IFP101_080918_Oregon_Medical_Individual_cover2019 Oregon Individual and Family Plans 

The information on this page is for plans beginning January 1, 2019.  

 

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
  • Lane

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
  • Yamhill

 

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
Bronze HSA 6650
$6,650
$6,650
Covered in Full
Covered in Full
Bronze 6650 (0)***
$0
$0
Covered in Full
Covered in Full
Bronze 6650 (AI)***
$6,650
$6,650
Covered in Full
Covered in Full
Standard Gold
$1,000
$6,850
Covered in Full
Primary: $20 co-pay*
Urgent Care: $60 co-pay*
Specialist: $40 co-pay*
Standard Gold (0)***
$0
$0
Covered in Full
Covered in Full
Standard Gold (AI)***
$1,000
$6,850
Covered in Full
Primary: $20 co-pay* 
Urgent Care: $60 co-pay* 
Specialist: $40 co-pay*
Standard Silver
$2,850
$7,900
Covered in Full
Primary: $40 co-pay*
Urgent Care: $70 co-pay*
Specialist: $80 co-pay*
Standard Silver (0)***
$0
$0
Covered in Full
Covered in Full
Standard Silver (AI)***
$2,850
$7,900
Covered in Full
Primary: $40 co-pay* 
Urgent Care: $70 co-pay* 
Specialist: $80 co-pay*
Standard Silver (73)**
$2,850
$6,300
Covered in Full
Primary: $40 co-pay* 
Urgent Care: $70 co-pay* 
Specialist: $70 co-pay*
Standard Silver (87)**
$850
$2,350
Covered in Full
Primary: $15 co-pay* 
Urgent Care: $40 co-pay* 
Specialist: $30 co-pay*
Standard Silver (94)**
$100
$900
Covered in Full
Primary: $10 co-pay* 
Urgent Care: $30 co-pay* 
Specialist: $20 co-pay*
Standard Bronze
$6,550
$6,550
Covered in Full
Covered in Full
Standard Bronze (0)***
$0
$0
Covered in Full
Covered in Full
Standard Bronze (AI)***
$6,550
$6,550
Covered in Full
Covered in Full
Catastrophic+
$7,900
$7,900
Covered in Full
Primary visits 1–3 no deductible. Visits 4+ covered in full after deductible.
Urgent Care/Specialist: Covered in Full

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

*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.

  

Review dental plans.


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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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 >