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Posted by on Aug 6, 2013 in Oregon | 0 comments

Oregon’s Health Insurance Marketplace

Cover Oregon

Oregon’s Health Insurance Marketplace

What do we know?

A quick editor’s note. The great thing about Oregon is that it is one of the few states that has made it fairly easy to find information regarding the Exchange. The state has really embraced healthcare reform. This means if you are really interested in learning more about the Exchange and you have a lot of time to spare, you can probably find the information you are looking for.

BUT, if you don’t get the same pleasure out of hunting down information and piecing the puzzle together that I do, let me help answer some of your questions:

Will there be many options for health insurance on the exchange?

The short answer is “yes”. Governor John Kitzhaber (D) and the state legislature worked to establish a state-run health insurance exchange, Cover Oregon. Plans were filed with the Oregon Department of Consumer and Business Services Insurance Division and in May 2013, Cover Oregon announced Exchange plan filings from 12 health insurance carriers. 12 of the carriers will offer plans on the individual marketplace and 8 will offer plans in the small group marketplace.

So, I understand that competition should help lower prices, but what else is Oregon doing to help control health insurance costs?

Oregon has created what they call “innovative plans,” all spelled out in a very engaging 126 page plan (which makes for some GREAT leisure reading). Basically, these plans are designed to be efficient, effective, and sustainable, (low cost and high quality) with provider payment tied more to outcomes.

Which companies will be offering plans on the exchange?

Cover Oregon – Individual & SHOP Market Carriers

INDIVIDUAL & SHOP

INDIVIDUAL ONLY

ATRIO Health Plans BridgeSpan Health Company
Oregon’s Health CO-OP FamilyCare Health Plans
Freelancer’s CO-OP Health Net
Kaiser Permanente LifeWise Health Plan of Oregon
MODA (ODS)
PacificSource Health Plans
Providence Health Plans
Trillium Community Health Plan

Will coverage and premiums be the same statewide?

The simple answer is NO.

While most of the insurance companies will have plans available statewide, a few do not. Also, insurance premiums can vary across the state, it just depends where you live. Geographic Rating Areas are used to help determine rates/premiums. In Oregon, the state is broken up into groups of counties to create seven different rating areas. This means the same person may have a different premium in Area 1 than they would have in Area 6. Here, take a look at the different areas in Oregon:

Area

Counties

Short Name

1 Clackamas, Multnomah, Washington, Yamhill Portland
2 Benton, Lane, Linn Eugene
3 Marion, Polk Salem
4 Deschutes, Klamath, Lake Central or Bend
5 Clatsop, Columbia, Coos, Curry, Lincoln, Tillamook Coastal or North Coast
6 Baker, Crook, Gilliam, Grant, Harney, Hood River, Jefferson, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wasco, Wheeler Eastern or Pendleton-Hermiston
7 Douglas, Jackson, Josephine Medford

I heard that some states will have a Consumer Oriented and Operated Plan, does Oregon have one of these?

CMS (Centers for Medicare & Medicaid Services) awarded low-interest loans to 24 CO-OPs offering coverage in 24 states. At first glance, it appears that there will be 24 separate CO-OPs operating in 24 separate states, but this is not the case. CoOportunity Health will provide coverage in Iowa and Nebraska. Freelancers CO-OP of Oregon and Oregon’s Health CO-OP will operate in Oregon, the only state to receive funding for two new health insurance CO-OPs. If you are interested in learning more about the various state CO-OPs, CMS has a great list.

Oregon’s Health CO-OP will be offering plans statewide at the Gold, Silver, Bronze, and Catastrophic metal levels. These PPO-network based (preferred provider organization) plans will be available in standard as well as SiMPLE offerings with flat fees and copayments.

Freelancer’s CO-OP (Health Republic Insurance Company) will be offering plans statewide at the Platinum, Gold, Silver, Bronze, and Catastrophic metal levels. Freelancers will be offering three new plans with networks unique to each plan. Providence Health Plan is providing network services.

What plans will the other insurance companies be offering on the exchange?

ATRIO will be offering plans in rating Areas: 3, 4, and 7 at Platinum, Gold, Silver, and Bronze metal levels. ATRIO will be offering its pioneering Innovative Plans.

Kaiser Permanente will be offering plans statewide at the Gold, Silver, Bronze, and Catastrophic levels. A  Platinum plan will also be available on the small group or SHOP exchange. Kaiser will be offering the standard plan along with two additional plans at each metal level.

MODA (ODS) will be offering plans statewide, however, limited network “innovative plans” will be available only in areas 1 and 3. Plans will be offered at the Gold, Silver, Bronze, and Catastrophic metal levels. MODA will be offering multiple products in addition to the standard state plan.

PacificSource Health Plans will be offering plans statewide at the Gold, Silver, Bronze, and Catastrophic levels. These PPO plans will be offered with three different networks and the company is establishing new coordinated care networks (CCNs).

Providence Health Plans will be offering plans statewide at the Gold, Silver, Bronze, and Catastrophic metal levels. These new plans will have new narrow networks to go with them, which can help reduce prices for consumers.

Trillium Community Health Plan, the “Coordinated Care Organization,” will be offering plans in rating areas 1, 2, 4, and 7 at the Gold, Silver, Bronze, and Catastrophic levels. These plans will be offered with three different networks and the company is establishing new coordinated care networks (CCNs).

BridgeSpan Health Company will be offering plans statewide at the Gold, Silver, Bronze, and Catastrophic level. BridgeSpan will be offering plans with “innovative” provider networks based on user locations.

Health Net will be offering plans statewide. This one is a little tricky; I will have to keeping searching to learn more about what this company is up to.

LifeWise Health Plan of Oregon will be offering plans statewide at the Gold, Silver, and Bronze levels. The company will be offering the standard plan along with two additional plans at the bronze and silver levels and three at the gold level

FamilyCare Health Plans originally submitted plans for review; however, the company withdrew from the market after the Insurance Division approved rates that would have been much lower than the company proposed.

New information is being released every day. Follow this blog to receive updates as new information is released in Oregon.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

About Strenuus

Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

Learn more at www.strenuus.com.

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