If you received the Spring 2013 FHIAP newsletter and have questions about your current coverage or how you will transition into other coverage beginning in 2014, please call our customer service staff at 888-564-9669. We encourage you to review our list of Frequently Asked Questions (FAQs) to see if there is an answer to your question.
You may be able to get help paying for a large portion of monthly premiums and out-of-pocket costs. You can check how much you may receive by using the Cover Oregon calculator at CoverOregon.com/calculator.php. You’ll need to know your modified adjusted gross income. This means your gross income, or total income before taxes, minus any deductions (such as other tax credits). This is the same amount that you enter on your federal tax return, line 22 on form 1040A, or line 38 on form 1040. If you have someone prepare your taxes, you may want to ask them to be sure.
Cover Oregon will have more information on exact plan options later this year. You can get the latest information by signing up for email updates on their Website at CoverOregon.com
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What is Cover Oregon?
Cover Oregon is a new online marketplace where Oregonians can find and purchase health insurance. If you’re uninsured, buy insurance on your own or own a small business with fewer than 50 employees, you’ll be able to find health insurance through Cover Oregon. Cover Oregon will let you search for and compare health insurance plans and will offer help – online, in-person, and over the phone – to find the plan that’s right for you. Some people will also get help paying for their plan. For example, an individual earning up to $45,900 a year or a family of four earning up to $94,200 a year will get a tax credit to help cover the cost of their premiums. People will be able to begin shopping on Cover Oregon in October 2013, and coverage for plans purchased through Cover Oregon will be effective Jan. 1, 2014.
Who can use Cover Oregon?
Individuals who do not have access to affordable coverage at work will be able to use Cover Oregon to make “apples-to-apples” comparisons of health insurance plans and costs. The plans offered through Cover Oregon will meet specific requirements and will be graded in areas such as quality and customer service. Through one seamless application process, individuals will be able to enroll in commercial insurance plans or programs such as the Oregon Health Plan or Healthy Kids. They also will be able to find out whether they are eligible for financial assistance to help them pay for coverage.
Is Healthy Kids ending?
Healthy Kids coverage is not ending. Kids and teens currently covered by Healthy Kids will maintain coverage. When coverage becomes available through Cover Oregon in the fall of 2013, Healthy Kids will be one type of coverage available. However, the certified application assister program, Healthy Kids grants, and targeted outreach will be ending.
When can I apply for health insurance through Cover Oregon?
Oregonians can begin applying for coverage in October 2013. Coverage will begin January 1, 2014.
What is the difference between buying an insurance plan through Cover Oregon and buying a plan directly from an insurance company?
Individuals and small employers who shop through Cover Oregon will enjoy unique benefits. Through Cover Oregon, individuals will be able to check their eligibility and apply for public health care programs, such as Medicaid. They will also be able to apply for financial assistance (tax credits and cost-sharing assistance) to help make private health coverage more affordable. Small employers that offer coverage through Cover Oregon will be able to provide their employees with more plan choices. And, only through Cover Oregon, small employers will be able to apply for the small business tax credit. Cover Oregon will make it easy to purchase quality health insurance at the most affordable price. Plans will be rated based on customer service and quality, and consumers can compare features and prices of plans offered by competing health insurance companies.
Does everyone have to buy insurance through Cover Oregon?
No. Oregonians can buy health insurance directly from a carrier or through a licensed agent without using Cover Oregon. Most carriers likely will offer plans both inside and outside of Cover Oregon. However, federal tax credits and other forms of financial assistance to help you pay for coverage are only available through Cover Oregon.
Will individuals, families, and small employers be able to receive financial assistance through Cover Oregon?
Yes, by enrolling through Cover Oregon, individuals, families, and small employers in Oregon may qualify to receive help paying for coverage. Depending on income, individuals and families may be eligible for tax credits to help pay for monthly premiums and cost-sharing assistance to help pay for copays, deductibles, and other out-of-pocket costs. Small employers may also be eligible for a tax credit. You will be able to find out if you are eligible for financial assistance by answering a series of questions on the Cover Oregon website beginning in October 2013.
