Frequently Asked Questions:
Applying For and Managing Coverage After Open Enrollment Ends

The Cover Oregon Board of Directors has decided to stop further development on the current state website for private plans. If you are one of the more than 240,000 Oregonians enrolled in coverage through Cover Oregon, you do not need to do anything different right now. Our goal is to make this transition as easy as possible for consumers, and we will have more information in the coming weeks and months about what Cover Oregon will look like in the future. Here are some Q&As about the technology changes.

Below are some questions and answers about what is changing now that open enrollment for 2014 has ended. Open enrollment for 2015 will begin Nov. 15.

Cover Oregon is also providing retroactive tax credits to eligible Oregonians who tried to apply for health insurance through Cover Oregon, but experienced technology challenges. Those who attempted to apply without success, and then purchased a private plan directly through an insurance carrier may be eligible for a retroactive tax credit and should call Cover Oregon at 1-855-CoverOR (1-855-268-3767) no later than Friday, June 27, 2014 at 6:00 p.m. For more information on how to receive a retroactive tax credit, click here.


Applying for and Enrolling in Coverage

What if I did not apply by April 30?

If you did not apply by April 30, you can still submit an application. If you are eligible for a private plan, you will need to wait until the next open enrollment period to choose a plan and enroll unless you experience certain life changes, such as becoming a parent or a change in your marital status. The start of the next open enrollment period is Nov. 15, 2014, and the soonest coverage could start is Jan. 1, 2015.  If you are eligible for the Oregon Health Plan or Healthy Kids, you can enroll year round.


How do I apply for coverage now that open enrollment has ended?

You can submit a PDF application at CoverOregon.com or schedule an appointment with an agent or community partner who can help you apply. You can find an agent or community partner in your area at CoverOregon.com. You can also fax or mail in your application.


I applied by April 30 and am eligible for a private plan. What is the deadline to enroll?


If the date on your eligibility determination letter from Cover Oregon is on or before April 30 and shows that you are eligible for a private plan, you need to enroll by May 31.

If the date on your eligibility determination letter from Cover Oregon is after April 30 and shows that you are eligible for a private plan, you will have 30 days from the day you are notified to enroll.

If you applied through an agent or community partner, they can help you enroll online. If you received an enrollment packet in the mail, you can enroll in a plan here.


I submitted an application but have not heard back. Will my application be processed in time to get coverage in 2014?


Yes. Once we process your application, we will notify you what you are eligible for. If you are eligible for a private plan, you will have 30 days from the day we notify you to enroll. If you are eligible for the Oregon Health Plan, you will be automatically enrolled if your application is complete.


I missed the April 30 deadline. Can I apply directly through an insurance company?


No. Open enrollment for individual private coverage is closed for both Cover Oregon and insurance companies. You can, however, submit an application through Cover Oregon if you have had a life change.


I applied to Cover Oregon but haven’t enrolled yet. Do I need to apply again at the federal website healthcare.gov?


No, you do not need to reapply.    


I am enrolled in a private plan. What do I need to do?


Here’s what consumers need to know. If you’ve enrolled in coverage through Cover Oregon, you do not need to do anything different right now. Our goal is to make this transition as easy as possible for consumers when it’s time to re-enroll in the fall. We are exploring options right now and will have more information for consumers well before the beginning of the next open enrollment period in November.


When is the next open enrollment period?


The next open enrollment period for private coverage begins Nov. 15, 2014, and the soonest coverage could start is Jan. 1, 2015. However, if you have had a life change, you may be eligible for a private plan outside of the open enrollment period. If you are eligible for the Oregon Health Plan, you can enroll year-round.


What is the difference between applying and enrolling?


Applying is what you do to find out what plans you are eligible for and whether you qualify for financial assistance. The application is where you submit to Cover Oregon, an insurance agent or community partner information about your family size, income and where you live. The deadline to apply for private health insurance in 2014 has passed but you can still submit an application. If you are eligible for the Oregon Health Plan, you can enroll year round, and your coverage begins the day that the coverage is requested to begin. If you are eligible for a private plan, you’ll need to wait until Nov. 15. 2014 to enroll, and coverage would start no sooner than Jan. 1, 2015 (unless you have a life change).  

