss surgery and programs, acupuncture, and visits to a chiropractor.

Health Insurance Advisor: Check out Web MD’s Health Insurance Advisor to compare different kinds of plans based on your needs.

Financial Aid and Medicaid

You may be eligible for financial aid to help pay for insurance or for government sponsored insurance. Here’s what’s available:

Premium Subsidies (also known as Tax Credits): You may qualify for a subsidy -- money to help pay your health insurance premium each month. The subsidy may be sent directly to your health insurance company and is available only if you buy your insurance in the Marketplace.  In general, you'll be eligible if you're single and make about $45,960 or less a year, or if you have a family of four and make about $94,200 or less a year. Subsidies are based on your estimated household income for 2014.

You also may be eligible for cost-sharing subsidies that will reduce your costs when you get medical care. Cost sharing subsidies are available only if you buy a silver-level plan.

Medicaid Expansion: Some states, including Oregon, expanded Medicaid so more people can get health insurance coverage. You may be eligible if your yearly gross income is no more than about $15,856 for one person and $32,499 for a family of four. 

CHIP: The Children’s Health Insurance Program, called Healthy Kids in Oregon, provides coverage for children of some families who have a low income but are not eligible for Medicaid.

Check Cover Oregon to see if you qualify for these programs.

Available Resources

Trained navigators and assisters can teach you about the Marketplace and guide you through enrollment. They are supposed to be fair and impartial and cannot take money from insurance companies. Trained insurance agents also can help you with your choices. Here are several ways you can get help with your insurance decisions:

  • Call center: Call 855-CoverOR (855-268-3767) for information about your insurance options.
  • Web site: Find information about Oregon's Marketplace at Cover Oregon.
  • Other Resources:  You can also get help from an agent or community partner in your area.
  • Consumer Assistance Programs: Oregon Health Connect will help you understand your rights under the new law. They can help you with problems, complaints, and appeals. Call 855-999-3210. You also can get help filing an appeal from the consumer advocate at the Department of Insurance at 888-877-4894.

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