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Multiple health plans to choose from can be confusing

Individuals who submitted their application to Cover Oregon by Dec. 4 now have until this Friday to submit their enrollment for health insurance.

Cover Oregon is working around the clock with more 400 workers to verify tax credit and health insurance plan qualifications and they are mailing enrollment packets out as processed. Cover Oregon may even call or email an individual with information about their case number and shopping group number. These numbers are necessary for an individual to enroll and can be submitted online at www.coveroregon.com by clicking the green button labeled, “submit your enrollment.”

All enrollments need to be submitted by 5 p.m. on Friday to guarantee coverage for Jan. 1, 2014. If an individual is unable to enroll for Jan. 1, 2014 coverage, they still have until March 31, 2014 to enroll in health insurance.

Part of the process of enrolling for health insurance is choosing a plan that will best fit the individual and their family needs. There are more than 60 health insurance plans from nine different health insurance companies in this region that an individual can choose.

The Affordable Care Act created a system which categorizes all plans offered in the individual/family marketplace as one of four plan levels: bronze, silver, gold and platinum.

Even though each plan level needs to follow certain requirements set by the Affordable Care Act, there are still great differences between each plan in each of the different plan levels. Individuals should examine the differences between the plans to determine the best fit for their family. The website at Cover Oregon allows individuals to see a summary of each plan and will allow them to compare three different plans at the same time.

The following are some key areas that individuals should focus on when evaluating the plan details.

The deductible is the amount you must pay first before receiving financial assistance from the insurance company on your medical bills. The deductibles on the Cover Oregon website are listed with an I, which stands for individual, and an F, which stands for family.

A family is a group of two or more individuals on a policy, and the family deductible must be met if more than one person has medical expenses in the calendar year, except with plans that are Health Savings Accounts. With a Health Savings Account eligible insurance plan, the family deductible is the amount that must be met regardless if it is only one person that has medical expenses in 2014. The Health Savings Account plans are not necessary clearly marked on the Cover Oregon website and it is important to double check the insurance plan you want with the insurance company. A co-pay is generally a payment that is made for a doctor office visit and does not require that an individual pay the deductible first.

Not all plans have co-pays and often the number of times a co-pay can be used is limited.

The number of limited visits is not published on the Cover Oregon website, so individuals should check with the insurance company directly to verify how many co-pays are allowed.

Co-insurance is the percentage of the medical expenses that an individual will pay after the deductible is reached. The percentage will vary by each plan and the amounts shown on Cover Oregon are the percentage amount that an individual is responsible to pay. The out of pocket maximum is the total amount an individual could pay for the year and includes the deductible.

For assistance in choosing your plan, contact a Cover Oregon Agent to walk you through the process.



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