Individual Health Insurance 

Big news coming for 2027 Open Enrollment: November 1-January 15, 2027

New Oregon Marketplace beginning January 1, 2027 

   Oregon policyholders will need to change from the Federal Marketplace at www.healthcare.gov to the new Oregon insurance marketplace called Explore Health.  This new system should operate similarly to the federal website.

    Look for a letter from them this Fall.  Your current Marketplace account should be transferred to the new system (assuming it works), but you will need to take steps to 'claim' your new account.  I will be here at every step to help you.  

Providence and PacificSource leaving the individual Marketplace.

     Both Providence and PacificSource announced that they will not be offering individual health insurance in Oregon for 2027.  If you are a policyholder you will need to select coverage from one of the remaining companies--which will be Moda, Regence, and Kaiser.

Need new coverage for 2026 yet?

    For the remainder of 2026 I will help my clients get quotes and enroll in coverage with healthcare.gov  (Federal Marketplace) using a 3rd party enrollment tool called HealthSherpa.  

 Schedule an appointment with Dan

If you'd like to schedule an appointment with Dan, please click on the Calendly link below:

https://calendly.com/agapeinsurance

Are all of the Marketplace options unaffordable?

    Another option (however imperfect) for health insurance is Short Term Medical insurance.  These plans in Oregon only insure you for up to 90 days per contract. I personally am insured this way.  At age 57, the least expensive Marketplace plans would cost me $2439 for 3 months of coverage.   I just wrote a 3 month Pivot Health plan for $608 for 3 months of coverage. I am healthy without pre-existing conditions.  This approach saves me over $5000 in 2026 in premiums. For more information explore my Short Term Medical page    Short Term Medical page

QUALIFYING FOR A TAX CREDIT

SINGLE PERSON IN 2026:   
   A single person making under $32,000 likely will qualify for Oregon Health Plan (Medicaid).   If you earn between $32,000 and $62,000, you may qualify for a private plan with  a tax credit.  Over $62,000 in 2026 and you likely will pay full price.

MARRIED COUPLE IN 2026:   
   A couple earning under $44,000 will likely qualify for Oregon Health Plan (Medicaid).  If you earn between $44,000 and $84,000 you will likely qualify for a tax credit.   Beyond this you will likely pay full price.

 *Tax Household definition:

    A tax household is defined by anyone who will be on your tax return for 2026.  If you have a child living with you that will not be a tax dependent for 2026, do not include them on your enrollment application.  Have them create their own profile at the Marketplace and make application on their own.

*Income definition:

   What is your best guesstimate of your combined, household 'adjusted gross income' (AGI) for all those on your tax return for 2026?  If you have no clue, pull out your 2025 Federal Tax return. 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 are receiving it.  At the end of the year when you file taxes, the Internal Revenue Service  will reconcile what you said would be your AGI on your application with what it actually turns out to be then either charge you back money or credit you. For this reason it is important to update your income projection with the Marketplace mid-year, should your income change.

How to select the 'right plan' for you?

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?

   The only company for 2026 that contracts with the Providence Hospitals is Providence Health plans. For 2027 Regence will offer a Providence Network.   Kaiser only uses Kaiser providers. PacificSource uses both the Legacy, Adventist and OHSU Hospitals. Moda also will use both Legacy and OHSU providers for 2026.   This is general info for consideration.   

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

No family discount and no shared deductible

   There are no family discounts for selecting the same plan; Each person has their own premium based on age, and each person has their own deductible to fulfill for 2026.  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 to meet family needs

   You can mix and match plans to meet your family needs. For example one year in my home, I had a Kaiser HSA plan, my wife has a Providence Connect plan, and my son is on a Short Term Medical plan.  Select plans that meet each family members need.

   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 qualify for a tax credit, you will find that some plans offer 'Extra Savings', meaning the deductible and out of pocket maximum are reduced on some Silver-level plans.  There are 3 levels of extra savings, which depend on your income.

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, including prescriptions (Confusing, right?). Costs will always be more if you go to an out of network provider.  A trip to an 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.   I also suggest reading the company brochure so that you are familiar with the additional benefits offered.

    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.  

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.  

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 2026 income ready to go. The brief steps include:

1.  SET UP AN APPOINTMENT WITH DAN

 2.  SELECT A PLAN

   Prior to making application we will discuss the plan options for the remainder of 2026, then I can discuss your 2027 plan options using the information I know.

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 08/22/2026