Individual Health Insurance 

2026 PLAN INFORMATION COMING SOON!  PLAN ESTIMATOR LINK SHOULD BE LIVE ON 11/1/25.  

Selecting the right Individual Health insurance plan in Oregon can be a challenge. For 2025 there are 57 plans offered by 6 companies. The provider networks vary by company, and some companies offer 2 different provider networks. Understanding and qualifying for tax credits can also be a challenge to understand.

Working with a Broker experienced with these plans and and provider networks improves the chance that you make an informed decision and avoid making a costly error at tax time.

To schedule an appointment, give Dan a call  at 503-740-0535 or make an appointment directly on my calendar.

Preview plans and pricing for 2025

Before you consider applying for coverage, take time to browse the plans and pricing by using the estimator tool. You can determine your eligibility for a tax credit and view the 57 plans available by clicking the link HERE.  

You can add in the 'Filter' section the names of your doctors and prescriptions to filter plans by those that accept your providers.

How much can I earn in 2025 and still qualify for a tax credit?

When using the estimator tool above, you will see the extra help you qualify for. This comes in the form of an advanced tax credit. Qualifying for a monthly tax credit is determined by your age, zip code, your *projected household income for 2025 and your *household size for 2025.

*Household definition:

 A household is defined by who will be on your tax return for 2025. So if you have a child living with you that will not be a tax dependent for 2025, do not include them on your enrollment application,  and have them create their own profile at the Marketplace.

*Income definition:

What is your best guesstimate of your combined, household 'adjusted gross income' (AGI) for all those on your tax return for 2025? Your last years Adjusted Gross income can be seen on line 11 of your 1040 Federal Tax Return (or close to it). Include Social Security income if you qualify. At the end of the year when you file taxes, they will reconcile what you said would be your AGI with what it actually turns out to be.

How to sort the 57 insurance plans down to just one?

Is your doctor in-network for the plan you select?

Is it essential that your doctor is 'In Network'? If so, when looking at the plans available click 'Filter plans' then 'Add Medical Providers'. This is a filter for plans that accept your doctor. This will shorten the list of prospective companies. You can also filter by plans that accept your prescription drugs.

Is your preferred hospital in network?

In general, the only company for 2025 that contracts with the Providence Hospitals is Providence Health plans. Kaiser only uses Kaiser providers. PacificSource uses both the Legacy, Adventist and OHSU Hospitals. Moda uses OHSU, Tuality and Adventist. Regence has 2 networks: The Legacy Network uses only the Legacy Hospitals, and The 'Individual & Family Network' uses both the Legacy and OHSU/Adventist hospitals in the Portland Metro area. This is general info for consideration.

My 'Provider Directories' page helps you search for doctors and other providers year 'round.

No family discount

There are no family discounts for selecting the same plan; Each person has their own rate premium based on age, and each person has their own deductible to fulfill for 2025.    If you have a tax credit and select different plans, they apply part of the total credit towards each person's policy premium.

Mix and match plans

You can mix and match plans to meet your family needs. For example in my home, I have a Kaiser HSA plan, my wife has a Providence Connect plan, and my son is on a Short Term Medical plan (this was true a few years back anyway). You can ask me about this if you like.

This is where having a broker is helpful, to point out some of the subtle things you may miss when visiting the websites on your own. Ultimately Coverage is subject to the terms and conditions of the insurance contract, not your understanding of it.

Understand the 'Extra Savings' for some in the Silver Plans:

If you use the estimating tool above, and you qualify for a tax credit, often times the Silver level plans offer an Extra Savings benefit. For those with lower income, this benefit lowers the deductible, copays and out of pocket maximum on Silver Level plans only. Why? Who knows. For example, a 30 year old earning $20,000, $25,000, $30,000 may be offered the same plan with 3 different deductibles. The point? Before you select the lowest cost plan, always look at the Silver level plans to see if you qualify for 'Extra Savings'.

Pay attention to the term Out-Of-Pocket Maximum   

Note that in a larger claim situation (like a hospital stay or surgery), you pay your annual deductible first, then a percentage, which is called the coinsurance. After you reach your Out of Pocket Maximum, usually the plan will pay 100% of your following expenses for the rest of the calendar year (Confusing, right?). Costs will always be more if you go to an out of network provider. Emergency and Urgent Care visits should be covered nationwide if you need emergency care.

 Do you have any high cost prescriptions?   

