PORTLAND, Ore. (AP) — President Barack Obama’s health care overhaul requires most Americans to have health insurance coverage next year or pay a fine. And a key component to make that work, a health insurance exchange where people can shop for coverage and accept federal subsidies, will begin enrolling people on Oct. 1.
It’s called Cover Oregon. You’ve probably seen their catchy ads.
So what does it mean for you? That depends on who you are.
If you already get health insurance from your employer, you’re set. If you’re on the Oregon Health Plan or Medicare, you’re also set. No need to give much thought to Cover Oregon. No need to do anything differently.
But if you buy your health insurance on your own or through a broker, or if you don’t have any health coverage, you have some decisions to make.
Don’t fear, though. There are plenty of resources available to help you. Also, if you want your coverage to begin Jan. 1, you have until Dec. 15 to sign up, so there’s no big rush just yet.
Let’s start with an important fraud alert. Don’t pay anyone to help you. There are community groups and licensed insurance agents who can guide you through the process, and the legitimate ones will not charge you. They’re paid by the government or by the insurance companies.
When enrollment begins on Oct. 1, the only way to buy insurance will be to work with one of these community organizations or licensed agents. If you prefer to do it on your own, you can do so a few weeks later. We’ll get to that in a minute.
Depending on where you live, you’ll be able to choose from five to 10 insurance companies. Each company will have a slate of plans — called the Bronze, Silver, Gold and Platinum options. Bronze plans, for example, have lower monthly premiums but higher copays than other options.
Cover Oregon has given grants to 30 community organizations to get the word out and help people sign up. They’re existing health care providers or community service organizations that already work primarily with minority communities and lower-income residents.
They’ll have application forms and trained staff to help navigate application process and explain how it works.
If you want a professional to provide advice about which insurance company to select or what level of coverage makes the most sense for you or your family, you may want to enlist a licensed agent. Anyone can answer questions about how things work and what’s different between two plans, but only an agent with a license can recommend an insurance policy.
Agents earn a commission from the insurance company so they shouldn’t ask you for money, and using an agent won’t affect your premiums.
You’ll be able to find one who’s certified to sell plans for Cover Oregon on its website, http://www.CoverOregon.com, beginning Oct. 1. The website also has a list of the community organizations working with Cover Oregon.
If you prefer to do your own research and buy a plan on your own, the Cover Oregon website will let you do so starting around mid-October. It will ask you questions about your age, city, income and family size, then show you your options.
You can also reach their call center at 1-855-CoverOR (1-855-268-3767). They can answer your questions, but they can’t offer you advice. Only a licensed insurance agent can do that. They can also send you a paper application if you prefer a pen and paper to an online portal.
Eventually, the folks running Cover Oregon want to make it possible for you to search for your doctor and see which insurance plans are available for that provider. That capability may not be available on Day 1, though.
You are not required to buy your insurance through Cover Oregon unless you want to take advantage of federal subsidies that may be able to lower the price for you, depending on your family’s income. Financial assistance is available to a single person making up to $45,960 a year, a couple making up to $62,040 or a family of four earning up to $94,200. To check your exact situation, use the calculator on Cover Oregon’s website.
Financial assistance is technically a tax credit that you can choose to have applied automatically to your monthly premiums, lowering your cost each month, you can take it in a lump sum when you file your taxes, or you can do something in between.
If you make too much for financial assistance, you can still enroll through Cover Oregon, but you don’t have to. Many companies offer their own insurance plans independently.
If you already have an individual insurance plan — one you don’t get through an employer — you’ll probably want to see whether you qualify for a subsidy through Cover Oregon.
To recap: Don’t pay for assistance. You can get help from a licensed insurance agent or from a community organization at no cost to you, or you can figure it out on your own. To find an agent, or to look up your options, go to http://www.CoverOregon.com or call 1-855-CoverOR on or after Oct. 1.
Follow AP writer Jonathan J. Cooper at http://twitter.com/jjcooper .