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This is not the official website for Cover Oregon, but as a Certified Agent with Cover Oregon I can answer your questions.  Please visit http://www.coveroregon.com for complete information and coverage options.
 

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Coverage offered in the following cities and locations

A Real Person will Answer 9:00 AM to 8:00 PM

Call Doug Ellsworth

503-922-2903

Cascade Mountains

CITIES Brightwood, Camp Sherman, Cascade Locks, Cascadia, Chemult, Chiloquin, Crescent, Crescent Lake, Detroit, Diamond Lake, Drew, Estacada, Fort Klamath, Gates, Gilchrist, Government Camp, Idanha, Klamath Agency, La Pine, Lakeview, McKenzie Bridge, Mill City, North Umpqua, Oakridge, Prospect, Rhododendron, Sandy, Sisters, Sunriver, Warm Springs, Welches, Westfir, Zigzag
AREAS:  Crater Lake National Park, Deshutes National Forest, Fremont National Forest, Mount Hood National Forest, Rogue River National Forest, The Three Sisters, Umpqua National Forest, Willamette National Forest, Winema National Forest

Central Oregon
CITIES:  Antelope, Arlington, Bend, Brothers, Condon, Culver, Dufur, Fossil, Grass Valley, Hampton, Lonerock, Madras, Maupin, Metolius, Mitchell, Moro, Mosier, Paulina, Post, Prineville, Redmond, Rowena, Rufus, Shaniko, Spray, The Dalles, Wasco

Northeast Oregon
CITIES:  Adams, Arlington, Athena, Baker City, Boardman, Canyon City, Condon, Cove, Dayville, Echo, Elgin, Enterprise, Fossil, Greenhorn, Haines, Halfway, Heppner, Hermiston, Huntington, Imbler, Imnaha, Irrigon, Island City, John Day, Joseph, La Grande, Lexington, Long Creek, Lostine, Medical Springs, Milton-Freewater, Monument, Mt Vernon, North Powder, Oxbow, Pendleton, Pilot Rock, Prairie City, Richland, Seneca, Summerville, Sumpter, Ukiah, Umatilla, Union, Unity, Wallowa, Weston
AREAS Hell's Canyon

Oregon Coast
North Coast
Astoria, Bay City, Beaver, Cannon Beach, Garibaldi, Gearhart, Hebo, Nehalem, Manzanita, Neahkahnie, Oceanside, Pacific City, Rockaway Beach, Seaside, Tillamook, Warrenton, Wheeler
Central Coast
Depoe Bay, Dunes City, Florence, Gleneden Beach, Lincoln City, Mapleton, Newport, Otter Rock, Reedsport, Seal Rock, Siletz, Toledo, Waldport, Winchester Bay, Yachats
South Coast
Agness, Bandon, Brookings, Charleston, Coos Bay, Coquille, Gold Beach,
Lakeside, Myrtle Point, North Bend, Port Orford, Powers, Wedderburn

Portland and Vicinity
Banks, Barlow, Beaverton, Camas, Canby, Clackamas, Clatskanie, Columbia City, Cornelius, Forest Grove, Gaston, Gresham, Happy Valley, Hillsboro, Lake Oswego, Marquam, Milwaukie, Molalla, North Plains, Oregon City, Portland, Rainier, Sandy, Scappoose, St. Helens, Tigard, Troutdale, Tualatin, Vernonia, West Linn, Wilsonville

Southeast Oregon
Adel, Adrian, Burns, Diamond, Drewsey, Frenchglen, Hines, Jordan Valley, Juntura, Lakeview, Nyssa, Ontario, Plush, Vale

Southern Oregon
CITIES Ashland, Butte Falls, Cave Junction, Canyonville, Central Point, Dillard, Drain, Eagle Point, Elkton, Glendale, Glide, Gold Hill, Grants Pass, Jacksonville, Klamath Falls, Malin, Medford, Merlin, Myrtle Creek, Oakland, Phoenix, Prospect, Riddle, Rouge River, Roseburg, Shady Cove, Sutherlin, Talent, Umpqua, White City, Winchester, Winston, Wolf Creek, Yoncalla
AREAS:  Applegate Valley, Illinois Valley

