ACA Open Enrollment Goes Through Aug. 15

Many Oregonians are eligible to buy health insurance through the Oregon Health Insurance Marketplace. You might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Because of the pandemic, the Marketplace’s enrollment window is open through Aug. 15. 

Most people already enrolled in Marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households that qualify for them. Every household whose health coverage premiums are more than 8.5 percent of their household income now qualifies for federal premium tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person). 

The average American with an ACA marketplace plan can save an additional $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022. 

Who is eligible?

• Most Oregonians, including U.S. citizens and lawfully present immigrants with a wide range of statuses, as outlined on the HealthCare.gov website, are eligible to shop through the Marketplace if they are not offered coverage through an employer, Medicare, or the Oregon Health Plan.
• You may also qualify for the Oregon Health Plan  (Medicaid), which offers free or low-cost coverage to low-income individuals and families. Children and pregnant individuals may qualify for the Oregon Health Plan, regardless of their immigration status.

When can I enroll?

• Anytime through Aug. 15.
• Year-round enrollment is open to Oregonians who qualify for the Oregon Health Plan. American Indians and Alaska Native shareholders are eligible to enroll in coverage at any time throughout the year through the Marketplace.
• Special enrollment periods are also open to those who’ve lost or will be losing their job-based health coverage and to those who’ve experienced a qualifying life-change event, such as the birth of a child, a divorce, or a change in citizenship.
• Open enrollment for 2022 starts Nov. 1 and ends Dec. 15, 2021.

How do I sign up?

Get started by previewing plans and savings at OregonHealthCare.gov/WindowShop. Once you find out which program you qualify for, apply for health coverage. The Marketplace will allow you to enroll in health coverage right away if you’re eligible to shop. To get started: 

• Window shop: Go to OregonHealthCare.gov/WindowShop to preview what program, plans, and savings are available to you..
• Get help: Visit OregonHealthCare.gov/GetHelp to find a health coverage expert that offers free assistance near you.
• If you have health coverage and what to see if you can save more visit OregonHealthCare.gov/WindowShop to preview the updated savings available to you. To take advantage of these savings log in to HealthCare.gov and update your 2021 application. Once you submit your updated information the Marketplace will recalculate your financial help based on the updated rules.
• Jump in and enroll in health coverage through the Marketplace: Visit HealthCare.gov to create an account or log in to an existing account. Complete a 2021 application for coverage and choose your health plan. Dental coverage is also available to Marketplace health plan enrollees.
• By phone: Call the HealthCare.gov customer service line at 800-318-2596 (toll-free) for help with the Marketplace application in your language. HealthCare.gov customer service is available 24 hours a day, seven days a week. If you’re hearing impaired, call the TTY line at 855-889-4325.
• In person: Insurance agents can help you choose a plan, while application assisters can answer general questions and help you navigate the enrollment process. Both are typically available for free by phone, virtually or in person. Go to OregonHealthCare.gov/GetHelp to search for a health coverage expert in your area to arrange a one-on-one meeting.
  

What is covered, and how much will it cost?

Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age of who is enrolling in coverage.  If you qualify for the Oregon Health Plan, you’ll be able to get free coverage and will not need to worry about premiums or copays.  All Marketplace plans cover 10 essential health benefits including: 

• Ambulatory services, care you get without being admitted to a hospital
• Emergency services
• Hospitalization
• Pregnancy, maternity, and newborn care
• Mental health and substance use disorder services including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services, including services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills
• Lab services
• Pediatric care
• Preventive services and chronic disease management, including screenings and vaccinations, are available at no cost when ordered by a provider and visiting an in-network doctor.

Health insurance companies cannot deny coverage or charge more for coverage and care because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family. Deductibles and out-of-pocket costs vary between plans.

What about new federal assistance for premiums?

Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums. For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.

Is there any other financial assistance available?

Yes. You may also qualify for a cost-sharing reductions that reduce such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance unless you are an American Indian or Alaska Native shareholder. If you’ve recevied unemployment benefits this year, even for just one week, you may qualify for a $1/month premium health coverage option, thanks to the American Rescue Plan. This subsidy became available in July. If you’ve already received unemployment benefits this year while enrolled in a Marketplace plan, you’ll be able to claim the additional subsidies for the months prior to July when you file your 2021 tax returns. This extra financial help will expire at the end of 2021. 

What plans are available? All plans offered through the Marketplace offer three tiers of coverage:

• Bronze plans have the lowest monthly premiums, the highest deductibles and copays, and cover roughly 60 percent of care costs.
• Silver plans have moderate monthly premiums, deductibles, and copays. They cover roughly 70 percent of care costs.
• Gold plans have higher monthly premiums and lower deductibles and copays and cover roughly 80 percent of care costs.

Visit OregonHealthCare.gov/WindowShop to browse your options, estimate costs and benefits of various plans, and check whether you might qualify for financial assistance.  

What if I already have health insurance?

If you already have coverage directly through an insurance company but are eligible for lower premiums, you can switch to a Marketplace plan. You must enroll in Marketplace coverage before Aug. 15 or during open enrollment – Nov. 1 to Dec. 15. If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours, you should be receiving a temporary COBRA premium subsidy that covers 100 percent of your monthly premium cost. This premium assistance, made possible through the American Rescue Plan, runs through the end of September or the end of your last month of COBRA eligibility, whichever comes first.  If you’re on COBRA, you may want to sign up for a Marketplace plan that starts as soon as your COBRA coverage ends. If you’re not sure about whether making this switch makes sense for you, ask for free advice from a certified insurance  agent. If you already have a plan through the Marketplace and want to adjust your coverage, you can select a new plan by the Aug. 15 deadline.

Will I need to get a new doctor?

That depends. Major insurance providers, Bridgespan, Kaiser Permanente, Moda Health, PacificSource, Providence, and Regence, offer Marketplace plans, but not all doctors are in network with all plans. The insurance company websites include links to search for doctors in their networks, but you should double check with your doctor’s office to see whether a certain doctor or practice will accept a particular Marketplace plan.

Will my family members qualify for the same health plan that I do?

It depends. You can enroll as a family, but some families may choose to enroll in different plans. Children and pregnant people may qualify for coverage through the Oregon Health Plan. The Marketplace will guide you through your eligibility. If you’re not sure what coverage and plans make sense for your family, find a health coverage expert at OregonHealthCare.gov/GetHelp.

Thank you to the Dept. of Consumer & Business Services for providing current information https://www.oregon.gov/dcbs/Pages/index.aspx