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Oregon Marketplace for Individual Medical Insurance

If self enrolling, please reference your agent's FFM ID and National Producer Number (NPN) - Click Here to locate AIA Agent FFM ID & NPN Numbers

Beginning January 1st, 2014, all individual and family health plans must meet new Affordable Care Act (ACA) requirements.

There is not a requirement to use Marketplace (HealthCare.gov) however, application for advance tax credits towards your insurance premium is only available by applying for coverage through Marketplace (HealthCare.gov).

This information applies to people who are on their own to buy individual (non-group) health insurance including: self-employed, between jobs or coverage not offered from an employer for other reasons.

Access to Healthcare

All people will qualify for health insurance regardless of health or pre-existing conditions and starting January 1st, 2014, most people must have basic (minimum essential) coverage or pay a penalty. There are certain exceptions/exemptions to this rule.

Coverage & Costs

Rates are based upon age, geographic location, tobacco use, and the benefit plan you choose.  The rates will be the same if accessed directly via the Insurance Carrier or through Marketplace.

When comparing the available health plans, your Local Certified Marketplace Affiliated Agent - Abel Insurance will be your resource to navigate you to the most beneficial plan for your needs.  There is NO additional cost for utilizing the assistance of your Local Certified Marketplace Affiliated Agent - Abel Insurance.

Individual Responsibility Payment

If you can afford Health Insurance but choose NOT to buy it, you will pay the penalty, which is known as the “Individual Responsibility Payment.”

  • In 2016, the tax penalty will increase annually based on a cost-of-living adjustment
  • The penalty for a child is half of that of an adult. Only the first 2 children are counted in calculating the penalty.
  • If you are required to pay a penalty but do not, the IRS will send you a notice. If you do not pay, the IRS can reduce the amount of any future tax refund

Get lower costs on monthly premiums in the Health Insurance Marketplace

Essential Health Benefits: The core benefits of all qualified health plans

Beginning in 2014, the Federal Affordable Care Act (ACA) requires that all health care plans, sold either through the market place exchange (ie: Cover Oregon) or directly with insurance company provide a basic package of core benefits called “Essential Health Benefits.”

The 10 Minimum Set of Essential Health Benefit Categories are:

  • Ambulatory Patient Services
  • Emergency Services
  • Hospitalization
  • Maternity & Newborn Care
  • Mental Health & Substance Abuse Disorder Services, including behavioral health treatment
  • Prescription Drugs
  • Rehabilitative & Habilitative Services
  • Laboratory Services
  • Preventive & Wellness Services & Chronic Disease Management
  • Pediatric Services, including Oral & Vision Care

Level of Coverage for Each Plan Tier:

Plan labels will help you understand the level of coverage you are buying. Insurers can sell more than one plan in each of the categories. Standard Plans will have the same essential health benefits, which make it easier to compare between different companies based on price, doctor/hospital networks, customer service, and other factors.

  • Bronze: 60% coverage of expected costs
  • Silver: 70% coverage
  • Gold: 80% coverage
  • Platinum: 90% coverage

Financial Assistance: 3 Ways to Help Pay for Coverage

Advance Payment of Premium Tax Credit (APTC)

Advance Payment of Premium Tax Credits (APTC) help offset the monthly costs of health insurance premiums. The amount you will receive is based on household income and family size. APTC can be refundable and/or advanceable. A refundable APTC is available to an individual even if you do not owe any taxes. An APTC allows an individual to receive help at the time of purchase rather than paying their premium out of pocket and waiting to be reimbursed when filing their annual tax returns.

Advance Tax Credits may not be used to help cover the cost of an employer-sponsored coverage or coverage bought outside of Marketplace. 

Oregon Health Plan

The Oregon Health Plan (OHP) provides health coverage to low‐income Oregonians through programs administered by the Division of Medical Assistance Programs (DMAP).

Healthy Kids

Healthy Kids (Oregon’s Medicaid/CHIP coverage) provides no-cost health coverage options for uninsured children and teens up to 19 years of age.

This comprehensive coverage includes provider visits, prescriptions, behavioral care, dental services and preventative care. A family’s income determines whether a child is eligible to participate.

For more information, visit: https://www.healthcare.gov/lower-costs/