Individual & Family Plans

Do I qualify for a health plan if I have a pre-existing condition? Yes, you can’t be denied because of a pre-existing condition.

Do you qualify for a Subsidy? Most people who earn 400% or less of the federal poverty level.

What is a Subsidy? Under the ACA (Affordable Care Act) the government subsidizes your monthly health insurance premium by paying a specific dollar amount each month (based on your income) to the health insurance company of your choice and you pay the difference.

When can I apply for an individual plan? Under the ACA guidelines you can apply for health insurance during Open Enrollment and Special Enrollment periods.

Is it best to apply through the federal Marketplace or directly through the insurance company? It depends on if you will qualify for a subsidy or not. When you don’t qualify for a subsidy why add another layer of bureaucracy if you don’t have to?

Can I have my naturopathic doctor covered as my PCP (Primary Care Physician)? It depends on the naturopathic physician. Oregon law says: An insurer shall provide a naturopathic physician the choice of applying to be credentialed by the insurer as a primary care provider or as a specialty care provider. To be credentialed by an insurer as a primary care provider, a naturopathic physician must meet the credentialing requirements as established by the insurer.

Age
 
The older you are the higher your health insurance premiums.

Location 
Premiums also differ depending on your county and the area’s cost of living.

Tobacco Use 
If you use tobacco you will be charged more for your health insurance premium.

Plan Category
There are 3 plan categories: Gold, Bronze and Silver. The Gold plans have lower deductibles, out of pocket, and lower copays which contribute to their higher premiums. Bronze plans have the highest deductibles, out of pocket, and highest copays. Therefore they have the lowest premiums. Silver plans are a happy medium between the Gold and Silver plans in cost and coverage.