Willamette Valley
Albany, Alsea, Amity, Aumsville, Aurora, Brooks, Brownsville, Canby, Canyonville, Carlton, Corvallis, Coburg, Cottage Grove, Creswell, Culp Creek, Dallas, Dayton, Detroit, Donald, Dundee, Eugene, Falls City, Gates, Gervais, Halsey, Harrisburg, Independence, Jefferson, Junction City, Keizer, Lebanon, Lowell, Lyons, McMinnville, Mill City, Millersburg, Mt.Angel, Molalla, Monmouth, Newberg, Oakridge, Oregon City, Philomath, Salem, Scio, Scott Mills, Sheridan, Silverton, Sodaville, Springfield, Stayton, St. Paul, Sublimity, Sweet Home, Tangerit, Turner, Veneta, Walterville, Waterloo, Willamina, Woodburn, Yamhill

Key words when looking for information on the CoverOregon Health Insurance Exchange.  Most people search for Free Obama Health Care in Oregon, or Obama Care Oregon, or Low Cost Obama health insurance, or Obama free health insurance oregon.  This site has all the information needed at this time with Low Cost options prior to Free Low Cost Obama care health insurance.

OregonACA.com

Key Websites

Cover Oregon

1-855-268-3767


OHP/Medicaid

1-800-699-9075

503-945-5772


HealthCare.gov

800-318-2596





Breaking News

 
 

 


   Health Benefits Solution, Inc

   Cover Oregon Health Insurance Exchange


CoverOregon Health Insurance Exchange, ACA Affordable Care Act, Obama Care

Fax Completed Application to 503-488-5597 or Toll Free 1-877-722-2378

To View ACA 2015 Health Plans and Rates visit

Oregon ACA Affordable Care Act

http://www.OregonACA.com

Health Insurance Companies 2014 Health Plans

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Select Your Plan

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Submit Your Enrollment

 

Open Enrollment Ends April 30th, 2014

 

"Click this Link"

Find My Doctor

 

 

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STM Short Term Medical

Agent of Record Consent Form

Careington Dental Fee Schedule

$11.95 Online Application

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IMG Travel Medical Insurance

IMG coverage brochure

Dr. Dan Thompson, Recommended Dentist for most all Dental Coverage "Click this Link"

My time and services are free and I am available 9:00 am to 8:00 pm 7 days a week.

Talk With A Real Person! 

Doug Ellsworth Certified Agent NPR# 7139388 Will Answer Your Questions

503-922-2903

Doug@MyOregonAgent.com

Currently the Cover Oregon software and website portal to see plans and rates, including Tax Credits are only available to Agents and Community Assisters, and the public will have access later in October 2013

As a Certified Agent with Cover Oregon I can explain Obama Care Plans available October 1st, 2014 and let you know if Tax Credits and Reduced premiums are available, and what Health Insurance will cost for you! 

If you would like my help just click the link below and e-mail your request for help in October, or any questions that I can answer now! If you call I will Answer!

Help Me Set Up Obama Care Health Insurance Plans in Oregon

About the Carriers in Oregon and plans offered in counties

Use our Individual Calculator and Plans to estimate your 2014 health care costs

through Cover Oregon Exchange Plans.

Prior to Oregon's Health Insurance Exchange, Health Benefits Solution, Inc can offer and explain the best health insurance options available in Oregon for Child Only, Individual, Family and Small Business offering major health coverage, vision, prescriptions and dental coverage.

Visit http://www.MyOregonAgent.com for health insurance options

Health Benefits Solution, Inc is a leader in offering health insurance coverage for all individuals, and small business in Oregon.  The Affordable Care Act and CoverOregon will offer affordable health insurance options to all Oregonians.

The purpose of this webpage is to help share the information on the Oregon Health Insurance Exchange, and the Affordable Care Act signed by President Obama. All information on this webpage is collected and shared from websites currently explaining progression of the Oregon Health Insurance Exchange including but not limited to http://www.CoverOregon.com Please visit this official website for all and current information.

March 26th, 2014

Governor Kitzhaber Announces Cover Oregon Extended Application Period, New Tax Credit Options for Small Businesses

Oregonians have until April 30 to apply for private health insurance

 

(Salem, OR) — Governor Kitzhaber announced today that Oregonians now have until April 30, 2014, to apply for private health insurance. The announcement came following conversations between the Governor and Health & Human Services (HHS) Secretary Kathleen Sebelius. Oregon’s extended application period is in response to technology issues that lengthened the time it takes to apply for and enroll in health insurance through Cover Oregon, the state's health insurance exchange. 

“I know that for too many Oregonians, the Cover Oregon website and its ongoing technical problems have created delays, confusion, and frustration,” said Governor Kitzhaber. “I worked with Secretary Sebelius to give Oregonians more opportunity to secure health care coverage and get the financial help they deserve.” 

