Insurance Exchanges

September 27, 2013

If patients ask me about "the Exchange", what do I say?


The Affordable Care Act has been confusing for a lot of people, and your patients may be asking you questions as their healthcare provider about the October 1st deadline and the health insurance exchanges that have been in the news. 


It’s helpful for patients to know that health exchanges only apply to people that need to buy an individual plan, need to get on Medicaid, or that work for a small employer that is going to start offering insurance this way. 


Second, patients should know that that urgent, immediate action is not needed by anyone right now.  If a patient does need to buy an individual plan, they have plenty of time, and if they are going to use the exchange through their employer, their employer will be guiding them with enrollment directions in the next few months.


Here are some additional answers that will help you respond to patient questions:

Q: I heard about the Affordable Care Act and some deadline on October 1.  What do I need to do?


October 1 just refers to the date that people can start to use a website to compare and buy individual insurance coverage online.  The website is called the health insurance exchange, and in Oregon, it’s called “Cover Oregon”. 

  • If you have insurance through Medicare or the VA, the exchange does not apply to you, and you do not need to do anything.

  • If you have insurance through your employer, your employer might require you to keep their insurance, but if they don't, you can go to the exchange to buy an individual plan instead.   If you have the option of insurance at work but buy from the exchange however, it's possible that you won't get the tax subsidy to help pay the premiums (it depends on your income and how much your employer contributes to their plan premium).

  •  If you have an individual plan now, your carrier will be sending you a letter to let you know if your existing plan will be rolling over into a new plan or if you need to shop for something else on the exchange before December 15th. 


  • In addition, people continue to have the option of paying cash for medical services.  During the upcoming months, people that are uninsured will be asking the risk versus benefit question of whether the cash price is more affordable than the cost of premiums plus the penalty for not having insurance.  


Q: What is the penalty for not carrying any health insurance?


The penalty applies if you don't have insurance for 3 or more months per year, starting in 2014.  It is based on each person’s individual income, and there are people that qualify for full exemptions. 


(For 2014, the penalty is 1% of income or $95 per adult and $47.50 per child, and increases each year –  for more detail, click here).  

Q: How do I find the exchange?



1-855-268-3767 (1-855-CoverOR)



1-855-923-4633 (1-855-WAFinder)


Q: Can I sign up any time? 


You can only enroll in individual plans from October 1st until March 31st, 2014.  If you sign up between October 1 and December 15, your insurance coverage will start on January 1, 2014.  If you enroll between December 16th and March 31st, your plan begins the first of the month after they receive your application and first payment.


Q: What happens if I don't sign up by March 31st, 2014?


If you miss the March 31st deadline, the next time you can buy an individual plan in Oregon is between October 1st and December 7th of the next year unless you have a qualifying event, like losing other insurance, getting married, or having a baby.

Q: How will this change my visits when I come to see you?


Our policies and your care here are not changing based on the exchange.  Again, the October 1 deadline is just a start date for people to be able to buy individual insurance coverage online, and we will bill these insurance plans just the same way as we do all insurance plans. 


We will continue to collect co-payments and your portion of your care just like any other insurance. 


-OR- Use this as an opportunity to introduce any new policies that you are implementing, like collection of deposits for procedures or credit card on file programs.    


Additional, more detailed answers can be found on the Cover Oregon exchange website or the federal Health Insurance Marketplace website.  

Subscribe to Receive Future Articles