Cover Oregon is our new Health Insurance Marketplace where you can access the Oregon Health Plan, Private insurance plans, and financial assistance to help pay for insurance.
Who can apply: Everyone can apply to find out what they qualify for.
Cover Oregon 2014 Income Guidelines
How to apply: You can apply on your own or with help from a Cover Oregon Assister.
To apply on your own: go to www.CoverOregon.com and click the green “Apply Now” button on the front page. You can then download the application, print it, fill it out, and then mail or fax it to Cover Oregon.
To apply with help: Call our Medford office at 541-772-4029 to make an appointment to meet with Michelle or Virginia. We offer assistance in English and Spanish.
Basic information you need to apply: personal information for each household member including date of birth, social security number (if they have one), income estimates for each person for the current month and for all of 2014, and information about current medical insurance (if you have it).
When to apply:
Apply as soon as you can. The deadline for enrolling in private insurance is March 31st, 2014. Oregon Health Plan enrollment continues all year.
The next open enrollment period for Cover Oregon will start on November 15, 2014 and go until January 15th, 2015.
If you lose your insurance, get married or divorced, have a child, or experience a big change in your income during the year you may be able to shop for a new plan through Cover Oregon. You can find out by calling 1-855-268-3767.
What is the penalty for not having insurance? If you are not covered by health insurance by March 31, and you are not exempted from the penalty, you will have to pay a penalty when you file your taxes next year. The penalty amount is $95 per adult, $54 per child, or 1% of your household yearly income. The maximum any family will have to pay in 2014 is $285. These fees are scheduled to go up every year. (Click here to read about who is exempt from these fees: https://www.healthcare.gov/exemptions/ )
Applicant and Oregon Action member Shirley signs her application.
I’ve already applied, now what?
If you have applied and have not heard back from Cover Oregon yet:
Call the Cover Oregon Helpline at 1-855-268-3767. Be prepared for what could be a long wait on hold.
What you need to ask: After confirming your identity and looking up your application the agent should be able to tell you the status of your application and whether there is any missing information. If you application is pending or waiting to be processed, ask what needs to be done to escalate the application. If your application has been determined, ask what the eligibility determination is for each household member and be sure to write down all of the information. If anyone will be shopping for a private insurance plan, ask for the shopping group number and the client ID number (you can use these to enroll in whatever plan you choose at www.coveroregon.com, click on the green “complete enrollment” button on the front page.) If anyone is eligible for a tax credit, ask what the tax credit amount is.
Be sure to ask for the name of the person you speak to and write down what they tell you and the date and time you called for your records.
Be sure to mention if there is an urgent medical need, if for example, you are waiting to get an important prescription or go see your doctor.
If you were told you are now covered by the Oregon Health Plan
Congratulations! Thanks to the Affordable Care Act and the state of Oregon there is no longer any waiting period or lottery drawing to be able to enroll in the Oregon Health Plan. The income limits were also raised (see chart) on January 1st, 2014 so that more people can qualify for Oregon Health Plan coverage.As a result, we have enrolled 200,000 new Oregonians in the Oregon Health Plan since October of last year!
There is a delay in getting medical cards mailed to new clients. If you have not received you card, don’t worry unless it has been more than 8 weeks since you applied.
If it has been more than 8 weeks, or if you have an urgent medical need, you can call Oregon Health Plan Client Services at 1-800-273-0557. Be prepared to what may be a long wait on hold.
Who can call: Only the person who is covered, or their parent/legal guardian, can request information from Oregon Health Plan. You cannot call for a friend or other family member because of privacy policies.
What to ask: Ask for your member ID number, the name of your Coordinated Care Organization, and the date your coverage started. You can use your member ID number just like an insurance card at most doctors’ offices.
Other important information
If you applied through Cover Oregon and got insurance, no matter what kind it is, you are responsible for updating your application if you experience a change in your household size or income. You can do this by calling Cover Oregon at 1-855-268-3767.
The Cover Oregon Website is where you can browse plans and find out what financial assistance you may qualify for.
Healthcare.gov has some great Frequently Asked Questions and other resources to help explain the new healthcare law. (Note: if you live in Oregon you cannot sign up for insurance on the Healthcare.gov website. You will go through Cover Oregon instead.)
The Oregon Health Plan Website is where you can find Fast Track information, look up your Coordinated Care Organization (CCO), find out what is covered by OHP, and get their contact information.