As all states work to come into compliance with the terms of the 2010 Patient Protection and Affordable Care Act numerous changes are taking places in their basic insurance regulations. Children already enjoy protection for pre-existing condition exclusions, and may now remain on their parents’ health policies up to age 26 regardless of their status as students or even if they have married. Temporary high-risk insurance pools have been created in most states to address the insurance needs of adults with pre-existing conditions, a system that will be replaced by the federally mandated health care exchanges on January 1, 2014.
Health insurance companies in Oregon must follow the mandates stipulated in the Health Insurance Portability and Accountability Act, HIPAA, which was enacted in 1996 by congress. The purpose of HIPAA is to protect patient medical records and private health information. A signed authorization must be submitted before any medical records or health information can be released to anyone. Additionally, HIPAA mandates how medical information can be shared electronically.
General Insurance Regulations
Oregon insurers are currently allowed to exclude pre-existing conditions from coverage for up to 6 months, however, state regulations recognize continuous coverage. If there has been no policy gap, the applicant would not likely be subject to the exclusion. Health status can, however, be used to deny initial coverage, but not to set premium rates, which can only be increased due to age.
Health Care Exchanges
Oregon established the Oregon Health Insurance Exchange Corporation on June 22, 2011, which will be implemented in stages on target for a functional launch between July 2013 and July 2014. The exchange will operate on the active purchaser model.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in the state is run by the Oregon Medical Insurance Pool. The coverage includes benefits for primary and specialty care, hospitalization, and prescription drugs. Premiums range from $262 to $826 a month, with deductibles ranging from $500 to $750. The out-of-pocket limit is $1000 for medical expenses and $4050 for prescriptions.
Medicaid eligibility is determined by income as a percentage of the Federal Poverty Level. In Oregon, children under 5 years of age qualify for Medicaid at 133% FPL, while the 6-19 age bracket is eligible at 100%.
Pregnant women may draw Medicaid benefits at 185% FPL, adults at 185%, and disabled Social Security recipients at 74%.
Approximatley 15 percent of Oregon residents are enrolled in Medicare, with more than 587,800 accessing prescription drug coverage. (Additional help may be available for out-of-pocket expenses through the Oregon Prescription Drug Program.)
Additionally, the Senior Health Benefits Assistance Program offers both counseling and educational services to Medicare recipients to facilitate their health care choices.