Introduce other CO staff in attendance and have them stand up so they can be identified laterTELL PERSONAL STORY
Cover Oregon is a new online marketplace—opening in October 2013—where Oregon individuals, families and small employers can compare and enroll in health and dental coverage that fits their needs and budget. Plans will be described in simplified language, and you’ll be able to make side-by-side comparisons to help you choose the right one. By shopping through Cover Oregon, individuals and businesses can take advantage of financial assistance.
This mission statement, written by our board of directors, reflects our goal to provide access to health insurance to all Oregonians, including hard to reach communities.
For background, Oregon had been planning a health insurance exchange for more than 10 years – the biggest challenge, however, was funding. Federal health reform provided the funding necessary to start up an exchange, now called Cover Oregon.The Oregon Legislature created the exchange –Cover Oregon – in 2011. We were created as public corporation, meaning we operate for the benefit of all Oregonians.We are managed by a Board of Directors and Consumer Advisory Committee, made up individuals, providers, small business owners and consumer advocates. That means that the people who can directly benefit and use Cover Oregon were involved in the initial development and continue to provide support and feedback.
In October, Cover Oregon will open for business. Individuals can enroll from October through March. Just like now, employers can choose to have their health benefits begin anytime during the year, provided it’s after October 2013. Coverage will begin in January of 2014.
State-based health insurance marketplaces are a key provision of the Affordable Care Act, which is making health care more accessible and easier to understand than ever before.
The Patient Protection and Affordable Care Act, enacted in 2010, is designed to significantly expand the number of Americans that have health care coverage. One way is through the use of tax credits, making it more affordable to purchase healthcare. Another way is through the establishment of healthcare marketplaces, like Cover Oregon to make it easier to purchase. Other market changes include:No longer can someone with a pre-existing medical condition be denied health coverage, nor can their coverage be canceled should they get sick;Each health plan offered through a health marketplace offers a suite of ten health benefits that most people are likely to need throughout their life; Medicaid expansion through a streamlined application and expanded income limits;The requirement that each individual have health coverage or face a penalty;And patient protection provisions like ensuring carriers spend money from premiums on delivering healthcare services– if they spend more than 20% on administration, they must provide rebates to their customers
Another important component of the Affordable Care Act, is the “metal tiers”. All plans sold to individual and small group will fall into these groups. Simply put, the higher the metal tier, the less an individual is required to pay out-of-pocket for healthcare expenses like co-pays, deductibles, etc. A Gold Plan would cover 80% of the healthcare costs, leaving 20% to be paid for by the customer. While the premium is higher for the higher metal tier plans, it may provide more peace-of-mind, knowing more of the healthcare costs will be covered.
Rates and plans were just approved and now they are being certified by Cover OregonWile the number of plans available will vary by county, there will be plans available throughout the state.
All the health plans available through Cover Oregon must cover ten essential health benefits, including coverage for doctors visits, hospital stays, maternity care, prescriptions, mental health services, ER care, preventive care, vision coverage for kids and more. Some plans may offer more benefits such as alternative care, but ALL plans will cover these 10 core benefits.
Now, let’s talk about the benefits of Cover Oregon for individuals and families.
Shopping for health coverage through Cover Oregon allows individuals and families to take advantage of financial help, in the form of premium tax subsidies. Individuals can choose to take those subsidies monthly, to buy-down the monthly cost of their insurance premiums, as a tax credit at the end of the year, or somewhere in between. While many people are likely to prefer to offset their monthly premium, if a person’s income fluctuates, taking it in one lump sum at the end may be the best approach for them. Cover Oregon is a one-stop shop, so after answering a few questions about income and family make-up, it will be determined if an individual is eligible for a Medicaid-funded program or a commercial qualified health plan. Either way, they can enroll through Cover Oregon.com. As with the small group market, plans can be compared side-by-side, with plan information and costs clearly spelled out. And each plan will feature a quality grade. HSA-eligible plans will also be available through Cover Oregon.
