Laughlin Insurance Market Report

October 2024

Market Report

Oregon and Washington

Greetings Laughlin Insurance Customers and Referral Partners

Our Newsletter is designed with you in mind, and for anyone whom you think can benefit from our specialized services. Each edition provides valuable insights, updates on the Health Insurance Markets, Medicare, and Group markets, and tips to help you make informed decisions.

Our goal is to provide you with news, information, opportunities, and resources that you can use, related to Health Insurance and the other types of insurance, and special programs that we offer here at our Agency. We actively monitor the Health Insurance Marketplaces, Medicare Markets, Employer Group Programs, Favorable Tax Programs, Carrier Rate Filings, Financial Help, and more.

Thank you for being a valued customer of ours! We are dedicated to providing you with exceptional service and coverage that fits your needs.

Open Enrollment is approaching!

As the Individual Open Enrollment and Medicare Annual Election periods approach, it's important to understand your options and make informed decisions about your coverage. We are here to help you review your options, and complete your enrollment in the plan you want for the new year.

The Individual Health Insurance Open Enrollment is from Nov 1 through Dec 15 for a Jan 1 start date, and from Dec 16 through Jan 15, for a Feb 1 start date.

The Medicare Annual Election Period is from Oct 15 through Dec 7 for Jan 1 start date.

If you are enrolled on a Medicare plan and would like to review your options or review the changes to your current plan, complete the annual Medicare Scope of Appointment form for your Agent from the links below, so your agent can provide you with the specific details Medicare plans available in your area.

Paris Laughlin, Stuart Ouellette. Katie Ostgarden, Rachel Laughlin

If you are enrolled in a plan on the Marketplace, or would like to review your Marketplace options, complete the Marketplace Consent Form for your Agent, from the links below. If you have completed the marketplace consent form for your agent in the past, you will not need to complete it again;

Paris Laughlin, Stuart Ouellette, Katie Ostgarden, Rachel Laughlin

Call our office at (503) 282-0827 to schedule an appointment with your Agent to ensure that your coverage will meet your needs in 2025, or to explore any other options available in your area.

Below are some updates for the Individual, Medicare, and Employer markets, followed by other topics, that we hope will be of interest to you.

Moda Medicare Advantage and Regence HMO Market Exit

There are some Medicare Advantage plans leaving the market for 2025.

Regence Medicare Advantage HMO Plans
All Moda Medicare Advantage plans
There may be other Medicare plan discontinuations in other parts of Oregon and Washington for 2025

If you are enrolled in a Regence HMO Medicare Advantage Plan, a Moda Medicare Advantage plan, or another Medicare plan that is leaving for 2025, then you will need to select a new plan for 2025. Complete the Scope of Appointment Form for your Agent, and contact our office at (503) 282-0827 at your earliest convenience to schedule an appointment with your Agent to review your 2025 options, so you can have the plan that works best for you form what is available in your area for the new year.

Individual Marketplace Health Insurance continues to be stable for most consumers. The increase in the Advanced Premium Tax Credit may benefit many individuals, even those with higher incomes, making coverage on the Marketplace more affordable. Provider Networks, and Out of Pocket Maximums are stable, with some changes for 2025.

Project Access Now Premium Support Program is an approved third-party support program that can help qualified marketplace consumers with premiums, outpatient prescription expenses, and also help request support from participating hospitals. The income guidelines for this program have increased, space is limited, and there is currently a waiting list. For 2025, Project Access Now will pay premium for Bronze level plans, for those who qualify for the program. If you have been enrolled in the program for 2024, please contact us at your earliest convenience to determine your 2025 eligibility, and re-enroll in the program if you qualify. Project Access Now will take 2025 re-enrollments first, and then open the program to new applicants. Contact us today to see if you may be eligible for this special program.