Under HHS guidelines, each state may have its own approach to managing extended application periods. Oregon’s extended application period is targeted to people purchasing private health insurance coverage either through Cover Oregon or directly from an insurance carrier. People who purchase through Cover Oregon can access tax credits and other financial assistance. Oregonians who are eligible for the Oregon Health Plan or Healthy Kids can apply for coverage year round. Governor Kitzhaber said, “Cover Oregon has successfully completed more than 175,000 enrollments for Oregonians across our state. I want to make sure that people know they can still apply. They have time to do so, for themselves and their families, and they should take advantage right away.” Oregonians have until April 30 to submit their application for private coverage.

Oregonians can find an agent or community partner in their area who can help them enroll in one sitting by visiting CoverOregon.com. They can also go to CoverOregon.com to find resources to apply, including an online PDF application they can submit electronically. Those who apply for coverage from a private plan through Cover Oregon before April 30 and then later enroll will not be subject to a potential federal tax penalty. People who apply and enroll in plans outside of Cover Oregon between April 1 and April 30 may have to pay a partial federal penalty. The Oregon Insurance Division will provide more information about how penalties may apply to individuals who do not apply for coverage through Cover Oregon. Answers to questions about the extended application period can be found here

Help With Tax Credits for Small Businesses

The Governor also announced an agreement between Cover Oregon and participating insurance companies that will help small businesses access federal tax credits. Qualified small businesses that purchase a Cover Oregon-certified plan after April 1 directly from an insurance company will be able to access tax credits for 2014. “This is an important step forward to support small businesses and get health insurance coverage for more people,” said Governor Kitzhaber. 

For the small business tax credit, Cover Oregon will provide an eligibility notice to Oregon employers that qualify to participate. Eligible businesses must have 50 or fewer full-time equivalent employees; purchase a “qualified health plan” certified by Cover Oregon; and contribute at least 50 percent of the premium cost for employee coverage. With confirmed eligibility, employers can apply for the Small Business Health Care Tax Credit when filing their 2014 taxes. The Internal Revenue Service, not Cover Oregon, determines eligibility for the tax credit. Cover Oregon developed the new process for facilitating the employer tax credit in cooperation with Atrio, Health Republic, Kaiser Permanente, Moda, Oregon’s Health Co-op, PacificSource, Providence, Trillium, Best Life, Dental Health Services, Guardian, and ODS. “Insurance companies have provided us a great deal of flexibility to serve Oregon small businesses,” said the Governor. 

Oregonians with questions about how to apply can visit CoverOregon.com or call 1-855-CoverOR. The Cover Oregon service center is open Monday-Friday from 8am to 8pm, and Saturday-Sunday from 8am-6pm. Additional information on small business tax credit may be found here

Key dates in the future:

October 2013 Open enrollment starts. This is when you’ll be able to start shopping for insurance plans at www.coveroregon.com

JANUARY 2014: Coverage begins for plans purchased through Cover Oregon


Every plan offered through Cover Oregon covers essential health benefits, including doctor visits, hospital stays, maternity care, emergency room care, prescriptions, preventive care, mental health services, vision coverage for kids and more. Some plans even cover alternative care. And you'll be able to compare plans side by side so you can make the best choice for you.

Individuals and businesses can get help paying for their coverage. Financial help for individuals and families includes no-cost coverage through the Oregon Health Plan (OHP) and Healthy Kids, or APTC to help pay for private health insurance. Businesses that purchase health insurance through Cover Oregon may be eligible for the Small Business Health Care Tax Credit.

Exemptions from the requirement to have insurance

Starting in 2014, an individual must (1) have minimum essential coverage, or (2) have an exemption from the shared responsibility payment or (3) make a shared responsibility payment when filing federal income tax.

What is a shared responsibility payment?

It is the payment imposed by the federal government to an individual who does not have health insurance coverage and does not qualify for an exemption.

What does 'exemption' mean?

An exemption from the shared responsibility payment means a person isn't required to have coverage or make a payment if they don't have minimum essential coverage.

Who can qualify for an exemption?