As mentioned earlier, Medicaid is expanding to those making up to 138% of the federal poverty level or $15,000 for a an individual.And approximately 400,000 Oregonians will be newly eligible for tax credits, here in the far right column, which are available for those who make up to 400% of the federal poverty level or $45,000 for an individual and $94,000 for a family of four.
Businesses with less than 50 employees can also shop on Cover Oregon. Those with less than 25 employees may be eligible for a tax credit too, only available through Cover Oregon.
For small businesses we know that providing health insurance helps their workers stay healthy and productive, reduces sick days, and gives them an edge in recruiting and retaining top talent.Cover Oregon offers small businesses:Choice. Compare and select from a broad range of plans from multiple carriers, and give employees more options. Employers will determine the level of choice they want to make available to their employees.Clear information. The site will describe each plan in plain language so you can make side-by-side comparisons. Set contribution. You decide the amount you will pay toward premiums, and then let your employees shop. Quality coverage.: Every plan will provide coverage you can count on—even for people with a pre-existing health condition. The plans will provide coverage for all of the 10 essential health benefits I mentioned earlier.Streamlined administration. Cover Oregon will provide the employer with a single monthly invoice and will then receive a single premium payment, regardless of the number of plans or the number of carriers ultimately chosen by the employees.Help. Purchase online, work with an insurance agent, or access our trained specialists for help online, in person, or over the phone.
As I mentioned earlier, if you’re a small business with fewer than 25 employees, and those employees’ average annual wages are less than $50,000, and you’re paying at least 50% of the employees’ premium costs, you will be eligible for a 35% federal tax credit that will go up to 50% in 2014
The best part is that employers who shop on Cover Oregon can now get out of the business of choosing a health plan for all of their employees that likely only meets the needs of a percentage of them.Employers can choose from these 4 ways to shop: They can still offer one plan through one carrier Or all plans at a certain metal tier across all carriers One carrier and any tier level that carrier offers Or broad choice where the employer determines a reference plan and employees can choose any plan at that level or below and up to one metal tier above.
Right now, only small businesses will less than 50 employees can shop on Cover Oregon. That goes up to 100 employees in 2016 and we’re still waiting to hear what will happen after 2017.
Finally, here are a few more details about the portal itself. No matter if you’re an individual, family or small business, you’ll all go through the same door to access health coverage.
Consumers will be able to search, sort and filter by:Geography, Price, Provider, Quality rating, Carrier, Plan type (e.g., HMO, PPO), Deductible, Out-of-pocket maximum, Metal tier (bronze, silver, gold, platinum)
Here’s a mock up of what the home page will look like where you select if you’re shopping as an individual, family, small business or member of a tribe.
You can see here that in our design each section will tell you the information you need as well as an estimate of how long it will take. You can always save your information and come back later as well. The information is saved, BUT NOT SHARED IN ANYWAY, so the process will only become more streamlined for you over time.A shopper would start by describing the total physical household - - everyone living there. Next, the shopper would be guided through a series of financial questions about the tax households that may make up that physical household. Finally, based on all that information, the shopper will be provided with options for shopping groups based on their eligibility for different levels of financial help.
Here is a screen mock-up from the middle of the shopping and browsing experience that shows side by side comparisons of different plans that meet specific search requirements and needs. Scrolling down, the shopper would see a full benefit comparison for the selected plans.You see here that there are ratings. Much like Yelp or Angie’s list, we will be developing consumer ratings over time so you can hear from your peers about the best plans out there.
There are agents across the state who can help you navigate this process at no cost to youYou can also call 1-855-COVER-OR to talk to a live person on the phone, in English or other languages.There is also a robust network of community partners across the state who will be helping people in their communities.
Our comprehensive statewide outreach and marketing campaign aims to reach as many Oregonians as possible to let them know what Cover Oregon offers them and/or people they know. Now more Oregonians can access health coverage, even if they already have a health condition, and more Oregonians can access financial help to pay for coverage. The statewide marketing campaign—which includes radio, TV and out-of-home spots, such as murals and billboards—is set to launch on July 9 with new spots rolling out shortly thereafter. Already underway is a high impact, on-the-ground outreach effort in partnership with agents, community organizations, Tribes, providers, business associations, state agencies and other key partners across the state. While we have been conducting community-based outreach for the past 18 months, our advertising campaign is launching now and ramping up as we get closer to October when Oregonians can begin enrolling.
