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Only 7% of Oregon residents are uninsured, so you probably know that health insurance coverage is important. That doesn’t make shopping for a plan any easier. We’ll help you discover how health insurance works and which providers are the best in Oregon.
Best Health Insurance in Oregon:
- Best Overall: Kaiser Permanente
- Best Budget Plans: Providence Health
- Best for Individual Assistance Programs: Moda Health
- Largest Network: UnitedHealthcare
- Best Incentives: Regence BCBS of Oregon
What is Health Insurance?
Health insurance is insurance coverage that helps you pay for medical treatments.
It works by allowing you to protect yourself from unexpected, large medical bills. You pay a fee, known as a premium, to be enrolled in a health insurance plan. Your health insurance helps cover part or all of the costs when you visit your doctor.
For example, you’re in a car accident and break your leg. You require surgery and a stay at the hospital for a couple of weeks. Your medical bills for the surgery and hospital stay are going to cost $30,000. You probably don’t have that much money available for a medical bill. Luckily, your health insurance covers your injury and pays for the majority.
In addition to premiums, there are a lot of common health insurance terms and concepts. Knowing these terms can help you better understand how health insurance works. This knowledge also helps you read through confusing health insurance documents as you search for health insurance in Oregon.
Some terms you’ll encounter while looking for insurance include:
- Claim: Your request for coverage of medical treatments or surgeries. It’s common for the financial office of your healthcare facility to make the claim to your insurance company on your behalf.
- Coinsurance: A percentage representing the portion of a treatment you must pay. If you have a 50% coinsurance for a $100 treatment, you pay $50. Your insurance company pays the remaining 50% of the bill.
- Copayment: Copays are fixed prices for certain medical procedures. They’re a lot like coinsurance, but you have a set price for each service. For example, a regular doctor’s visit requires a $25 copay.
- Deductible: Your deductible is a dollar amount you must pay for medical services before your health insurance starts paying for treatments. For example, a $3,000 deductible requires you to pay for the first $3,000 of medical bills.
- Network: Health insurance companies contract with certain doctors, hospitals and other healthcare facilities and suppliers. The providers who contract with the insurance company are known as the network. You will likely pay less for healthcare costs if you use a doctor or other provider within your insurance company’s network.
- Out-of-pocket limit: Your out-of-pocket limit is the maximum amount you’ll pay for covered medical treatments or services each year. While premium payments don’t count toward your limit, your deductible does. Most plans also count payments like coinsurance or copays toward the limit as well.
Average Cost of Health Insurance in Oregon
The average annual cost of health insurance for an individual on an employer’s plan in Oregon is $6,441, with the employee covering $1,061 of the total cost. This is just over $88 per month for employees with health insurance benefits.
Don’t have coverage from your employer and wondering how to get health insurance? You may have to shop for an individual plan on the health insurance marketplace. The average cost of a mid-level plan, known as Silver plans is $428 per month or $5,136 per year.
The cost of health insurance is based on 3 important factors:
- Your age
- Your location
- Tobacco use
You probably won’t find any discounts for health insurance, but that doesn’t mean you can’t find ways to lower your costs. Consider some of these options for affordable health insurance:
- Choose a catastrophic plan, one that only covers major expenses like surgery, if you’re under 30 years old and eligible.
- Pick a plan with a higher deductible and lower monthly premium.
- Stop smoking, as tobacco use can greatly increase your insurance costs.
- Go to in-network doctors for medical services.
Check to see if you qualify for government subsidies. Subsidies are essentially money the government uses to help cover your health insurance costs if you meet certain income restrictions.
Types of Health Coverage
You have several different types of health insurance plans available. Each type of health coverage offers different advantages and disadvantages. What’s right for one person may not be the best fit for you.
Get to know the different types of health coverage to make your decision easier when it’s time to buy insurance. Even if you have health insurance benefits through your employer, most employer plans have a couple of different coverage options.
Preferred Provider Organization (PPO) Plans
A PPO plan uses a network of contracted doctors and healthcare facilities to help you save money on medical costs. You can visit any doctor you want and still receive insurance benefits. If you visit a doctor within the network, your insurance will probably cover more of the cost. With a PPO plan, you don’t need to choose a primary provider and can visit a specialist without your doctor’s referral.
Health Maintenance Organization (HMO) Plans
HMO plans require you to only use healthcare providers within the HMO network. If you visit a doctor outside the network, you usually have to pay the full cost of your visit out of pocket. Some HMO plans have a service area in which you must live or work to be eligible for the plan.