There are nine categories of people who are exempt from the requirement to have health coverage and any penalties that may result from not having coverage. These categories are:

  • Individuals who cannot afford coverage. Individuals are exempt if their monthly contribution toward coverage exceeds 8 percent of household income. In the individual market, a person's contribution is based on the premium for the lowest cost bronze plan after any APTC.
  • Individuals with household income below the tax filing threshold. Individuals are exempt if their annual household income is so low that they are not required to file a tax return.
  • Enrolled members of federally recognized Tribes, descendant of enrolled Tribal member, and individuals eligible for the Indian Health Service are exempt.
  • Individuals who experience a hardship. Individuals who have experienced a hardship in their capability to obtain coverage under a qualified health plan are exempt.
  • Individuals who experience a short coverage gap. individuals do not have to pay any penalties if they are uninsured for a period up to three months during the year.
  • Members of certain religious groups. Members of a recognized religious group or division who, by reason of adherence to the tenets of teaching of the group or division, are conscientiously opposed to the acceptance of any private or public insurance that makes payments or provides services for medical care.
  • Members of a health care sharing ministry. Persons must be members of a health care sharing ministry (as defined in IRC 5000A(d)(2)(B)).
  • Incarcerated individuals. Does not include individuals who are incarcerated pending the disposition of charges.
  • Non-citizens. Individuals who are not citizens or nationals of the United States or aliens lawfully present in the United States.

How do I get an exemption?

To receive a certificate of exemption, you must either claim an exemption on your federal tax return or apply to the federal Department of Health and Human Services (HHS). Which of these two methods you must use will depend on which of the above categories apply to your situation. In some cases, you may choose either of the two options. The table below shows which process to use for each category of exemptions. (When more information is available on how to apply for an exemption, we will provide further details about the process. Please check back.)

CATEGORY OF EXEMPTION CLAIM ON TAX RETURN APPLY TO HHS
Affordability X  
Income below filing threshold X  
Member of Indian Tribe X X
Hardship X X
Short coverage gap X  
Religious conscience   X
Health care sharing ministry X X
Incarceration X X
Non-citizens X  

What is a hardship exemption?

These exemptions are granted to individuals determined to have suffered a hardship with respect to the capability to obtain coverage in a qualified health plan. Hardship exemptions will be available to the following groups of individuals:

  • Individuals who have no offer of affordable coverage in a month based on their projected annual income
  • Individuals who in addition to one or more employed members of their family have been determined eligible for affordable self-only employer-sponsored coverage, but for whom the aggregate cost of employer-sponsored coverage for all the employed members of the family is unaffordable
  • Certain individuals who are not required to file an income tax return but who technically fall outside the exemption for those with household income below the income tax filing threshold
  • Individuals who are American Indians, as well as their spouses and descendants, who are eligible for services through an Indian health care provider

Why can't I apply for an exemption through Cover Oregon?

State-based exchanges such as Cover Oregon were given the option to either directly process the exemptions or use the federal service to process exemptions. Cover Oregon has chosen to use the federal service. In the first year (prior to October 15, 2014), individuals seeking an exemption will need to apply to and receive a certificate of exemption from HHS. Starting October 15, 2014, an individual will be able to submit an application to Cover Oregon, which will be forwarded to HHS for processing. HHS will handle all appeals of exemption eligibility decisions.

When will my exemption expire?

Exemptions for religious reasons and members of Indian Tribes are ongoing, meaning the people who receive these exemptions are not required to annually renew the exemption. However, if a person under the age of 21 is granted a religious conscience exemption, he or she must submit a new application for an exemption upon reaching the age of 21. The duration of hardship exemptions varies based on individual circumstances. Exemptions for being incarcerated and for being a member of a health care sharing ministry apply only for months when the individual was actually incarcerated or actually a member of the health care sharing ministry. All other exemptions are good for the calendar year in which an applicant submitted an application for such exemption.

 

Glossary of terms

Actual Rates

Actual rates are developed and presented to individuals or group applicants after they have provided specific demographic information.

Adjustment Type

Adjustments are deducted from income on Federal tax returns in order to arrive at your Modified Adjusted Gross Income (MAGI).

Advance payment of premium tax credit (APTC)

If a person qualifies for advance payment of premium tax credits (APTC), the amount will be applied right away and sent directly to the insurance company each month to reduce the premium. See also "APTC."

Affordable Care Act (ACA)

The Affordable Care Act (ACA) is the health care reform law enacted in March 2010 that mandates all Americans have health insurance coverage. It puts individuals, families, small businesses and Tribal organizations in control of selecting and managing their insurance coverage. It also provides other reforms, including guaranteed coverage regardless of an individual’s health status.

Agent

Agents affiliated with Cover Oregon are licensed health insurance agents who have also completed the Cover Oregon training and certification program. They help individuals and small employers by guiding them through the complexities of purchasing and enrolling in health insurance coverage to get the best price based on specific situations and needs. Agents also act as advisors when clients need help navigating claims processing after they incur services. Agents are paid a commission for their work, which does not increase the cost of insurance coverage.

Allowed Amount

Allowed amount, also known as 'eligible expense,' 'payment allowance' or 'negotiated rate,'' is the maximum amount a carrier will pay for covered health care services. If services cost more than the allowed amount, the insured individual may have to pay the difference.