SCHOOL FLYER; ORDER ONLINEGeneral marketing materials Customizable brochures, flyers, posters
This is one meeting in a series of meetings that bring together individuals, families and small business owners, and other members of the community to learn about Cover Oregon. We will post the schedule online. Schedule:July 10: EugeneJuly 23: BendAugust 6: Online MeetingAugust 14: PendletonAugust 15: Hood RiverSept 4: Coos BaySept 24: MedfordPast meetings: Portland, Bend, Astoria and Seaside
Creative concept: Our creative concept and message for this phase of the ad campaign is simple: Rather than approach this as a traditional marketing campaign, we wanted to do something true to the Cover Oregon mission, creating something made for Oregonians, by Oregonians. We looked into some of the history of Oregon-grown initiatives, especially when a substantial change was in the air, and came across the story of the Bonneville Dam. To help gain support for the project, Woody Guthrie wrote a number of songs that helped explain what the project would do, how it would benefit them, and encourage support from people all around the area – through a medium that was easy for people to relate to and helped people remember the message as they hummed the songs throughout their day. We were inspired. And rather than ask a single well-known artist from outside of Oregon, we looked in our own backyard, and called upon any and all willing musicians here in Oregon to help bring their unique expression of the Cover Oregon mission to the people of the state by writing a song. And we didn’t stop there. Part of our media plan is Out-of-Home ads across the state, so we asked visual artists of all forms (illustrators, painters, letter-press, etc.) to help us express the Cover Oregon mission as well. Not only did this empower Oregonians to share their view of Cover Oregon and help us create communications that feel true to the communities across the state, it allowed us to put the Cover Oregon marketing dollars right back into the state, and into a population that is historically uninsured. Our hope is that this work will be genuine, and both grassroots and sophisticated at the same time, helping build awareness, positive sentiment and excitement about enrollment throughout the state.
Long Live Oregonians (Matt Sheehy)Live Long in Oregon (Laura Gibson, a Porland-area folk singer and songwriter.)
Briefly show each digital slide…Note, I only included three so as to save time.
You can stay abreast with what’s happening at Cover Oregon by checking us out with your Social Media of choice……
Or by visiting our website.
Cover Oregon Online Community Meeting
ONLINE COMMUNITY MEETING
DAMIAN BRAYKO, DIRECTOR OF OPERATIONS
AUGUST 6, 2013
• Cover Oregon overview
• Cover Oregon for individuals and families
• Cover Oregon for small businesses
• Questions & Answers
WHAT WE’LL COVER THIS EVENING
• Can’t be denied for pre-
• Essential health benefits
• Financial help
• Medicaid expansion
• Requirement to have
• Health insurance
• Carriers must spend 80%
of premiums on care
Number of plans in individual market: 110
Number of plans in small group market: 73
Number of HSA-qualified plans (tentative): 29
HEALTH INSURANCE RATES
• Oregon Insurance Division (OID) conducted a
rigorous public rate review process
• Rates have been approved by OID
• Cover Oregon is currently certifying carriers
• Rates are based on age, county of residence
and tobacco usage
• Sample rates for your area are at
ESSENTIAL HEALTH BENEFITS
Hospitalizations Ambulatory services
services & devices
Pediatric vision care
• Financial help
• Clear information and
• One-stop shopping
• Quality coverage and
• Help enrolling
• HSA-eligible plans
INCOME ELIGIBILITY GUIDELINES
Program Eligibility Medicaid Cost-Sharing
Healthy Kids Premium Tax
Household Size 138% 250% 300% 400%
1 $15,856 $28,725 $34,470 $45,960
2 21,404 38,775 46,530 62,040
3 26,951 48,825 58,590 78,120
4 32,499 58,875 70,650 94,200
5 38,047 68,925 82,710 110,280
6 43,594 78,975 94,770 126,360
For families/households with more than 8 people, add $4,020 for each additional person
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