Oregon Plans2017 Oregon Individual and Family Plans

The information on this page is for plans beginning January 1, 2017.  

 

Get great care at lower costs.

The SmartChoice and Legacy Health Networks are designed to give you a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care at a lower cost.

SmartChoice Network Availability

If you live in one of the following counties, you can choose plans on the SmartChoice Network:

  • Crook
  • Deschutes
  • Jefferson

Legacy Health Network Availability

If you live in one of the following counties, you can choose plans on the Legacy Health Network:

  • Clackamas
  • Multnomah
  • Washington

 

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:

Plan

Deductible*

Out-of-pocket limit*

Co-pay for office visits

Co-insurance after deductible

SBCs
by Network
Summaries
by Network
Standard Bronze
$7,150 
$7,150 
$70 co-pay^
No charge
Standard Bronze (0)*** 
$0
$0
No charge
No charge
Standard Bronze (AI)***
$7,150 
$7,150 
$70 co-pay^
No charge
Standard Silver
$2,500
$6,850
$35 co-pay^
30%
Standard Silver (0)***
$0
$0
No charge
No charge
Standard Silver (AI)***
$2,500
$6,850
$35 co-pay^
30%
Standard Silver (73)**
$2,500
$4,750
$35 co-pay^
30%
Standard Silver (87)**
$850
$1,650
$15 co-pay^
10%
Standard Silver (94)**
$100
$750
$10 co-pay^
10%
Standard Gold
$1,000
$6,850
$20 co-pay^
20%
Standard Gold (0)***
$0
$0
No charge
No charge
Standard Gold (AI)***
$1,000
$6,850
$20 co-pay^
20%
Catastrophic
$7,150 
$7,150 
No charge+
No charge

Catastrophic plan available if under age 30 at start of plan year. If age 30 or over, visit Oregon Health Insurance Marketplace to see if eligible due to financial hardship or lack of affordable coverage.

*Deductible and out-of-pocket limit amounts shown above are the costs for individuals. Amounts for families are twice the individual amounts.

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

^Not subject to annual deductible.

+The first three primary care practitioner (PCP) Office visits are paid at 100 percent. After that, PCP office visits are subject to deductible and co-insurance.

 

Review dental plans

Dental Advantage 0/20/50 - Sample policy
Kids Dental Advantage 0/20/50 - Sample policy
Dental Advantage Essentials Core - Sample policy

 

Get more information.

Brochures:

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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 >