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Health Insurance Exchange takes effect January 2014
Small businesses, as well as families and individuals, will be able to use the central online marketplace to shop for and compare coverage options
December 27, 2012
The Centers for Medicare and Medicaid Services (CMS) gave Oregon conditional approval earlier this month for its plan to operate a health insurance exchange.
The plan, called Cover Oregon, will help connect thousands of Oregonians to health coverage. Oregon was among the first six states in the nation to receive conditional approval of its “blueprint” application. The plan will affect Oregonians in all parts of the state, including Central Oregon.
Cover Oregon is a central online marketplace where individuals and small businesses can shop for and compare health coverage options and access financial assistance, starting in October 2013. Coverage for plans purchased through Cover Oregon will be effective Jan. 1, 2014.
“I think this gives individuals and businesses more options to be able to provide health insurance for individuals,” commented Muriel DeLaVergne-Brown, Crook County Health Department Director.
According to the Small Business Administration, Oregon’s small employers account for more than 50 percent of the private sector jobs in Oregon, but as health care costs continue to increase, only about 34 percent with fewer than 10 employees offer health insurance.
Cover Oregon’s online marketplace will make it easier for employers to offer insurance to employees and simple for employees to enroll. Initially, only employers with fewer than 50 employees are eligible to purchase Cover Oregon plans. In 2016, Cover Oregon will begin enrollment for employers with up to 100 employees. For rural areas such as Prineville, this will impact small businesses that struggle to provide health insurance for their employees.
“Cover Oregon basically will provide an internet portal site for people to go so that they can determine first, their eligibility for either the state’s Medicaid program, or to see if they are eligible for tax credits from the federal government to purchase health insurance,” explained Cover Oregon CEO Rocky King.
He went on to say that depending on their eligibility, they will have a choice of plans that can be sorted by a variety of factors. Visitors to the site can make comparisons on prices, networks, and quality of care, among other things. They can enroll in a plan online, make a first payment, and start coverage immediately.
“And then it’s really between the carrier and them.”
He added that a small business can go on the portal and have the same access that an individual does. The lines will be open Oct. 1, 2013 for enrollment, and effective coverage begins Jan. 1, 2014.
“Cover Oregon is a key piece of Oregon’s efforts to transform our health care system,” said Governor Kitzhaber. “With transparency about quality and prices and the ability to make apples-to-apples comparisons, Oregonians will be empowered to make decisions about their health coverage.”
“The Oregon State Legislature created the exchange,” said Jamal Raad, spokesperson for Senator Jeff Merkley (D-Ore.)
Oregon’s Health CO-OP is a not-for-profit health plan that is forming under the provisions of the Federal Patient Protection and Affordable Care Act, which will offer commercial health insurance plans for individuals and employers through the Cover Oregon health insurance exchange.
“The idea behind the exchange is to give people the opportunity (to get affordable health insurance) — both individuals and small businesses — who have traditionally had difficulty affording and getting insurance,” said Oregon’s Health CO-OP CEO Dr. Ralph Prows.
He added that part of the concept behind the exchanges is that there will be subsidies for people up to 400 percent of the federal poverty level, which will allow them to receive a subsidy towards the cost of insurance premiums on the exchange.
“That will mean that it will become much more affordable for many more people,” he said.
Through Cover Oregon, individuals and families will be able to easily compare plans, see quality grades for carriers and plans, and access financial assistance to help pay for premiums.
Small businesses will be able to offer more options to their employees through Cover Oregon, and some will qualify for tax credits to help pay to cover their employees.
“We are pleased to have completed this important step in developing a state-based exchange,” said Liz Baxter, chair of the Cover Oregon Board of Directors. “As we prepare for our launch next fall, we will continue to engage the public to ensure Cover Oregon meets the unique needs of Oregonians.”
To learn more about Cover Oregon, including schedules of public meetings, visit www.coveroregon.com.
Oregonians can find out if they may qualify for financial help by visiting the calculator on the Cover Oregon website, at http://www.coveroregon.com/calculator.php.