Kitzhaber and Cover Oregon Roll Out Plan for Those Who Missed Out on Tax Credits

Former director Bruce Goldberg mentioned in March that consumers who bought qualified health plans outside the exchange would be eligible for retroactive tax credits, but Cover Oregon has only now made this opportunity possible. Consumers have until June 27 to apply.

Gov. John Kitzhaber announced a new order Tuesday night to help consumers who had trouble with Cover Oregon and bought health insurance outside the exchange -- giving them the opportunity to receive tax credits had Cover Oregon worked as promised.

If a consumer attempted to buy a plan on Cover Oregon during the disastrous days between Oct. 1 and March 31, but gave up and bought a plan off the exchange, such as from an insurance agent, they can now get retroactive tax credits by calling Cover Oregon, where customer service will switch them to a similar plan that was sold on the exchange.

The money will be released from the consumers’ insurance company and be used as a large rebate to reduce premium costs followed by lower premiums in each following month.

Former director Bruce Goldberg first mentioned in March that retroactive tax credits would be available to these consumers, but consumers are only now able to apply, said Cover Oregon spokeswoman Ariane Holm.

Consumers now have until June 27 -- slightly more than two weeks away -- to contact Cover Oregon and try to get their rebate. The customer service line is 1-855-COVEROR (1-855-268-3767).

The credits are limited to those with an adjusted growth income below 400 percent of the federal poverty level -- about $47,000 for an individual or $95,000 for a family of four. The retroactive tax credit program is further limited from what Goldberg described in March because it only applies to people who tried to sign up for Cover Oregon, not those who avoided the mess altogether when they opted to buy a qualifying health plan off the exchange.

“While Cover Oregon has processed more than 85,000 enrollments for commercial health insurance plans, we know too many people faced delays,” Kitzhaber wrote in a statement. “To make sure they had health coverage, some families enrolled in a plan directly with an insurance carrier. They may have missed out on tax credits that help make healthcare more affordable. Earlier this year, I said that I would work to make it right. This program delivers on that promise."

Kitzhaber’s spokeswoman, Nkenge Harmon-Johnson, did not respond to attempts for further comment.

The retroactive tax credits were made possible by a late February decision by the Centers for Medicare and Medicaid to give some flexibility to states with dysfunctional insurance exchanges. CMS did this to help these unfortunate citizens get the tax credits promised by the Affordable Care Act.

During the last legislative session, these tax credits were turned into a policy decision after passage of House Bill 4154, which was sponsored by Rep. Shemia Fagan, D-Clackamas. Fagan did not respond to a request to comment by press time.

Jesse Ellis O’Brien, the consumer health advocate at the Oregon State Public Interest Research Group, applauded the governor’s order.

“People should know if they tried to sign up at Cover Oregon, got frustrated and went elsewhere, they can now get credits. And I think that’s great,” said O’Brien.

But O’Brien did say Kitzhaber’s new tax credit opportunity comes with several caveats that might limit the number of people who participate. “It’s a complicated situation. I think a lot of people who read about it are going to be confused.”

Consumers had to purchase a qualified health plan outside the exchange from a participating insurance company. Plans offered by Regence BlueCross BlueShield do not qualify, for example, because they did not offer their BlueCross brand on the exchange. Old substandard plans that were scheduled to be canceled but got extended at the last minute by Insurance Commissioner Laura Cali also don’t count.

A consumer would also be ineligible if they bought a plan for a few months and then canceled their plan. Retroactive credits are only available for active plans. Once contacted and approved, Cover Oregon will switch the consumer to a similar or identical plan sold on the exchange.

This comes with its own caveat: plans sold on Cover Oregon frequently had smaller networks than those that insurance agents could sell that bypassed the exchange.

If a similar plan is not available at all, the consumer will be automatically enrolled in their insurance company’s standard plan. If a consumer doesn’t want that plan, they will have 30 days to pick a new Cover Oregon plan.

O’Brien said Cover Oregon has made it clear that the exchange must have evidence of some record such as a phone log proving that a consumer actually tried to get on a Cover Oregon plan before moving outside the exchange. Many of these people may have submitted an application in the fall when, it was impossible to sign up for a plan, before they aborted.

Proving you tried to apply may be difficult -- Cover Oregon lost some applications in last fall’s chaos, but Holm, the exchange spokeswoman, said they would be flexible given the circumstances.

“We will take people on their word that they made their best effort to apply,” Holm said. “Ideally, we’d have some kind of record or they submitted an application that we have on file.”

For more information on the new tax credit opportunity, check out Cover Oregon’s Q&A fact sheet.

Chris can be reached at [email protected].
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