So What is Cover Oregon All About?

By now, many of you have seen the Cover Oregon commercial that tries to make Oregonians aware of health insurance plans that will be available in 2014 (with Open Enrollment set to begin in October) under the state’s exchange, or marketplace.  If you have not seen the advertisement, here it is:


What is Cover Oregon?

Cover Oregon is a central online location where the people of Oregon can shop for and compare health insurance plans through the state’s exchange, or marketplace.  In addition, the site will assist potential customers with determining their eligibility for subsidies to make the insurance plans in the marketplace more affordable.

Gotcha.  Now What is a Health Insurance Marketplace?

The Patient Protection and Affordable Care Act (PPACA), or as most people know it, Obamacare, outlined what are called health insurance exchanges.  The terminology has been changed to marketplaces, but the idea is the same.  With one stated goal of the Affordable Care Act being to help more people obtain medical insurance coverage, lawmakers wanted to create a simple way for customers to compare plans while eliminating as much confusion as possible.  Enter the marketplaces.

The marketplaces will be set up by each state, but not all states are participating.  Citizens of states that do not have a marketplace will be allowed to purchase insurance through a federal marketplace.  Once set up, Americans will be allowed to go online to these exchanges, and compare health insurance plans.  The plans will have the same benefits, just different levels of potential out of pocket expenses.

The plans will be called Gold, Silver, Bronze, and Platinum.  The Platinum plan will have the least out of pocket exposure but will cost more than the other plans.  Conversely, the Bronze plan will have the most out of pocket exposure but will cost less than the other plans.

Will These Exchanges Cost More than My Group or Individual Plan?

Maybe, maybe not.  It is very hard to compare insurance plans on an apples-to-apples basis since there are so many variables that go into an insurance premium.  If you look for plans at an online marketplace like Cover Oregon and you are not satisfied with the premium, you are still free to look for insurance elsewhere.

Will I Be Able To Get Financial Assistance for the Premiums?

Financial assistance will be available to people if they make less than certain thresholds.  Individuals earning less than 400% of the federal poverty level will definitely be eligible for financial subsidies.  The subsidies work like a tax credit, but if you cannot wait until tax time to receive your money then there are options available to get the help immediately.

Will Other States Have Sites Like Cover Oregon?

For states that have marketplaces, then yes, they will have an online site where their citizens can buy medical insurance.  As time goes on, the sites will become easier to navigate and will truly be a one stop shop for finding solutions to your healthcare needs.  There is just no guarantee that they will have as catchy a tune as Cover Oregon.

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Is a Health Insurance Exchange Something a Young Person Should Enroll In?

When the Patient Protection and Affordable Care Act (PPACA), or as it is commonly known, Obamacare, was passed, the law set up the idea of a health insurance exchange, which would allow individuals to go online and more easily shop for medical insurance.  The exchanges did not eliminate the ability to obtain insurance through an employer or on the individual insurance market outside of the exchange.  But it did provide a new option.

What is a Health Insurance Exchange?

A health insurance exchange is an online marketplace that will allow individuals to compare medical insurance plans with different plan designs and from various health insurers.  In fact, the exchanges have now become known as health insurance marketplaces.

The exchanges are administered on a state level.  Each state has the responsibility to set up their own marketplace and recruit insurers to participate.  Some states have elected not to set up an exchange.  In those instances, the residents of a non-participating state will be able to find health insurance coverage through a federal exchange.

Insurance companies are not required to participate in every available exchange.  They are free to choose which one fits their plans the best.

What are the Benefits of a Health Insurance Exchange?

The online marketplaces allow individuals to see side-by-side the different options available to them.  Gone are the days of struggling to understand the coverages available and the premiums that the insurance plans cost.

PPACA also has a subsidy provision in it for lower wage earners.  If you earn under a certain threshold (originally set at 400% of the poverty level), you will be eligible for tax credits.  The health insurance exchanges will be able to run a calculation for you to determine if this tax subsidy applies to your situation.  In most cases, the subsidy will be taken into account on your next year’s tax return, but if you cannot wait that long, the exchanges can reduce your premium up front.

Lastly, the exchanges are simply another way to enter the health insurance market.  If you do not have a group plan available and you are not satisfied with your options in the individual market, the exchanges are another great place to look.

Should a Young Person Enroll in a Plan on a Health Insurance Exchange?

Whether or not to enroll in a plan on the exchange is a personal one.  If you have medical benefits available to you through your employer, then it will usually always be advantageous to accept those benefits.  Employers usually subsidize the cost of the premiums for their employees.

PPACA also requires insurers to allow children to remain on a parent’s plan until age 26.  If you are below age 26, you can probably save money by enrolling in your mom or dad’s plan, if they have one.  This is especially the case if you have siblings that are still on the plan.  Most likely, your parent is already enrolled in a family plan, so adding you will not cost any extra money.

If those options are not available, then it comes down to purchasing insurance on your own directly through an insurance company or through the health insurance exchange.  The exchange will probably be easier to navigate, but that doesn’t mean that you will find the best price there.  Not every insurance company is going to be available on the exchange, and you may be able to find a better price by staying away from the exchange, although that could take some effort on your part.

A health insurance exchange isn’t anything to be afraid of, but look around before deciding that it is your best option for your health care needs.  You can find your state’s exchange here.

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