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Facts and Figures

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State Government Insurance Programs Offered

Oregon Medical Insurance Pool (OMIP) Federal Medical Insurance Pool (FMIP) Federal program run by OMIP 503-225-6620 800-848-7280 (Search: FMIP)

OMIP: Max lifetime benefit is $2 million per covered person. Choose from 4 policy options. In some cases benefits will not be provided during the first six months of enrollment for expenses resulting from a pre- existing condition. FMIP: Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs. Eligibility: OMIP: Must be an Oregon resident and have a qualifying medical condition, or denied coverage due to pre-existing conditions, or offered coverage with substantially reduced benefits (e.g. elimination rider). May be eligible if previous coverage was terminated for reasons other than non- payment of premium or fraud. Cannot be eligible for COBRA, or government programs. FMIP: Must be a U.S. citizen or lawfully present in the U.S. Must have been uninsured for at least 6 months prior to applying. Must have had a problem getting insurance due to a pre-existing condition.

Oregon Health Plan (OHP) (Search: OHP) Programs: OHP Standard, OHP Plus, OHP with Limited Drug Benefit.

Coverage: OHP Standard: Acupuncture, Chemical dependency, Dental, Emergency/ urgent hospital care, Hospice and hospital care, Immunizations, Labor and delivery, Laboratory and x-ray, medical equipment and supplies, Medical transportation, Mental health, Physician care, Podiatry, Prescription drugs, Vision care. OHP Plus: Includes OHP Standard benefits, plus hearing aids and hearing aid exams, home health, naturopathy, therapy (occupational, physical and speech) and private duty nursing. OHP with Limited Drug: Same benefits as OHP Plus, but no coverage for prescription drugs that Medicare Part D covers. Eligibility: Must be an Oregon resident and a U.S. citizen or a qualified non- citizen. OHP Standard: Must be parents and childless adults 19 years or older with asset limit of $2,000, earning up to 100% FPL, and not getting Medicare. Must be uninsured for 6 months prior to enrollment (the six- month waiting period is waived in some cases), and paid all previously billed OHP premiums. OHP Plus: Aged and disabled singles earning 75% FPL, blind singles earning 78% FPL. Aged and disabled couples earning 83% FPL, blind couples earning 85% FPL. Asset limit for aged, blind and disabled singles is $4,000, and for couples $6,000. Pregnant women earning 185% FPL. Patients receiving TANF or Extended Medical Assistance. For children under 19, see “Healthy Kids” in the next column. OHP with Limited Drug Benefit: Must be eligible for both Medicaid and Medicare Part D.

Oregon Health Plan Plus (OHP Plus) (Search: OHP) OHP Plus includes the no-cost option of Healthy Kids Healthy Kids 503-378-2666 800-359-9517 Women-Infant-Children (WIC) 971-673-0040 (Search: WIC)

Coverage: OHP Plus/Healthy Kids: Acupuncture, Chemical dependency, Dental, Emergency/urgent hospital care, Hospice and hospital care, Immunizations, Labor and delivery, Laboratory and x-ray, Medical equipment and supplies, Medical transportation, Mental health, Physician care, Podiatry prescription drugs, Vision care, Hearing aids and Hearing aid exams, Home health, Naturopathy, Occupational therapy, physical therapy, Private duty nursing, and speech therapy. WIC: Nutrition education and services, breastfeeding promotion and education, monthly food prescription of nutritious foods, and maternal, prenatal and pediatric health-care services. Eligibility: OHP Plus/Healthy Kids: Must be an Oregon resident and a U.S. citizen or qualified non-citizen, and 0–18 years old. Must have been uninsured for 2 months (though there are exceptions to this rule for special circumstances, like a parent’s job loss or a child’s serious medical need). OHP Plus pays for the full premiums for enrollees whose families earn to 200% FPL. Otherwise, those earning 201%–300% FPL will have their premiums subsidized, and those earning 301% FPL or more must pay for the full premium. WIC: Must reside in Oregon. Must be a pregnant or recently pregnant woman, or child up to age 5, and determined to be at nutritional risk. Income must be at or below 185% FPL.

Family Health Insurance Assistance Program (FHIAP) Program is full for adults, due to budget. Reservation list remains open.

Use FHIAP to buy the private health insurance plan you choose. If an employer-sponsored plan is available then you must use FHIAP assistance to enroll in that plan. Applicants have 75 days to fill out the forms and return them with supporting documents. Must be an Oregon resident and U.S. citizen or legal immigrant, uninsured for at least 2 months (unless coming off OHP/Medicaid), and have investments and savings less than $10,000 (including rental property). Income limit is 200% FPL. Must not be eligible for or receiving Medicare.

Heath Care Reform

Small business tax credits. 67,000 small businesses in Oregon could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.
Closing the Medicare Part D donut hole. Last year, roughly 49,600 Medicare beneficiaries in Oregon hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Oregon who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.
Support for health coverage for early retirees. An estimated 70,100 people from Oregon retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.
New consumer protections in the insurance market beginning on or after September 23, 2010.
Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 2 million Oregon residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 257,000 individuals who purchase insurance in the individual market from dishonest insurance practices.
Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Oregon peace of mind.
Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 1.7 million residents of Oregon with health insurance from their employer, along with anyone who signs up with a new insurance plan in Oregon.
Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.
Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.
Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 15,000 individuals in Oregon who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.
Affordable insurance for uninsured with pre-existing conditions. $66 million federal dollars are available to Oregon starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.
Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 179 Community Health Centers in Oregon but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 7% of Oregon’s population who live in an underserved area.
New Medicaid options for states. For the first time, Oregon has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.

"Vista Health Solutions" Tel (888)215-4045 Email [email protected]