Frequently Asked Questions

The insurance requirements for Medicare beneficiaries differ from those who are not yet eligible. Generally, the Oregon Health Plan (OHP) and Qualified Health Plans coverage options are available to individuals under age 65 who do not qualify for Medicare.”

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Medicare Advantage Plans (sometimes called Part C or “MA Plans) are Medicare approved plans offered by private insurance companies. Medicare provides funding to these companies to help cover your Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide your Medicare Part A (hospital stays) Medicare Part B (doctor and outpatient visits) coverage.  Many Advantage plans include Medicare Part D (prescription drug) coverage.

Medicare Supplement Plans (sometimes referred to as Medigap plans) are sold by private insurance companies and can help pay some of the remaining health care costs for covered services and supplies, like copayments, coinsurance, and deductibles. Medicare Supplement plans are standardized and are identified by letters, such as Plan G and Plan N.

Advance Premium Tax Credits may be available to help pay premiums when you enroll for your coverage through the Federally Facilitated Marketplace – often referred to as healthcare.gov or the health insurance marketplace.  Since help is available based on income, the more you make, the less help you get.

A QHP is health insurance you buy that meets specific criteria from the Affordable Care Act.   In addition to covering hospital stays, doctor visits and prescriptions, a QHP includes things like wellness exams, flu shots and colonoscopies at no cost to the insured.

OHP is Medicaid and is primarily for people under age 65 (not eligible for Medicare).  If you qualify to be on OHP, generally, you will have access to medical care at no cost to you.  You are eligible for OHP if your income is below 138% of the Federal poverty level, you live in Oregon and are a US citizen.  Many non-citizens who meet the income requirements, live in Oregon and are lawfully in the US are also eligible for OHP.

An Advanced Premium Tax Credit (APTC) can be used to off-set your monthly premium.  You establish your tax credit amount by providing an estimate of your income.  You want to be careful when using your APTC.  If you underestimate your income, you’ll need to repay some or all of your PTC when you file your Federal tax return.

For people with incomes below certain levels, assistance is provided to off-set the cost of some services.  This is accomplished through lower co-pays, deductibles and out-of-pocket maximums.

The help you get paying for your medical costs or premiums is determined by your income, your family size and your age.

ObamaCare is a term that is used to describe the Affordable Care Act.  It is often misused and misunderstood.  When talking about your health insurance, it’s best to use the terms qualified health plans to talk about insurance you buy.  Oregon Health Plan (OHP) or Medicaid are good terms to use when referring to no-cost insurance.

There is no charge for our service. We may earn a commission from the insurance company if you enroll in a plan through us.

Typically, brokers represent more than one insurance carrier. Some agents may only represent one insurance carrier.

We represent multiple insurance carriers and are concerned about enrolling you in the most appropriate plan for your health needs.

If you go to the dentist twice a year, it’s likely that you will save money with dental insurance.  Also, if you need significant dental work, you may be able to save money, however, many dental plans have waiting periods of up to a year for major services like crowns and root canals.

Vision insurance generally covers your annual exam and helps with the cost of contacts or glasses only.  You should determine what the services will cost without insurance and compare that to what those services will cost with insurance.  Generally, people who wear contacts see some savings with vision insurance.  Medical services for your eyes (such as cataracts, glaucoma, macular degeneration, etc.)  are usually covered by your health insurance plan.

Many plans do not cover services provided by out-of-network providers (doctors, hospitals, labs, etc.) except in emergencies. If your plan provides out-of-network coverage, it will most likely be more expensive than services from in-network providers. Out-of-network providers are not required to provide services to you, except in the case of an emergency.

An HMO, or Health Maintenance Organization, requires that you see in-network providers, except in case of emergency, and typically requires a referral from your primary care to see a specialist. A PPO, or Preferred Provider Organization, allows you to see out-of-network providers if they accept the plan, and most do not require a referral to see a specialist.