Yes. You may buy a policy for a child through Cover Oregon. Any health plan offered through the exchange must also be offered as a child-only plan.

You may be eligible for tax credits for child-only plans purchased through Cover Oregon.

However, children who are not citizens or legal residents of the United States are not eligible for child-only plans through Cover Oregon. You may be able to buy a child-only policy in the market outside Cover Oregon, either from an insurance company or through an agent.

No. Undocumented immigrants are not eligible for coverage through Cover Oregon. However, some individuals may qualify for emergency-only coverage through the Citizen Alien Waived Emergent Medical (CAWEM) program through the Oregon Health Plan. If you think you might qualify for this, fill out a Cover Oregon/Oregon Health Plan application.​

A plan is considered unaffordable if the employee's premium costs more than 9.5 percent of the employee's household income or if it pays for less than 60 percent of covered health care expenses.

In considering whether a plan is affordable, the premium cost for an employee's spouse or children is not taken into account. In other words, the law looks at the cost of employee-only coverage and not a family plan.

If an employer of any size offers affordable coverage and makes it available to dependents, even though the employer may pay little or no part of the costs, family members will not be eligible for subsidies through an exchange.

Call the insurance company or go on its website. Remember, however, that it's important to find out who is in the network in your area. The company with the largest statewide network might not be the same company that has the most doctors and other providers in your part of the state.​

If you did not select new coverage by Jan. 1, 2014, you are likely in a temporary insurance program so that you have more time to find new coverage. Learn more here​​ or call 800-848-7280 (toll-free).

As you shop for new coverage, remember that you may be eligible for financial assistance to help reduce your monthly premiums and out-of-pocket costs. For help with insurance costs, enroll in a plan through Cover Oregon​.

You may still contribute to a health savings account (HSA) that is paired with a high-deductible health plan. In this type of plan, deductibles are higher than in some plans, making premiums lower.

Every small group and individual plan must cover essential health benefits. Even though you may not need every benefit in a plan, plans must cover all of the essential benefits to share risk across a broad pool of consumers.

Health insurers keep lists of what drugs they cover, at what cost. These lists are called formularies. Drug cost-sharing is often “tiered.” Typically, you pay less for a generic drug, more for a brand name drug, and sometimes even more for a nonpreferred brand-name drug.

Adult dental coverage: This is not required, but you can buy stand-alone plans.

Children's dental coverage: Plans sold through Cover Oregon do not have to include children’s dental benefits because you can buy stand-alone (separate) pediatric dental plans. Outside of the exchange, however, health plans must include pediatric dental benefits unless the insurer is reasonably assured that you purchased pediatric dental coverage through the exchange.​​​

Insurers must charge the same amount for the same plan whether it’s sold through Cover Oregon or in the market outside of Cover Oregon.​

​​​
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

GET THE HELP YOU NEED

1-888-877-4894

or email

cp.ins@state.or.us

Connect with an insurance expert.