Individual Health Insurance 2025

     Selecting the right Individual Health insurance plan in Oregon can be a challenge.  For 2025 there are 57 plans offered among 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 correctly understand.   

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

To schedule an appointment with me give me a call Dan at 503-740-0535 or use my scheduling tool below:

​CLICK HERE to schedule an appointment with Dan

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 below.   You can determine your eligibility for a tax credit and view the 65 plans available by clicking the link below.     

Click Here to preview plans at www.healthcare.gov/see-plans/#/

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.  *The chart below will show you how much you can earn based on your family size.

*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 and have them create their own profile at the Marketplace.

*INCOME DEFINITION:   

   What is your best guesstimated  of your combined, household 'adjusted gross income' for all those on your tax return for 2025.  Your Adjusted Gross income is what is on line 11 of a 1040 Federal Tax Return.    Include social security if you qualify.
 

How to sort the 65 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 then when looking at the plans available click 'Filter plans' then 'Add Medical Providers', and then filter the plans by plans that accept your doctor.  This will shorten the list of prospective companies.  You can also filter by plans that accept your prescription drugs if you are on expensive ones.

Is your preferred hospital in network?

   In general, the only company for 2025 that contracts with the Providence Hospitals is the Providence Health plans.   Kaiser only uses Kaiser providers.  PacificSource uses both the Legacy, Adventist & OHSU Hospitals.   Moda uses OHSU, Tuality  and Adventist.  Regence has 2 networks:  The Legacy Network uses only the Legacy Hospitals.  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 doctors and other providers year around.  

https://www.agapeinsurance.net/provider-networks.html

No family discount:   

       There are no family discounts:  Each person has their own rate premium based on age, and each person has their own deductible to fulfill for 2025.      However, if you have more than 3 kids on a single policy,  the 4th kid is free if you are insured under the same policy.  If you have a tax credit and select different plans, they apply part of the credit to each person.

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, and 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" in the Silver Plans for some people:

     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 both 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, then 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 expensive 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 expensive 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 get a drug denied, you can always try an appeal again if your doctor things this drug is best for you.    There are also sometimes special programs to help make those expensive drugs more affordable, which you can learn more about at www.goodrx.com 

Goodrx.com  savings  

        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.com is less expensive than the cost under the insurance plan.    For example, my gout medication was $15 with the insurance and only $8 using Goodrx pricing.    Goodrx.com can also be used to locate those discount programs for the expensive drugs.        

READY TO APPLY?

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

I have a page to the Left devoted to each insurance company ( The Providence Page) for example.  Here you can browse the 2024 plan brochure, which includes the plans  a partial list of the plans limitations and exclusions.  I also include links to do nurse video visits, the nurse hotline number, and customer service and claims contact numbers.

WHERE TO APPLY?

     I assist my clients apply 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 ERRORS:   
       When I help you complete the application the odds of a costly mistake goes down. Particularly if you misunderstand the income of dependent parameters.  I can also help you complete the enrollment in about 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, but I am only compensated if you lists me as your broker.   See below:

3.  IF YOU DE DECIDE TO APPLY ON YOUR OWN, THAT'S FINE:    
      The application does ask "Is anyone helping you complete this enrollment?"   

I would appreciate your 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 also how I am compensated for my  services (including this website education) and this come at no cost to you.   If I am your broker I will notify you each year about important changes to your plan.

     SCHEDULE AN APPONTMENT WITH DAN 

1.  MAKE AN APPOINTMENT USING MY ONLINE LINK:   
    To get on my calendar for a phone or in-person appointment,  I have a online calendar link to set up an appointment.   

CLICK HERE to make an appointment with Dan Neils 

2.  GIVE ME A CALL TO SET UP AN APPOINTMENT:   

    My  number is 503-740-0535 If you don't like calling for appointments, email me at danneils@gmail.com with a day and time or two and we'll work it out.   

3. 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).   

2.  COMPLETE THE APPLICATION: 
    Including in your application everyone on your tax return for 2024, 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.  You 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.

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 of 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, and no money down is required and the coverage is identical.  If  your life or income changes, the Marketplace offers you far greater options compared with applying directly to the carrier

Here are a few more things to consider relating to Individual Plans

 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 10/31/2024