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Marketplace Profile: Oregon's Health Insurance Exchange

Marketplace Profile: Oregon's Health Insurance Exchange

Posted Aug 26, 2013 by Jenifer Dorsey

Exchange name: Cover Oregon

Oregon’s health insurance marketplace had first been established as the Oregon Health Insurance Exchange Corporation and received the new name when the state legislature passed the final version of the business plan 

Website: www.coveroregon.com  

State-based or federally run: Cover Oregon is among the 17 declared state-based healthinsurance exchanges, which include Washington, D.C. The exchange structure is quasi-governmental, which means it is an independent public agency. 

Plans: Oregonians can enroll in medical and dental coverage through Cover Oregon, which will include plans for individuals and families as well as small employers. Twelve insurance carriers and two consumer-operated and –oriented plans Cover Oregon health plans will meet the metal level requirements —bronze, silver, gold and platinum—and include benefits in the 10 categories of essential health benefits and preventive care at no additional cost; both are Obamacare requirements for all health plans. A catastrophic plan will also be available to those who qualify, which include those younger than 30 or those who get a hardship exemption because they cannot afford health coverage through the marketplace.

A summary of the standardized health plans can be found here. Cover Oregon contracts with plans as an active purchaser, according to the Kaiser Family Foundation’s state exchange profiles. This means it can “limit the number of qualified health plans that may be offered through the exchange as long as the same limit applies to all insurers” and that it “while Cover Oregon will not negotiate rates, it will set requirements for [qualified health plans] that are stronger than the outside market in several areas.” In other words, the requirements are set to a higher standard than the Affordable Care Act baseline and limit the number of health plans sold on the exchange. Whereas the other model, the clearinghouse model, all plans that meet the minimum federal requirements for qualified health plans are sold on the exchange.

Consumers in all states are wise to consider additional protection. For instance, a bundled gap plan that includes coverages such as accident medical expense insurance and accident disability income insurancepays lump-sum cash benefits when a qualifying event occurs and can help create more comprehensive benefits like those offered through an employer. A critical illness insurance plan pays out lump-sum cash benefits upon diagnosis of certain illnesses that can be used for everything from medical bills to childcare. Supplemental insurance is not available through state-based or federally operated health insurance exchanges; however, they are easy to obtain directly from the plan’s carrier or a licensed agent or broker.


In July, the Oregon Insurance Division approved Cover Oregon health insurance premiums for 2014 and released examples. Click here to visit oregonhealthrates.org and find individual and small-group sample rates based on area. More detailed information will be available when open enrollment begins Oct. 1 for Jan. 1, 2014 coverage.

Twelve insurance companies and two consumer-operated and -oriented plans submitted rates for approval in the individual or small employer markets, according to a July 10, 2013, press release from Oregon’s Department of Consumer and Business Services Insurance Division. 

Under the Affordable Care Act, Americans cannot be denied coverage or charged more due to preexisting conditions. Premium rates will be established based on age, geography, family size and tobacco use. These provisions apply whether plans are purchased via the marketplace or not. Plans purchased off the marketplace will not qualify for subsidies or tax credits. 

Use the healthedeals.com Health Care Reform Calculator, which was listed among The Financial Times “Best Online Tools for the Toughest Health Questions,” to estimate your Obamacare health insurance cost and tax credit. 

Marketing campaign slogan: Long Live Oregonians

In July, Cover Oregon launched a nearly $10 million multimedia campaign officially introducing its residents to the marketplace. The first rollout included colorful, vibrant and catchy TV and radio ads featuring Oregon musicians Matt Sheehy and Laura Gibson against some of the state’s scenic backdrops. The spots also depicted residents fly fishing, welding, hiking, canoeing and sightseeing, among other activities enjoyed by Oregonians. Print and online ads will follow, and future waves will provide more specific information about Cover Oregon.  An estimated 320,000 people will buy health insurance through Cover Oregon, according to LifeHealthPro.com

In the news: 

Cover Oregon made headlines this month when news broke that consumers will not have direct access to the online exchange starting Oct. 1.  The Oregonian’s Oregon Live reported Aug. 8 that Cover Oregon will, however, list agents and community partners who can work with individuals who are ready to begin the process or even fully enroll at that time. The agency estimates that consumers will be able to directly purchase coverage from the Cover Oregon website sometime mid-October. 

Need coverage now?

If you need health insurance to get you by until January 1, 2014, a temporary insurance plan can provide coverage for as few as 30 days. Start shopping on healthedeals.com or contact a sales consultant for more information on short-term health insurance and supplemental plans.

Jenifer Dorsey is a freelance writer whose specialties include health and fitness, wellness, sports and recreation. She is a competitive amateur track cyclist who also enjoys mountain biking, hiking, camping and other outdoor adventure. Jenifer received a B.A. in journalism from Columbia College Chicago and is an MFA candidate at Naropa University. She lives in Colorado.