2020 Oregon Individual and Family Plans
 

The information on this page is for plans beginning January 1, 2020.  

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Download a brochure (PDFs): 

 

At your service: plans and networks come with choice

We’re excited to introduce our new Navigator coordinated care plans. What to expect? Simplified access to quality care and features that individuals and families want (but may not even know existed).

Navigator gives you exceptional coordinated care

In our effort to simplify health insurance, Navigator provides a more integrated approach to care—helping members get the right care, at the right time, in the right place. Navigator helps ensure a better member experience by promoting doctor-patient engagement and shared decision-making.

Navigator is available in the following counties:  

  • Clackamas
  • Crook
  • Deschutes
  • Jefferson
  • Multnomah
  • Washington
  • Yamhill

SmartChoice—coordinated care for those in Central Willamette Valley

As a coordinated care product, SmartChoice is powered by Legacy Health, OHSU Health, McKenzie-Willamette Medical Center, PeaceHealth, and Samaritan Health Services.

SmartChoice is available in the following counties:  

  • Benton
  • Lane
  • Linn

 

Review medical plans

Deductible and out-of-pocket limit amounts shown below are the costs for individuals. Amounts for families are twice the individual amounts. If members receive services from out-of-network providers, their deductible and out-of-pocket limit will be higher than the amounts listed in the chart below. All plans are available direct with PacificSource and through OregonHealthcare.gov.

Medical policy samples by plan and network (PDFs):

Plan

Deductible 

Out-of-pocket limit 

Preventive Services
No deductible, member pays:

Office Visits
After deductible, member pays:

SBCs (PDFs)
by Network
Summaries (PDFs)
by Network
Gold 1500 $1,500 $5,000 Covered in Full Primary/Urgent Care: $20*, 
Specialist: $40*
Navigator /
SmartChoice
Navigator /
SmartChoice
Gold 1500 (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Gold 1500 (AI)*** $1,500 $5,000 Covered in Full Primary/Urgent Care: $20*, 
Specialist: $40*
Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 3000 $3,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: 40%
Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 3000 (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 3000 (AI)*** $3,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: 40%

Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 3000 (73)** $2,500 $6,500 Covered in Full Primary/Urgent Care: $35*,
Specialist: $40
*
Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 3000 (87)** $1,000 $2,000 Covered in Full Primary/Urgent Care: $25*,
Specialist: 25%

Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 3000 (94)** $400 $700 Covered in Full Primary/Urgent Care: $25*,
Specialist: 20%

Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 4000 $4,000 $7,900 Covered in Full Primary/Urgent Care: $20*,
Specialist: $40*
Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 4000 (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 4000 (AI)*** $4,000 $7,900 Covered in Full Primary/Urgent Care: $20*,
Specialist: $40*

Navigator /
SmartChoice (rev. 9/23/19)
Navigator /
SmartChoice
Silver 4000 (73)** $2,800 $6,500 Covered in Full Primary/Urgent Care: $20*,
Specialist: $40*

Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 4000 (87)** $1,000 $2,000 Covered in Full Primary/Urgent Care: $20*,
Specialist: $40*

Navigator /
SmartChoice
Navigator /
SmartChoice
Silver 4000 (94)** $400 $800 Covered in Full Primary/Urgent Care: $20*,
Specialist: $40*

Navigator /
SmartChoice
Navigator /
SmartChoice
Bronze HSA 6750 $6,750 $6,750 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Bronze 6750 (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Bronze 6750 (AI)*** $6,750 $6,750 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Bronze 7000 $7,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: 40%
Navigator /
SmartChoice
Navigator /
SmartChoice
Bronze 7000 (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Bronze 7000 (AI)*** $7,000 $8,150 Covered in Full Primary/Urgent Care: $35*,
Specialist: 40%
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Gold $1,000 $7,300 Covered in Full Primary: $20*
Urgent Care: $60*
Specialist: $40*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Gold (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Gold (AI)*** $1,000 $7,300 Covered in Full Primary: $20* 
Urgent Care: $60* 
Specialist: $40*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Silver $3,550 $8,150 Covered in Full Primary: $40*
Urgent Care: $70*
Specialist: $80*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Silver (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Silver (AI)*** $3,550 $8,150 Covered in Full Primary: $40*
Urgent Care: $70*
Specialist: $80*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Silver (73)** $3,550 $6,500 Covered in Full Primary: $40*
Urgent Care: $70*
Specialist: $70*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Silver (87)** $900 $2,700 Covered in Full Primary: $15*
Urgent Care: $40*
Specialist: $30*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Silver (94)** $100 $1,000 Covered in Full Primary: $10*
Urgent Care: $30*
Specialist: $20*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Bronze $7,900 $7,900 Covered in Full Primary: $45*
Urgent Care: Covered in Full
Specialist: $90*
Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Bronze (0)*** $0 $0 Covered in Full Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice
Standard Bronze (AI)*** $7,900 $7,900 Covered in Full Primary: $45*
Urgent Care: Covered in Full
Specialist: $90*
Navigator /
SmartChoice
Navigator /
SmartChoice
Catastrophic+ $8,150 $8,150 Covered in Full Telemedicine and office combined visits 1-3 no deductible, covered in full. Visits 4+ covered in full after deductible. Urgent Care/Specialist: Covered in Full Navigator /
SmartChoice
Navigator /
SmartChoice

*Not subject to the deductible.

**This is a cost-sharing plan. Cost-sharing plans are only available to those who qualify financially and enroll through HealthCare.gov.

***The Affordable Care Act (ACA) has special provisions for members of federally recognized American Indian tribes that purchase healthcare coverage through the Marketplace, including zero-cost health services for those whose income is at or below 300 percent of the Federal Poverty Level. Please note that even with a zero cost-sharing plan, out-of-network providers can bill for the amount over the network rate.

+Only available for people under 30, or people of any age with a hardship exemption or affordability exemption.

  

Decide on a dental plan

Good dental health can lead to better overall health. You can add one of our dental plans to your health plan, or select dental-only. Available for purchase year-round, not just during open enrollment.

Dental Advantage 0-20-50 1000 - Sample policy  

Dental Advantage 0-20-50 1500 - Sample policy  

Kids Dental Advantage 0-20-50 - Sample policy  

 

Get more information

Brochures (PDFs):

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Compare rates, and apply online 

2020 Oregon Individual and Family Plan Rates (PDF) 

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Money 60 Remember: The only way to get help paying for your health insurance premiums is to purchase through the marketplace. You may also qualify for lower out-of-pocket costs. Click here for more information >

 

 

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