Tuesday, September 17, 2013
DALLAS -- If you watch television at all, you've probably seen the commercials with the catchy songs and scenes from all over the state declaring "long live Oregonians."But do you know how Cover Oregon -- the state's new online health insurance marketplace the commercials are promoting -- will work?You aren't alone if you don't. But with enrollment opening Tuesday, the time is quickly approaching for Oregonians to begin using the marketplace.Cover Oregon is the state's answer to provisions in the Affordable Care Act of 2010 that requires people to purchase health insurance or pay a penalty. The marketplace allows individuals and the owners of small businesses to compare plans and, if eligible, receive financial assistance. Cover Oregon includes plans through private insurance companies and public programs, such as the Oregon Health Plan, for those who qualify.In spite of the extensive marketing campaign in recent months, misinformation about the program is rampant, Cover Oregon spokesman Damian Brayko said last week during a Cover Oregon seminar in Dallas for small business owners. Cover Oregon He recommends those seeking information about using the marketplace go to reliable sources, such as the Cover Oregon website or one of the program's trained and certified insurance agents or "community partners" in their area."They need to go to a trusted source, not their neighbor, not the Internet," he said, with the noted exception of the program's website.The target demographic for Cover Oregon are those approximately 560,000 uninsured Oregonians -- including those who couldn't get coverage because of pre-existing conditions.About 400,000 of those people will be eligible to receive financial assistance. If you are single and make less than $45,960, financial assistance is available. Income thresholds for families vary depending on the number of people; for example, a family of four can qualify for assistance if its income is less than $94,200.Those already insured also can shop for a better plan on the marketplace if they wish, but those eligible for insurance through their employer may not qualify for financial assistance. Individuals who prefer to buy insurance outside Cover Oregon are welcome to do so.However, in the first few weeks those wishing to enroll may have to work with a customer service representative as the online application may not be available.For those considering not purchasing insurance, there are tax penalties. In the first year, that penalty is $95 annually or 1 percent of adjusted gross income, whichever is higher."The tax penalty goes up every year," he said. "It's going to become more substantial."He said the penalties are in place to encourage people - including those who are young and healthy and don't feel they need insurance - into the market."That is the thing that will make or break marketplaces in every state," Brayko said. "We have to get everyone into the pool and the hardest ones to get are the young and healthy."He said there are plans outside the standard bronze, silver, gold and platinum tiers geared just for that under-30 demographic. Called "catastrophic" plans, they offer a minimum level of coverage and limited preventive care."It's for the young and healthy, the invincibles who don't think they need health insurance," he said.Insurance on the marketplace can only be purchased during open enrollment periods, so those thinking they can wait until they are sick to purchase coverage may want to rethink that strategy, Brayko added.The initial enrollment period is from Oct. 1 to March 30, 2014. State Rep. Jim Thompson (R-Dallas), the host of last week's seminar, said people need to be patient with the process."This is a journey, not a destination," he said. "I advise you to be patient. We are being told that Oct. 1 when this kicks off that there will be some slow going." Common Questions about Cover Oregon: 1. What is Cover Oregon? Cover Oregon is an online marketplace where Oregonians can compare and enroll in health and dental plans, as well as receive financial assistance. 2. Who can use Cover Oregon? The target demographic is uninsured Oregonians, including those with pre-existing conditions. However, those already covered by insurance can shop for a better plan on the marketplace. 3. Who can receive financial assistance? Those who are not eligible for employer health care or Medicare and who make less than the following income thresholds: $45,630 for an individual; $62,040 for a family of two; $78,120 for a family of three; $94,200 for a family of four; $110,280 for a family of five; and $126,360 for a family of six.Note that you must purchase insurance through Cover Oregon to qualify for assistance. Individual assistance calculators are located at www.coveroregon.com. 4. What are the penalties for not purchasing insurance?People don't have to buy insurance, but they will be subject to a tax penalty. In the first year, the penalty will be $95 annually or 1 percent of adjusted gross income, whichever is greater. The penalty will increase each year for the first three years. 5. Where can I go to get more information? Many questions can be answered at Cover Oregon's website, www.coveroregon.com. Also, Cover Oregon has a network of trained and certified agents and "community partners." Agents will be able to assist in selecting plans and community partners -- those serving non-English speaking or hard-to-reach populations -- can help with the application process. To find a local agent and community partners go to www.coveroregon.com or call 1-855-268-3767. Cover Oregon Fast Facts: * Open enrollment period: Oct. 1 through March 30, 2014.* When coverage begins: Jan. 1, 2014, for plans purchased beginning in October.* Number of uninsured Oregonians: 560,000. Of those, 400,000 will likely qualify for financial assistance to purchase insurance.* Number of plans available on the marketplace: Individual plans -- 102 through 11 carriers; small business plans -- 73 through eight carriers.* First year tax penalties for not having coverage: $95 or 1 percent of adjusted gross income, whichever is greater. For most people, the latter would apply.* For more information: www.coveroregon.com or 1-855-268-3767.