For many Oregonians, it’s time to sign up for health insurance.
Low-income residents in the Portland metro area, Lane County and parts of Southern Oregon who are on Medicaid have through Nov. 17 to sign up for an insurer for 2020. In the Portland area, the choice for roughly 320,000 residents is between Trillium Community Health Plan and Health Share of Oregon. Lane County’s roughly 90,000 Medicaid patients can pick Trillium or PacificSource.
Open enrollment is also underway for senior citizens. People 65 and over who have Medicare Advantage plans and prescription drug coverage have until Dec. 7 to pick their insurer and plan for next year.
And it's open enrollment for the Oregon Health Insurance Marketplace, a state government program that helps people buy insurance in the private market for individuals and small businesses.
For many Oregonians, the fall enrollment or insurance choice periods aren’t that important. For example, Medicaid recipients in regions of the state covered by only a single Medicaid insurer, a so-called coordinated care organization, are automatically signed up for 2020 and don’t have to do anything. And, for example, if you have commercial health and are not slated to turn 65 until mid-2020, you don’t have to sign up yet for Medicare. Your signup window opens three months before you turn 65, including the month you turn 65.
If you expect to have commercial health insurance through your employer in 2020, you don’t need to give the Marketplace a second thought.
But for many, the final quarter of the year is an important time to pay attention.
About 1 million low-income Oregonians are on Medicaid (the Oregon Health Plan). About 600,000 elderly state residents are on federal Medicare. About 185,000 people are covered by individual commercial policies, and about 174,000 people are covered by small-group policies. These are typically bought via the state Health Insurance Marketplace.
Finally, about 1.8 million private- and public-sector employees receive or pay for insurance through their workplace.
Medicaid Members Have Multiple Choice Times
The Oregon Health Authority is already sending Medicaid/Oregon Health Plan beneficiaries information about their insurance choices. In regions where there is a choice, the state has tentatively assigned a member to an insurer. Members can change insurers through Nov. 17, and then again Jan. 1 through March 31. The state and insurers have websites where members can compare plans. But those websites may not be accurate, especially for determining provider networks. For example, Eugene-based Trillium, which is seeking to sign up Medicaid members in the Portland metro area, notes on its website that its “provider search tool” isn’t applicable for Portland-area residents and that its “provider directory is subject to change.” Trillium urges members or potential members to telephone its call center instead.
For more information about the Oregon Health Plan: www.oregon.gov/oha/HSD/OHP
New Website For Marketplace
Meanwhile, the Oregon Department of Consumer and Business Services has unveiled a new website for people who need insurance through the Oregon Health Insurance Marketplace or need to re-enroll in insurance. The site allows people or small businesses to compare plans in their region and see whether they’ll be able to apply for a subsidy in the form of a federal income tax credit in 2020. The tax credits are based on an individual’s or household’s income.
The marketplace is only open for general enrollment from Nov. 1 through Dec.15. Once that deadline passes, people can buy insurance via the Marketplace only when they have a major life change, such as having a baby, adopting a child or losing other health insurance, the state said.
Consumers typically buy health insurance through the Marketplace if their income level makes them ineligible for Medicaid, if they don’t receive insurance through an employer or if they are not yet 65. The federal tax subsidies can be a big help. In 2019, 74 percent of Oregonians who purchased health insurance via the Marketplace received subsidies and paid an average of just $140 per month for their coverage, the state said.
“People who do not qualify for the Oregon Health Plan and do not get health insurance at work may qualify for a subsidy through the Marketplace,” said Chiqui Flowers, Marketplace administrator. “This (website) tool helps get specific about costs and benefits for those Oregonians.”
Health insurance sold through the Marketplace is individual and family coverage offered by private companies, such as Bridgespan, Kaiser, Moda, PacificSource, and Providence. Not every company is available in every part of the state, but at least two insurance companies and at least seven plan choices are available everywhere in Oregon. In the Portland metro area, all five companies offer a total of 41 plan options.
For more information, visit www.OregonHealthCare.gov/windowshop
Medicare Annual Enrollment Underway
Meanwhile, the annual enrollment period for Medicare Advantage plans and drug coverage runs through Dec. 7.
Medicare members can use the annual enrollment period to re-evaluate and compare their Medicare Advantage and Part D prescription drug plans to other offerings on the market. The annual enrollment period is important because each year insurance companies can make changes to their Medicare plans, covering everything from a member’s out of pocket payments to provider or pharmacy networks. For example, Trillium and Tigard-based health insurer Health Net both have the PeaceHealth hospital system on their provider panels for 2019, but the hospital system will not participate in Trillium’s and Health Net’s Medicare plan in 2020.
In 2020. During open enrollment, patients can switch Medicare plans, but the period cannot be used to sign up for Medicare. That happens around a person’s 65th birthday.
Seniors and those with disabilities can drop their Medicare Advantage plans and revert to original Medicare from Jan. 1 through Feb. 14.
For more information on Medicare, visit healthcare.oregon.gov and navigate to Medicare.
You can reach Christian Wihtol at [email protected].