Most HMO plans require you to pick a primary care provider. This is an in-network doctor you choose for all routine medical care. You’ll usually have to get a referral from your primary care physician to see a specialist.
Exclusive Provider Organization (EPO)
EPO plans are similar to HMO plans. Your insurance only covers visits to in-network providers. However, you usually don’t have to pick a primary care provider or need a referral to see an in-network specialist.
What Does Health Insurance Cover?
The type of health coverage you choose can affect what services and treatments are covered. However, most health insurance plans cover many of the same services. In fact, the Affordable Care Act mandates that all health insurance plans cover 10 essential benefits:
- Ambulatory patient services, or care you receive without being admitted to a hospital
- Emergency services
- Pregnancy and newborn care for both before and after the birth of a child
- Services for mental health and substance use disorders
- Prescription drugs
- Services and devices for people with injuries, disabilities or chronic conditions to help them recover from mental and physical skills
- Laboratory services
- Preventive services
- Medical care for children, or pediatric care
While coverage for these categories is required, most health insurance plans cover more than the 10 essential categories. Common services covered by health insurance, including essential care services, include:
- Routine doctor visits
- Urgent care and emergency room visits
- Cancer treatments
- Blood tests
- Physical therapy
What Does Health Insurance Not Cover?
Health insurance doesn’t cover all medical treatments. While insurance companies are required to cover the 10 essential benefits, there are several categories most insurance companies won’t cover. Most of these services are considered not medically necessary or too experimental in nature.
Common services and treatments health insurance plans exclude from their coverage include:
- Plastic surgery, unless it’s deemed medically necessary, such as facial reconstruction for a burn victim
- Weight loss treatments or surgery
- Alternative healing practices like acupuncture
- Nursing home costs related to room and board
- Over-the-counter medications
- Fertility treatments
Best Health Insurance Providers in Oregon
To find the best health insurance in Oregon, you should think about the level of coverage you need and your budget. Our extensive research on top providers in Oregon can help make your search a little easier. We looked at independent ratings, financial stability and the overall reputation of insurance companies to bring you the best providers.
1. Kaiser Permanente
Kaiser Permanente, or the Kaiser Foundation Health Plan of the Northwest, provides health insurance to a large portion of Northwest Oregon.
The company is the winner of the 2019 J.D. Power Commercial Member Health Plan Satisfaction Study. It received top ratings for categories including overall satisfaction, communication and cost.
Additionally, the National Committee for Quality Assurance (NCQA) makes Kaiser the top pick for Oregon health insurance with a 4.5/5 overall rating.
2. Providence Health Plan
Slightly behind the Kaiser health insurance plan in most ratings is Providence Health Plan. The company offers health insurance plans in Washington and Oregon.
Providence received a 4.0/5 rating by the NCQA and came in 3rd in the J.D. Power Health Plan Satisfaction Study.
The company has a range of health insurance plans to meet almost any coverage needs and budget.
3. Moda Health
Moda Health is available only in Oregon and Alaska. In addition to health benefits, Moda health insurance plans give you access to additional benefits.
The intuitive online platform allows you to use the Individual Assistance Program.
This free service gives you and your family access to counseling sessions for various personal situations including grieving a loss, workplace conflict and depression.
As the largest health insurance provider in the U.S., UnitedHealthcare has a large network of doctors and healthcare facilities for your use.
If you need the flexibility of a large provider network, UnitedHealthcare may be right for you. Additionally, there’s a good chance that your existing doctor and other healthcare providers are already a part of its network.
UnitedHealthcare earned a respectable 3.5/5 from the NCQA for health insurance in Oregon.
5. Regence Blue Cross Blue Shield of Oregon
Blue Cross Blue Shield is a nationwide insurance company of combined independent companies. Regence Blue Cross Blue Shield of Oregon provides health insurance for Oregon residents.
The NCQA and J.D. Power both rate Regence Blue Cross Blue Shield of Oregon as about average compared to other providers.
However, the company offers an incentive program called Blue365 that reimburses members for weight loss and fitness programs.
Choose the Provider That’s Right for You
To get the right health insurance, consider all of your options. You may have access to health insurance through your employer. If your employer is working with an insurance company that doesn’t meet your needs, be sure to talk to your human resources or benefits department to request more plan options.
If you need individual health insurance in Oregon, it pays to shop around. Look at the Healthcare.gov Marketplace and request quotes directly from insurance companies.
Learn more about the best health insurance companies and get quotes for health plans today.