Health insurance overview
Individual health insurance
Buying a policy
- You can buy an individual plan for you or for you and your family through an agent or directly from an insurance company. Find companies that offer individual health insurance in your area at healthcare.gov/
- You and anyone else applying to be on your policy must complete a detailed health application called the "Oregon Standard Health Statement." All companies must use this statement to decide if applicants age 19 and older qualify based on health.
- The company will ask whether in the past five years you have had any medical advice; diagnosis; care or treatment, including any prescribed medications; or surgery or hospitalization. If you don't remember everything, you may need to check with your doctor or review your medical records to accurately complete this form.
- It's important to fill out the application accurately and truthfully. If you commit fraud or intentionally misrepresent a material fact on an application, the company can rescind your policy. If this happens, you will have to pay all of the medical bills you accumulated when you thought you had insurance. In other words, it would be as though you never had coverage.
- If you are under age 19, you cannot be denied coverage because of pre-existing conditions.
- If you are 19 or older and pregnant when you apply for an individual health plan, an insurance company may legally decide not to insure you and your spouse.
- If an insurance company declines to cover you or a family member, you can apply for coverage through state-run high-risk pools that serve Oregonians who get turned down for health insurance. Learn more at: www.omip.state.or.us/
- Young adults may stay on their parents' plan until age 26.
- If you are age 19 and older and get accepted for coverage but have a medical condition, you may have to wait up to six months before that pre-existing condition will be covered. Example: You have asthma and discussed the disease with your doctor two months before getting insurance. The insurance company may not cover asthma related issues for six months.
- If you had health insurance within 63 days of the start of the new policy, you get credit for this coverage and the waiting period is reduced one month for every month of coverage you had. This may reduce or even eliminate the waiting period for coverage of existing medical conditions.
- If you are under age 19, insurance companies may no longer make you wait before coverage of pre-existing conditions begins.
- Your monthly premium for health insurance and any rate changes depend on your plan choices, your age, where you live in the state, and your family size. Your rates cannot be based on your health or claims history.
- Your rates can be increased annually and will typically reflect increases in medical costs. You may see additional rate increases if you or members of your family move into a higher age bracket.
Once you have insurance
- A company can't end your coverage if you get sick.
Tip: Finding a policy that fits your needs
There are many types of insurance policies with varying price tags. The key is to find the policy that best fits your medical needs and your pocketbook. For example, if you are young and healthy, you may want a higher deductible plan with a lower premium. Maybe you want a plan that emphasizes preventive benefits. Do you want a lot of freedom to select your doctor, or are you willing to pay a bit less for the type of managed care that requires a primary physician to coordinate your care?
An insurance agent can help you shop. The Insurance Division's consumer advocates can also help you understand basic insurance concepts: 503-947-7984 or 888-877-4894.