Annual Income

Annual income is the total amount an individual received via wages, salary and various investments throughout a calendar year.

Annual Maximum

Annual maximum, or 'annual max,' is the total dollar amount that an insurer will pay toward services in a coverage year. Once the annual maximum is reached, the insurer will not cover additional services until the beginning of the next plan year.

Appeal

An appeal is a request to review a decision.

APTC

APTC refers to advance payment of premium tax credits. If a person qualifies for APTC, the amount will be applied right away and sent directly to the insurance company each month to reduce the premium. See also "Advance payment of premium tax credit."

Assister

Assisters are staff members or volunteers at community partner organizations who are trained and certified to help educate individuals and families about health coverage plans and assist them with the Cover Oregon application and enrollment processes. Assisters include application counselors, consumer assisters, in-person assisters, navigators and non-navigators as defined by the Department of Health and Human Services.

Authorized Representative

An authorized representative is a person, such as a guardian or an individual who has power of attorney, who is authorized to help make decisions for others. These decisions include enrolling in a health coverage plan or handling claims and payments. An authorized representative may sign the application on behalf of the enrollee.

Balance Billing

Balance billing occurs when a provider bills the insured individual for the difference between the provider’s charge and the allowed amount. A preferred provider may not balance bill for covered services.

Benefits

Benefits refer to any available services under health coverage.

Calendar Year

Calendar year is the period from January 1 through December 31 of the same year.

Carrier

A carrier is a licensed company that provides health and/or dental insurance coverage for individuals, families and groups. A carrier may also be referred to as an 'insurer' or 'insurance company.'

Catastrophic Plan

As defined in the Affordable Care Act (ACA), a catastrophic plan will provide individuals with coverage for essential health benefits only after they have paid for cost sharing equal to maximum out-of-pocket limits. Catastrophic plans are available to individuals who are under the age of 30 prior to the start of the plan year, or who have received an exemption from the individual mandate because they do not have an affordable coverage option or because they qualify for a hardship exemption. In 2014, the annual maximum out of pocket cost will be $6,350 for self-only coverage and $12,700 for family coverage.

Census

See: 'Employee census.'

Change In Circumstance

A change in circumstance allows individuals, families and employees to change their health coverage enrollment outside of the open enrollment period because of a qualifying event such as marriage, childbirth, adoption, legal separation, death or loss of employment, among others. Also see: 'qualifying event.'

Children's Health Insurance Program (CHIP)

The Children’s Health Insurance Program (CHIP) provides health coverage for children whose families can’t afford private insurance. CHIP is administered by each state and jointly funded by the federal and state governments. In Oregon, the program operates under the name “Healthy Kids.” Also see: 'Healthy Kids.'

COBRA

CCOBRA is a type of continuation coverage that allows employees and their families to temporarily continue their health coverage offered through an employer, even if they have changed or lost a job, or experienced a change in their eligibility status. Also see: 'continuation coverage.'

Coinsurance

Coinsurance is the insured individual’s share of costs for a covered health care service. This is calculated as a percentage (e.g., 20 percent) of the allowed amount for the service before or after the deductible is met. The insurer pays the rest of the allowed amount.

Community Partner

Community partner organizations are provider clinics, local governments, non-profits and community-based groups that conduct outreach and/or enrollment assistance on behalf of Cover Oregon. This assistance is provided at no cost to individuals and families.

Continuation Coverage

Continuation coverage allows individuals to temporarily continue their health coverage offered through an employer, even if they have changed or lost a job, or experienced a change in their eligibility status. Companies with 20 or more employees are subject to COBRA Continuation. Companies with fewer than 20 employees are subject to State Continuation.

Coordinated Care Organization

A coordinated care organization (CCO) is a network of all types of health care providers (physical health care, addiction and mental health care and sometimes dental care providers) who have agreed to work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan (Medicaid).

Copayment (Copay)

A copayment, also called “copay,” is the fixed dollar amount (e.g., $15) an insured person pays for a covered health care service. Copayment amounts can change depending on the type of service received.

Cost Sharing

Cost sharing refers to any expense paid by an individual for essential health benefits such as deductibles, copayments and coinsurance. These costs are above and beyond the amount the individual pays for a premium.

Cost-Sharing Reduction

Cost-sharing reductions lower the maximum out-of-pocket limits, and they reduce Silver plan deductibles, co-pays and coinsurance amounts for certain qualified applicants.

Coverage Year

The coverage year is the calendar year in which a health coverage plan is effective (e.g., the period from January 1 through December 31 of the same year.)