Is Cover Oregon only for health insurance?
Yes. Cover Oregon will only offer health insurance plans – both medical and dental. We do not offer any other kind of insurance, such as auto or home insurance.
What happens to me when OMIP closes?
OMIP members will be able to select a plan from Cover Oregon starting in October 2013. Coverage for plans purchased through Cover Oregon will take effect January 1, 2014, so there will be no break in your health coverage. There are no waiting periods, and no one can be turned down for coverage because of health conditions. You also may be eligible for financial assistance to help you pay your monthly premiums and out-of-pocket costs. Cover Oregon will have a customer service center, insurance agents, and community partners throughout the state to help you through this process.
What coverage will be available to those who are currently enrolled in OMIP?
OMIP members will be able to choose from all the plans available through Cover Oregon (and the outside market). No one can be turned down for coverage because of health conditions, so OMIP members will have significantly more choice than they have today. Although plan details are not yet available, all plans starting in 2014 will have to cover a basic package of benefits that includes things such as prescription drugs, maternity and newborn care, and mental health. There also will be limits on out-of-pocket costs such as co-pays and deductibles.
Who will notify OMIP members that they can move to other guaranteed issue plans?
The Oregon Medical Insurance Pool sent notices to their members in January informing them that the OMIP program will end December 31, 2013 and that coverage will be available to them through Cover Oregon. This was the first of many communications that OMIP members will receive over the next year to advise of the next steps as information is available. Cover Oregon will partner with the Oregon Health Authority to ensure that OMIP members are aware of the resources available and timelines for applying.
Will individuals and families be able to receive financial assistance through Cover Oregon?
Yes, by enrolling in a health plan through Cover Oregon, you may qualify to receive help paying for coverage. Depending on your income, you may be eligible for tax credits to help pay for monthly premiums. For example, an individual earning up to $45,900 a year or a family of four earning up to $94,200 a year will get a tax credit to help cover the cost of their premiums. You may also be eligible for cost-sharing assistance to help pay for copays, deductibles, and other out-of-pocket costs. You will be able to find out if you are eligible for financial assistance by answering a series of questions on the Cover Oregon website beginning in October 2013. Eligibility will be based on the modified adjusted gross income for your entire household.
What is Modified Adjusted Gross Income (MAGI)?
MAGI is adjusted gross income as determined under the federal income tax, plus any foreign income or tax-exempt interest that a taxpayer receives. In other words, MAGI is the amount of income a household reports on their annual federal tax form (with a few exclusions that will not affect the majority of households applying for coverage in 2014).
How do I determine the number of people in my household? If unrelated people live in my house, do I count them when figuring out the number of people in my household?
In general, the household consists of the applicant and the applicant’s spouse, children, and qualifying relatives. Unrelated individuals living in the house are not included in the household unless they are claimed as dependents on a tax return by a member of the household.
Do I use family size to determine my household, and, if so, what constitutes the family?
Household and family size are not necessarily the same number. One or more family members living in the house may not be considered part of the household. For example, a cousin who lives with you but is claimed as a tax dependent by his or her parents would not be considered part your household.
I have a child who no longer lives at home. Do I count him as a household member?
If you claim the child as a dependent on your taxes, count them as a household member. If you claim the individual as a dependent, age is not a factor.
Does household size include those who are under 26 years of age?
Your household may include individuals of any age.
If my child files his/her own taxes, is the child still considered part of my household?
No. Your child is considered part of your household only if you claim him or her as a dependent on your taxes. If your child is required to claim a personal exemption, you cannot claim the child as a tax dependent
Can I include a child not living in the home in my household count if he stays with me part time? What would be counted as part time?
If you claim the child as a tax dependent, you should include him or her as part of your household. If you do not file taxes, include the child only if you have primary custody (if the child lives with you more than 50 percent of the time).