Enrolling is what you do after you have heard back from Cover Oregon. It means you’ve been notified what you are eligible for and you choose which insurance plan you want. If the date on your eligibility determination letter from Cover Oregon is on or before April 30 that you are eligible for a private plan, you need to enroll by May 31. If the date on your eligibility determination letter from Cover Oregon is after April 30 that you are eligible for a private plan, you will have 30 days from the day you are notified to enroll. Please note that if you are eligible for the Oregon Health Plan, you will be automatically enrolled and don’t have to take further action. If you experience certain life changes, such as becoming a parent or getting married, you may be able to apply for and enroll in a private plan outside of the open enrollment period.


I enrolled in an insurance plan in March. Is my plan good for a year or do I need to do something now?


You do not need to do anything right now. Your current coverage ends on Dec. 31, and you will need to re-enroll in a plan. We will notify you well before the next open enrollment period what you will need to do.


Can I still apply for the Oregon Health Plan?

Yes. Those who are eligible for the Oregon Health Plan (OHP) or Healthy Kids can enroll year round, though they may be subject to the federal tax penalty for not having health insurance if they didn’t apply by April 30. Coverage generally begins the day the application is received, so there is no lag time.


I was notified my application is incomplete. When do I need to complete it by?


You have 45 days from when Cover Oregon received your application to complete it. If you have questions about your specific date, please call the Cover Oregon service center at 1-855-CoverOR (1-855-268-3767).


Life Changes (Qualifying Events)

I have had a life change and might be eligible for insurance through Cover Oregon. Can I apply outside of open enrollment?

Yes. If you have experienced a life change, you may be able to enroll in a private plan outside of the open enrollment period for what’s called a qualifying event. You should submit an application. Keep in mind that you can enroll in the Oregon Health Plan year round if you are eligible.


What is considered a life change?


This is a life change such as marriage, divorce, adding children to your family, changing income, etc. Here is a full list. If you have a life change, you may be able to enroll in a private plan outside of the open enrollment period for what’s called a qualifying event.


Changes/Cancellations

What kind of changes do I need to report?

You need to report life changes such as income going up or down, someone becoming pregnant, marriage or divorce, loss of a job, having access to health insurance, etc. Here is a full list of changes you need to report.


How do I report changes?


Call Cover Oregon at 1-855-CoverOR (1-855-268-3767) to report the changes within 30 days of the change.


I am enrolled in a private plan but have had a life change. Do I need to report the change to you or my insurance company?

You would need to notify Cover Oregon. This is because we might need to re-determine what you are eligible for. Here is a full list of changes you need to report. Call Cover Oregon at 1-855-CoverOR (1-855-268-3767) to report the changes within 30 days of the change, or as soon as possible.


I enrolled in the Oregon Health Plan through Cover Oregon. Do I report changes to Cover Oregon or the Oregon Health Authority?


You can report changes to either Cover Oregon or the Oregon Health Authority


I want to terminate my private insurance. How do I do that?


Call Cover Oregon at 1-855-CoverOR (1-855-268-3767) to make the request. Keep in mind that you may be subject to a potential federal tax penalty for not having health insurance if you go without health insurance.


Federal Tax Penalty

How can I be sure that I won’t get a penalty?

Oregon had the authority to call an extended application period and the federal government has agreed not to assess any potential penalties for Oregonians who apply for coverage through Cover Oregon by April 30, 2014.  If you waited to buy coverage directly from an insurance company between April 1 and April 30, you may have to pay a partial federal tax penalty. The Oregon Insurance Division will provide more information about how penalties may apply to individuals who do not apply for coverage through Cover Oregon as soon as possible.


I applied between April 1 and April 30. Do I need to do anything to make sure I don’t get a federal tax penalty?


We are working out the details with the federal government on that and will have more specific guidelines soon. Be assured that Oregonians who apply by April 30, 2014 and enroll in a plan through Cover Oregon will not be subject to a potential federal tax penalty. If you wait to buy coverage directly from an insurance company between April 1 and April 30, you may have to pay a partial federal tax penalty. The Oregon Insurance Division will provide more information about how penalties may apply to individuals who do not apply for coverage through Cover Oregon as soon as possible.


How much is the federal tax penalty? Are there any exemptions?


The federal tax penalty for not having health insurance in 2014 is either 1 percent of your family household income, or a maximum $95 per person ($47.50 per child under 18), whichever is greater (note: penalty is calculated on number of months uninsured and is prorated). The penalty amount increases every year until 2016 when it reaches $695/per adult, or 2.5 percent of income. From then it will be adjusted by inflation (there is an overall cap each year). In essence, the options for each month are (1) get insurance, (2) claim an exemption or (3) pay the penalty. There are hardship exemptions for the penalty and those can be found here.