People in the Beaver State have plenty of options when it comes to health care. According to a study by US News, Oregon has the 20th best health insurance in the country. The study considers access, quality, and good public health.
Health insurance options in Oregon
The Oregon Division of Financial Regulation is a great resource for health care. You can also find coverage in Oregon through these options:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Oregonians get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 48% | ||
| Individual or family | 7% | ||
| Medicaid | 22% | ||
| Medicare | 16% | ||
| Military | 1% | ||
| Uninsured | 7% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Only seven percent of Oregonians are uninsured, less than the national average. That’s good news for Oregon policyholders! More uninsured people lead to higher rates for insured people.
Oregon health insurance companies
What are the best health insurance companies in OR? These are the providers that offer individual and family plans in your state:
- BridgeSpan
- Kaiser Permanente
- Moda
- PacificSource Health Plans
- Providence Health Plan Oregon
- Regence
Oregon health insurance costs and rate factors
State residents spend an average of $8,044 per year on health care, about the same as the national average. What determines your costs in OR? Insurance rates vary person to person, but they mostly depend on these factors:
Plan type
The more health care coverage you want, the more you’ll have to pay in monthly premiums. Marketplace plans come in metal tiers: bronze, silver, gold, and platinum.
How much should you expect to pay in the Beaver State? These are the average rates for a middle-aged Oregonian in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $314 | $428 | $468 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
You’ll be paying about 49 percent more for a gold plan than for a bronze plan. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent.
The lowest level of coverage available in the marketplace is a catastrophic plan. These plans have low monthly premiums but a high yearly deductible of $8,150. Because of this, it may save you money to purchase a bronze or silver plan.
Body mass index
According to the CDC, a higher body mass can lead to several serious health conditions. That’s why insurers will look at your BMI to analyze your risk-level. A higher BMI leads to higher insurance rates.
In 2019, OR had a 29 percent obesity rate, the 40th highest in the country. Of the many Oregon residents using QuoteWizard to compare health insurance plans, 33 percent have a BMI in the obese range.
Tobacco use
It’s no surprise that tobacco users pay more for health insurance due to the health risks from smoking. About 16.1 percent of Oregonians are smokers, the 31st lowest rate in the country.
Age
Older people tend to pay up to three times more than younger people for health care. OR residents who used QuoteWizard to shop for health insurance are, on average, 40 years old.
Location
A big factor in your costs comes from where you live. Every state has different rules, regulations, and providers surrounding their marketplace.
Also, many insurers use community-rating systems to determine your costs. That means rates are based on the combined claims everyone files. So, if people in your state file an abnormally high number of rates, your prices could jump.
That means living in a healthier state could lower your premiums. According to America’s Health Rankings, Oregon is the 20th healthiest state in the country.
Coverage options vary based on your zip code, so check provider websites for more information on your county.
Oregon health insurance laws
The Affordable Care Act limits what insurers can consider while pricing your policy.
- Pre-existing conditions: Thanks to the ACA, insurance companies can’t charge you more because of a pre-existing condition. That didn’t used to be the case. People who fell into this category paid significantly more- if they could even get coverage to begin with.
- Gender: Insurance companies aren’t allowed to charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Providers also used to analyze your insurance and medical history. Now, they can’t price your policy based on any lapses in insurance or previous medical problems.
Your marketplace plan has a cap on it for out-of-pocket costs. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Oregon law requires health insurance companies to provide at least some coverage for the following services:
- Emergency room services
- Clinical trials
- Pregnancy and childbirth
- Contraceptives
- Prosthetic and orthotic devices
- Speech therapy
There are more services that companies need to offer coverage for. Find the entire list on cms.gov.
Medicare and Medicaid in Oregon
Medicare and Medicaid are both government-funded programs. Program specifics vary state to state, but they always cover two different groups of people. Medicare aids seniors, whereas Medicaid helps low-income families and children.
Medicare
Medicare was created for people age 65 and older. There are several types of coverage within Medicare. These categories include parts A, B, C, D, and supplemental coverage plans. As an OR resident, you may also qualify for one of these Medicare Savings Programs:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Oregon Office of the Insurance Commissioner
Oregon Division of Financial Regulation
- Insurance Commissioner:
- Andrew R. Stolfi
- Insurance Hotline:
- 866-814-9710
- Hours:
- Monday - Friday
8:00 am - 5:00 pm
File a Consumer Insurance Complaint
Sources:
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