Getting Health Insurance for Your Family
Pollywog works to support families and help our community stay healthy. We want to highlight the importance of health coverage for you and your children and provide valuable information about resources available in Oregon.
Understanding Health Coverage Options
Oregon offers a range of health coverage options to ensure that every individual has access to the healthcare they need. Understanding these options can help you make informed decisions and secure the best possible care for you and your children.
1. Oregon Health Plan (OHP) Plus:
• OHP Plus is Oregon’s Medicaid program, providing free health coverage for eligible low-income individuals and families, including children.
• Services covered by OHP Plus include doctor visits, hospital care, dental, vision, mental health services, and prescription medications.
• You can sign up for OHP Plus at any time. If your situation changes midyear, you may be able to get benefits as soon as the first of the month you apply.
• More information can be found at OHP.Oregon.gov.
Parent Newsletter July 2024
2. OHP Bridge:
• OHP Bridge is Oregon’s newest health coverage option for adults ages 1964 with income below 200 percent of the federal poverty level who have an eligible immigration status and do not have access to other affordable health coverage.
• There are no member costs for OHP Bridge such as monthly premiums or when using benefits.
• All OHP Plus benefits are covered by OHP Bridge, except for long-term services and supports and healthrelated social needs.
• You can sign up for OHP Bridge at any time. If your situation changes midyear, you may be able to get benefits as soon as the first of the next month, or even sooner!
• More information can be found at OHP.Oregon.gov/Bridge.
3. Private Insurance and Marketplace Plans:
• For individuals not eligible for OHP Plus or OHP Bridge, OregonHealthCare. gov offers high quality health plans and dental coverage.
• Financial help is available to lower the cost of monthly premiums and out-of-pocket costs like copayments, coinsurance, and deductibles. 80 percent of Marketplace enrollees are getting financial help!
• Open enrollment is from Nov. 1 to Jan. 15 each year. This is the primary time when most people can enroll. If you experience a life change – like losing OHP Plus or employer coverage, moving, or a household change – you may be able to get coverage midyear.
• Marketplace plans cover all routine care and much more.
• Preventive services like immunizations and important screenings to help keep you and your family healthy are FREE when visiting an in-network provider!
Learn more about Marketplace coverage at orhim.info/Marketplace.
Steps to Get Health Coverage
1. Assess Your Needs: Think about your and your family’s health needs, including routine check-ups, medical conditions, and prescription medications.
2. Gather Documents: When applying for any health coverage program, have important documents ready, such as proof of income, social security numbers, and immigration status (if applicable).
3. Apply and Enroll: Utilize online resources or a certified local expert to help navigate the application process.
4. Maintain Your Coverage: Keep track of renewal dates and required documentation to ensure continuous coverage without interruptions.
How to Apply
Before applying, we recommend using the Window Shopping tool on OregonHealthCare. gov to preview what coverage options and savings may be available. The tool will ask a few general questions about you and your family and then tell you what application you should complete.
Applying for OHP Plus and OHP Bridge:
• Find a certified community partner that provides free OHP application assistance.
• Visit ONE.Oregon.gov
• Call 800-699-9075
• Visit a local Oregon Department of Human Services (ODHS) office
Applying for Marketplace Coverage:
• Find a certified community partner or insurance agent that provides free Marketplace application assistance.
• Call 855-268-3767 to find free local help.
• Visit HealthCare.gov or call 800-318-2596
Ensuring that your children have reliable health coverage is crucial for their growth and well-being. If you have any questions or need assistance with the application process, please don’t hesitate to reach out to the Oregon Health Insurance Marketplace. We are happy to point you in the right direction to ensure you and your children have access to the coverage and care they need.
Benefits Covered by Marketplace Health Plans
Navigating health insurance can be overwhelming, but understanding the benefits included in Marketplace health plans can help you make informed decisions for your family’s health care needs. OregonHealthCare.gov offers a variety of plans with robust benefits designed to ensure that you and your family have access to high-quality health coverage to fit your needs.
Here’s a breakdown of the benefits covered by all Marketplace health plans:
Essential Health Benefits
All Marketplace health plans cover a set of essential health benefits, which include:
1. Preventive and Wellness Services: Coverage for immunizations, annual check-ups, screenings, and counseling to prevent illnesses and maintain overall health. In most cases, these services are provided at no additional cost when visiting an in-network provider.
2. Maternity and Newborn Care: Comprehensive care throughout pregnancy, childbirth, and postnatal care. Includes prenatal visits, labor and delivery, and care for newborns.
3. Pediatric Services: Pediatric care includes routine exams, immunizations, and vision care for children. Pediatric dental care is often included in health plans and is also available as standalone plans if not covered by the health plan. This ensures your children get a healthy start and regular check-ups to monitor growth and development.
4. Emergency Services: Coverage for emergency room visits and services without needing prior authorization, ensuring immediate care during emergencies.
5. Hospitalization: Inpatient care, including surgeries, overnight stays, and specialized care, is covered to alleviate financial burdens during hospital stays.
6. Mental Health and Substance Use Disorder Services: Coverage for mental health services, including therapy, counseling, and substance use treatment, ensuring support for emotional and psychological well-being.
7. Prescription Drugs: A wide range of medications are covered, from generic to specialty drugs, to manage chronic conditions and acute illnesses.
8. Rehabilitative and Habilitative Services: Services to help recover skills lost due to injury or illness and to gain skills necessary for daily living. Includes physical therapy, occupational therapy, and speechlanguage pathology.
9. Laboratory Services: Diagnostic tests, including blood work and X-rays, are covered to diagnose and monitor health conditions.
10. Ambulatory Patient Services: Outpatient care without hospitalization, such as doctor visits and outpatient surgery, ensures access to medical care without overnight stays.
Additional Benefits
In addition to the essential health benefits, many Marketplace plans offer extra perks that can enhance your family’s health care experience:
1. Telehealth Services: Access to virtual doctor visits and consultations, providing convenient and timely medical advice and care from the comfort of your home.
2. Wellness Programs: Programs and resources to promote healthy living, including weight management, smoking cessation, and fitness programs.
3. Discounts on Health Products and Services: Discounts on gym memberships, alternative medicine services (like acupuncture or chiropractic care), and wellness products.
4. Family Planning Services: Coverage for contraception and counseling, ensuring that you have the resources to plan and manage your family’s health.
5. Chronic Disease Management: Support for managing chronic conditions, including diabetes education programs, asthma management plans, and access to specialists.
Financial Assistance
To make health coverage more affordable, the Marketplace offers financial help based on your household income:
• Premium Tax Credits: These credits can lower your monthly premium costs, making health insurance more affordable.
• Cost-Sharing Reductions: These reductions lower out-of-pocket costs for deductibles, copayments, and coinsurance if you qualify.
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