Frequently Asked Questions
Important dates for enrollment
November 1, 2015
Open Enrollment starts first day you can enroll in a 2016 Marketplace plan
January 31, 2016
2016 Open Enrollment ends
January 1, 2016
First date 2016 coverage can start
Downloadable Fact Sheets
What is HealthCare.gov?
HealthCare.gov is a new central marketplace where Oregon individuals and employers will be able to shop for health insurance plans and access financial assistance to help pay for coverage. Starting in the fall of 2013, HealthCare.gov will serve as a one-stop resource that makes it easy to find the plan for your unique needs.
Who is HealthCare.gov for?
Individuals and families who do not have access to affordable coverage at work will be able to use HealthCare.gov to make “apples-to-apples” comparisons of health insurance plans, costs and quality as well as access financial assistance.
For small employers with 50 or fewer full-time equivalents (FTEs), HealthCare.gov will offer health coverage that gives more choice to your employees and is easy to administer.
How can HealthCare.gov help me?
HealthCare.gov will determine whether individuals qualify for financial assistance to help pay for their coverage. IIndividuals and families can get financial help paying for health insurance in the form of tax credits. For example, an individual earning up to $45,900 a year or a family of four earning up to $94,200 a year may be eligible for a tax credit to help cover the cost of their monthly premiums.
Small employers with fewer than 25 full-time equivalent employees and who pay an average wage of less than $50,000 a year may qualify for a tax credit worth up to 50% of the premium costs.
What is the difference between buying an insurance plan through HealthCare.gov and buying a plan directly from an insurance company?
Individuals and small employers who shop through HealthCare.gov will enjoy unique benefits. Through HealthCare.gov, 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 HealthCare.gov will be able to provide their employees with more plan choices. And, only through HealthCare.gov, small employers will be able to apply for the small business tax credit.
Individuals & Families FAQs
As a retired public employee who has PERS, will I be able to purchase health insurance through HealthCare.gov? Or, will I have to purchase through PERS?
Yes, you will be able to purchase health coverage through HealthCare.gov even if you have access to health insurance through the Public Employees Retirement System (PERS) upon retirement. Depending on factors such as your age and income at the time of retirement, you may also qualify for premium tax credits and cost-sharing assistance. However, Medicare-eligible retirees would not qualify for premium assistance.
Will individuals and families be able to receive financial assistance through HealthCare.gov?
Yes, by enrolling in a health plan through HealthCare.gov, 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 HealthCare.gov website beginning in October 2013. Eligibility will be based on the modified adjusted gross income for your entire household.
I have a child who no longer lives at home. Do I count him as a household member? Does it depend on his age?
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.
What happens to me when the Oregon Medical Insurance Pool closes?
OMIP members will be able to select a plan from HealthCare.gov starting in October 2013. Coverage for plans purchased through HealthCare.gov 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. HealthCare.gov will have a customer service center, insurance agents, and community partners throughout the state to help you through this process.
If my employer chooses not to provide health insurance benefits, what other choices do I have?
If your employer does not offer health insurance benefits, you will be able to shop for health coverage for you and your family through HealthCare.gov. You also can apply for financial assistance or other programs that make health coverage more affordable. The number of plans available through HealthCare.gov will depend on where you live. You will be able to narrow your search by using a number of filters to find a plan that best fits your budget and meets your health coverage needs.
What size of business can use HealthCare.gov?
HealthCare.gov will serve employers with 50 or fewer employees in 2014 and beginning in 2016, up to 100 employees.
Do all employer plans have to include coverage for dependent children?
No. When a small employer sets up their plan offering, they will choose one of the following: employee-only coverage or employee-and-dependent coverage.
As an employer, what are the penalties for not participating in HealthCare.gov?
Employers are not required to participate in HealthCare.gov. Only large employers – with 50 or more full-time equivalents (FTEs) – are required to provide insurance to their employees. The penalty for large employers is based on the number of full-time employees (30 hours or more per week) that were not offered affordable health insurance. Small employers are not required to offer insurance.
Will a small employer with 15 employees be required to provide insurance to all 15 employees?
Small employers with fewer than 50 employees are not required to provide insurance to their employees. However, if a small employer does choose to provide coverage, the employer must offer coverage to all of its eligible employees.
What is the minimum participation rate for small employers? What happens if a small employer does not achieve the participation rate?
The minimum participation requirement for medical plans is 75 percent of eligible employees must enroll. The minimum participation requirement for dental plans is 50 percent of eligible employees must enroll. All full-time active employees who work the weekly eligible hours specified in the group contract are eligible to enroll. Valid waivers, such as employees with other employer group coverage, do not count toward participation. If a group does not meet the minimum participation requirement, they will not be able to proceed with purchasing a group plan through HealthCare.gov.