Generally the 'Standard Silver or Standard Gold' plans with any company will offer the best prescription drug coverage without having to meet a deductible first on any high cost covered drug.  Each company has a different list of covered drugs called a formulary, with some drugs always excluded.  If you take an excluded drug, your doctor can try to appeal to the company and request a formulary exception. If you have a drug denied to you, you can always try to appeal again if your doctor thinks the particular drug is best for you.

Sometimes there are special programs to help make those expensive drugs more affordable, which you can learn more about at GoodRx. When looking at prescription drug costs, first go to the website www.goodrx.com to see what the best 'cash' price is for the drug. Sometimes using GoodRX is less expensive than the cost under the insurance plan. For example, my gout medication was $15 with insurance and only $8 using GoodRx pricing.  GoodRx can also be used to locate discount programs for the high cost drugs.        

Ready to apply?

That's great! There a lot more I think is important to consider before making application, such as reading the full plan summary and reviewing the plan 'limitations and exclusions' sections.   

When you see a plan click on  'Go to plan details'.    Scroll down to 'Plan documents', then click on the  'Summary of Benefits' to view the plan summary for the plan.   I also recommend you browse the  "Plan Brochure" to view the company brochure (like Providence, if there is one).   There are also links for 'Provider director' and 'List of Covered Drugs.  

Where to apply?

I assist my clients in applying for coverage through www.healthcare.gov. While most people could manage to navigate this site and enroll on their own, here are a few benefits of working through with me:

1. REDUCE COSTLY ERROR:   

With help completing the application the odds of a costly mistake goes down, particularly if you misunderstand the income, or dependent parameters. I can also help you complete the enrollment in around a quarter the time it would take to correctly apply on your own.   

2.  NO COST EXPERT HELP:

Fortunately, I do not need to charge for my services, but I am only compensated if you list me as your broker on your enrollment. Broker commissions are paid by the insurance carriers, not the consumer. I am only compensated if you lists me as your broker. See below:

If you decide to apply on your own, that's fine. The application does ask "Is anyone helping you complete this enrollment?"   

I would appreciate you checking YES, and adding in broker Dan Neils,  NPN 757811
 

This will appoint me as your broker and allow met to help you 12 months of the year with problems you may encounter like denied claims, finding providers, etc. Listing my name on your enrollment is how I am compensated for my services (including this website education) and this comes at no cost to you. If I am your broker, I will notify you each year about important changes to your plan.

Schedule an appointment with Dan

There are several ways you can make an appointment with me:

1.  Make an appointment using my Online Calendar: To get on my calendar for a phone or in-person appointment,  I have a online calendar link to set up an appointment.   

2.  Give me a call to set up an appointment at 503-740-0535

3.  Email me at danneils@gmail.com with a day and time or two and we'll work out a convenient time for an appointment.

4. Fill out the form on my Contact page and I will reach out to you via your preferred method.

How long does it take, and how can I prepare to apply?

Start to finish I can complete a Marketplace enrollment in  10-20 minutes if you have your DOB, SS numbers, and projected 2025 income ready to go. The brief steps include:

1.  CREATE AN ACCOUNT

Go to www.healthcare.gov and create an account. Your email used is your login and you are asked to create a password and security questions (please write these down, as well as the security question answers).   Please test your login before our meeting if possible.

2.  COMPLETE THE APPLICATION

Include in your application everyone on your tax return for 2025, even if they are not applying for coverage. At the end of this you receive a determination whether you qualify for a tax credit or not.  Again, if you do this on your own, I appreciate it if you add in Dan Neils,  NPN 757811

3.  SELECT A PLAN

The final step is selecting a health insurance plan for each family member enrolling. They offer an option of adding a dental plan as well. It would be wise to consult with me before your final plan selection, as the provider networks can be hard to follow from plan to plan.   

After you submit your enrollment, the information is sent to the insurance company.  The company will bill you directly and coverage will not go into effect (and Member card issued) until they receive payment.

Apply directly with the carrier or use the federal Marketplace?

With Individual Health Insurance you have an option of buying directly from a company--like Kaiser or Providence, or through the Marketplace at www.healthcare.gov.   However, you can only qualify for a tax credit if you purchase through the Marketplace.   

For most people I recommend purchasing through the Marketplace, even if you earn too much for a tax credit. The process is paperless, no money down is required, and the coverage is identical (with a few exceptions).  If  your life or income changes, the Marketplace offers you far greater options compared to applying directly with the carrier.

If health insurance stresses you out...

Try not to worry about how things may change in the future. All we can do is plan one year at a time.

Matthew 6:24 'Therefore do not worry about tomorrow, for tomorrow will worry about itself.
Each day has enough trouble of it's own'.

-Jesus

page updated 5/15/2025