PORTLAND, Ore. (AP) – Oregonians enrolling or re-enrolling in health insurance for 2016 will face some of the highest rate increases in the country – but their monthly premiums will remain among some of the lowest across the U.S.
The third open enrollment period for buying health insurance under the federal Affordable Care Act starts Sunday. Oregon residents will use the federal exchange portal, HealthCare.Gov, to sign up, renew or change plans.
Federal data shows that from 2015 to 2016, Oregon and the Portland area saw some of the highest rate increases for benchmark silver plans.
But state officials say Oregon, and Portland, still have some of the lowest rates in the country. That’s because Oregon’s original plan rates in 2014 were extremely low, and they remain in the lower half of the pack despite price increases.
“What we found is that the states with the largest increases in 2016, including Oregon, had some of the lowest rates in 2015. And the most expensive states in 2015 had some of the lowest increases in 2016,” Insurance Division spokesman Jake Sunderland said.
Meaning, Oregon’s monthly rates are still lower than in many other states. Nationally in 2016, Sunderland said, Oregon has the 18th lowest rate in the country. In the West, it’s ranked 4th lowest.
Why did rates in Oregon rise so fast?
In 2013 and 2014, when the state’s Insurance Division approved rates, there was little data on what the health insurance market would look like, Sunderland said. The rates were partly set low, he said, because Oregon has one of the most competitive health insurance markets in the country.
But the costs of health care proved much higher than expected, leading many carriers to lose money. In 2014, for example, the cost of providing coverage for individual plans totaled $830 million in the state, but premiums covered only $703 million of those costs, Sunderland said. That meant losses of $127 million.
Moda Health Plan, one of Oregon’s largest health insurers, initially offered the cheapest plans on the exchange. As a result, the company lost millions on claims and in 2016 will raise premiums by an average of 25.6 percent.
Approximately 107,000 Oregonians enrolled in individual plans through HealthCare.gov for 2015 coverage. Oregon switched to the federal exchange after its much touted Cover Oregon portal failed to launch in 2013.
According to census data, about 9 percent of the state’s population remains uninsured.
State officials say people who already have health insurance should still shop around for a plan, because prices and benefits can change year to year. Returning customers who don’t act by Dec. 15 will automatically be re-enrolled in their current plan.
Beyond comparing monthly premiums, shoppers should scrutinize out-of-pocket expenses such as deductibles and co-pays, check into which hospitals and doctors are covered by a plan and which prescription drugs are included. Lower monthly rates, Sunderland said, often mean higher out-of-pocket expenses or slimmer benefits.
Most Oregonians who bought plans via HealthCare.gov last year qualified for financial assistance, which can cover both premiums and out of pocket expenses.
Oregonians who need help picking the right plan or enrolling can go to a drop-in center during the open enrollment period. They can find an agent or community organization by going to OregonHealthCare.gov or calling 1-855-268-3767. The help is free.
In addition, the federal portal has an online plan comparison that shows expected out-of-pocket costs.
The penalty for not having insurance in 2016 is even steeper than in previous years: $695 for every adult and $347.50 for every child, or 2.5 percent of the yearly household income — whichever number is higher.
Open enrollment runs through the end of January, but people who sign up after Dec. 15 get coverage in February or later.
Low-income Oregonians who qualify for the Oregon Health Plan, the state’s version of Medicaid, can use either a paper application or an online PDF application found on OregonHealthCare.gov.
Oregon is currently working to adapt the Kentucky eligibility and enrollment system for Medicaid. But that website won’t be available to Oregonians until February 2016.