The Oregon Insurance Division regulates rates for small employer and individual health insurance plans. Small employers are those with 50 or fewer employees. Individual health plans are for the self-employed and others who are not covered through an employer and buy a plan on their own. This can be for one person or a family. The state does not regulate rates for large employers or public entities, such as a school district or the State of Oregon.
Insurance companies and cooperatives must file proposed rates by April 30, 2013, to sell small employer and individual health insurance plans for 2014. The plans take effect Jan. 1, 2014, and include new benefits and other changes under the Affordable Care Act. Oregon is one of the first states to review proposed rates for the new plans. The division will make rate decisions by early July 2013.
Rate review approves a "base rate" for insurance company health plans plus the factors that determine the actual rate you pay. Your personal cost for health insurance may be more or less than the base rate. It depends on your age, how many family members are on the plan, where you live, and whether you use tobacco. It will be easier to shop for insurance after the Insurance Division approves base rates and insurance companies create easy-to-understand information about different plans and prices. Rate review provides an idea of how much plan costs will vary by insurer and how plan prices generally are affected by health reform.
The 2014 health plans focus on preventive care. They limit how much you must pay in deductibles and other out-of-pocket costs. In many cases, these plans will cover more services than plans in the past. Everyone will be accepted. These changes will result in new pricing.
For more information, The Consumer Guide to Health Insurance Rate Review can be found at http://www.oregonhealthrates.org/files/4961.pdf.
In addition to new plans and accepting everyone for coverage, federal reforms reduce the difference in premiums charged to younger and older people. Because of these changes, insurance is likely to cost more for some people and less for others. To make coverage affordable, many people who buy coverage on their own in the individual market will be eligible for financial help to buy a plan. People younger than 30 years old who cannot afford coverage can buy a catastrophic plan, which covers less and costs less.
Many people will qualify for financial help to pay the costs of private insurance sold in the state-based insurance exchange, Cover Oregon. These premium subsidies will be available for individuals and families with incomes between 133 percent and 400 percent of the federal poverty level. That means a single person with an income ranging from $15,282 to $45,960 could qualify, as could a family of four with an income of $31,322 to $94,200.
Cover Oregon is a marketplace where individuals, families, and small employers can compare health insurance plans and buy the plan that best fits them. You may qualify for financial help through Cover Oregon. You can apply for coverage through the exchange either online, through a toll-free telephone call, or in person. Learn more at www.coveroregon.com.
Starting Oct. 1, 2013, Cover Oregon will post information about the plans and make it easier for you to compare plans and prices from different companies. As Oct. 1 nears, more information will also be available through public education, health insurance agents, insurance companies, and others.
Click on the "new rate requests" tab after May 10 to find easy links to proposed rates companies have filed. You will also find links to how you can comment about a rate request. Click on the "public hearings" button to see when rate hearings will be streamed live. You can watch hearings live from your computer or you can view them later. The Consumer Guide to Health Insurance Rate Review in Oregon provides more information about how we make rate decisions.
You can also sign up for e-notify. This will allow you to receive notifications whenever a carrier files for new rates as well as when we post our decisions about those rates.
A Consumer Operated and Oriented Plan (CO-OP) is a nonprofit insurer that is run by members. The federal Affordable Care Act provided money for start-up costs. In addition to a mix of for-profit and nonprofit health insurance companies, Oregon has two cooperatives that will offer plans in 2014.
Health insurance companies must take in enough money to pay medical claims plus a reasonable amount for administration. In 2011, Oregon's largest health insurers spent 89 cents of every premium dollar to pay health care claims. Another 10 cents paid for insurance company administrative costs, including collecting premiums, paying claims, and selling insurance. The remaining penny went to profit. These numbers reflect an insurer's companywide business and not a particular insurance market. The division provides detailed information about insurance company finances at http://www.oregonhealthrates.org/?pg=data.html.
The Insurance Division knows how much today's benefits cost, so we can make judgments about the costs of new benefits required by federal reforms. More than a dozen companies will file 2014 rate requests at about the same time. Companies that are outside the typical range on pricing will merit additional scrutiny. For example, companies must tell us how much they believe new benefits will affect projected claims costs and estimate the cost of high-risk and uninsured Oregonians who will gain coverage in the individual market. Also, federal and state governments designed programs to spread the costs of high-risk people in the individual market and limit risk to insurers, keeping prices down. We'll look at how much the different companies took this into account in setting proposed rates.