Choosing An Individual Oregon Health Insurance Plan

Introduction

If you are self-employed or your employer doesn't offer health insurance, you may not have access to group insurance. You may, however, be able to buy individual/family coverage directly from an insurance company. When you buy your own health insurance, you pay the entire premium rather than sharing the cost with an employer.

Insurance plans differ greatly from one company to another and, within an insurance company, from plan to plan. Some plans have options such as dental or vision. Read the "fine print" so you understand the choices.

Self-employed

Most self-employed workers are able to deduct their health insurance premiums from their federal taxable income, providing them with an important tax saving. Most states also offer similar tax savings. If you are self-employed and buy individual health insurance, consult a tax advisor to see if you are eligible for this deduction.

If you are self-employed and have at least two people in the business - and both work at least 17.5 hours a week - you may be able to buy a group health plan. You may want to read our small business owner section or consult a health insurance agent for assistance.

Pre-existing Conditions

Insurance companies may turn you down for individual coverage based on your health. This is different from group (employer-sponsored) insurance, where no one can be rejected based on their health. The companies use information from your insurance application to decide if they will sell you an individual policy.

However, if you are turned down for an individual policy, you can still get insurance through a state program called the Oregon Medical Insurance Pool (OMIP). In fact, if you have certain medical conditions such as diabetes or cancer, you can apply directly to OMIP without first applying to an insurance company. For more OMIP information, click here.

Choosing A Health Plan

Working with a professional health insurance agent can make it easier to select a plan. You may also contact insurance companies directly for information. You may want to read types of insurance for more information on features of different plans, such as HMOs and PPOs. Your choice of plans may determine:

• How much choice you have in selecting doctors/hospitals. (Even if you don't have a doctor you want to use, are providers, hospitals and pharmacies used by the plan conveniently located with hours that work for you.)
• What medical services are covered by your plan
• The quality of care you receive
• How much you pay

Cost

Premiums (monthly bills for insurance) for individual/family policies vary based on your age and the benefits provided. Rates will also vary among the insurance companies so it is a good idea to compare prices and benefits. Out-of-pocket refers to costs you pay. Some questions you might want to ask:

• How much is the premium?
• If there is a deductible, how much will I have to pay before the plan starts to pay for medical care?
• What will my prescription medicines cost? Is there a separate deductible for these drugs?
• How much will I have to pay (co-payment) each time I use a service, such as a doctor visit. For example, will the emergency room visit co-pay be waived if I am admitted?
• How much more will I need to pay if I go outside the health plan's network of doctors, hospitals, and other providers to get services?

Benefits

All individual/family plans must include certain state benefits, called mandates.

For example: Most individual plans include prescription drug coverage but probably don't include dental or vision coverage. You may be able to purchase these separately. All policies will have a list of exclusions and limitations. These are things the plan won't cover or may cover subject to limits.

If you are pregnant and don't already have insurance, an insurance company will not sell you an individual policy. You can buy insurance through the Oregon Medical Insurance Pool (OMIP) for people with pre-existing medical conditions. However, this state program has a six-month wait before it will cover any pre-existing condition, including pregnancy. So, unless you are early in your pregnancy, the birth won't be covered. If you have limited income, you may want to see if you qualify for coverage through Oregon Health Plan.

Insurance Companies Selling Individual Plans in Oregon

A list of insurance companies selling individual plans in Oregon