Medicare Advantage Prescription Drug Plans (MAPD) are still showing stable premiums, reasonable out-of-pocket costs, and extras like dental, hearing, and vision. Medicare Beneficiaries can make changes during the Medicare Open Enrollment Period that runs from Oct 15 to Dec 7th, for a Jan 1, 2025 start date. Read More

Medicare Supplement Plans (MediGap) are different from Medicare Advantage Plans and are a popular choice for those who travel, those who don't want Advantage Plan Prior Authorizations, those who want low out-of-pocket costs, and for those who want access to a large number of providers thorught the U.S. who accept Original Medicare. Medicare Supplement premiums are usually higher than Medicare Advantage plans, and Medicare Supplement plans do not include Prescription Drug benefits, or extras, like hearing, dental, and vision. Medicare Supplement plans may be available withoug Medical underwriting, for some Beneficiaries who have Medicare Advantage Plans leaving their areas for 2025. Read More

Medicare Prescription Drug Plans (PDP) are usually purchased by those who have Medicare Supplement Plans, or for those who who need creditable pharmacy coverage. There are numerous Medicare Prescription Drug Plans in most areas, and we can help you review your prescription drug needs, and help you purchase the plan that works best for you. You can also change Medicare Prescription Drug Plans during the Medicare Open Enrollment Period, if your pharmacy needs have changed, and a better prescription drug plan is offered in your area. Read More

Employer Benefit Programs are still a popular way for employers to help employees with their health insurance needs. Many employers offering group health plans, may also offer dental, life insurance, disability insurance plans, and Paid Leave Programs. We offer most major Health Plans in the Portland Metro and SW Washington areas, for employers. We are seeing some rate increases in the small group health insurnace markets, but there are numerous ways to save premium, including increasing employee contributions, higher copays and deductibles, higher out of pocket maximums, or lower cost narrow networks. We recommend that employers review their employee benefit programs annually with their agent, to be sure the costs, coverage levels, contribution arrangements, tax & compliance responsibilities, administrative efficiencies, and employee communications are all set up in the way that works best for the employer and their employees.

Employer Compliance

Employers who provide Health Insurance, Dental, and other benefits to employees, are required by numerous Regulatory Authorities to keep certain documents, and provide employees with certain disclosures, and notifications. Most of our employer customers have adopted documents, and published required employee disclosures and notifications, but there are still many employers are not aware of these responsibilities, and are at risk for significant penalties and business disruption. Affordable commercially available compliance solutions are available, and we offer compliance services from a variety of Professional Vendors and Administrators. We recommend an annual compliance review, and we can help you. It is very important that employers have personal awareness of their responsibility, even if they have benefit managers or payroll companies helping with plan administration, so please contact us, and we can help review your compliance status. Read More

Employer Health Insurance Coverage Affordability

For 2025, a job-based health plan is considered affordable if your share of the monthly premium for the lowest-cost plan offered by the employer is less than 9.02% of your household gross income. There are also affordability rules for dependent premiums on group plans also, so the Advanced Premium Tax Credit, may be available to help you pay monthly health insurance premiums on the marketplace. Be sure to contact us if you want to know if your employer health plan is affordable for you and your dependents, and if premium savings and financial help is availabe on the Marketplace. Employer Health Plan Affordability Calculator. Read more

Online Account Administration for Employers

Adding and removing employees to your benefit programs, or making employee changes and updates is easy, with online administration available through most health and dental insurance carriers. Most insurance companies allow us to support you with online administration, as your authorized representative. We have decades of experience in this space, and welcome the opportunity to support you with account administration. Read more

Life Insurance

Life Insurance is a contract between an insurance company and a policyholder, where the insurance company promises to pay the beneficiary a sum of money upon the death of the insured person. Life Insurance may be purchased as an Individual, and Employers may also purchase Life Insurance for Employees. Life Insurance benefits are typically tax-free and can help to fund end of life expenses, debts, childcare expenses, college tuition, business obligations, and other costs. We offer Group and individual Life Insurance from various carriers, and are here to help you get the policy you need. Read More

Disability Insurance

What is your greatest asset: Your home? Your business? While both are vital to your lifestyle, they are the result of your most valuable asset-your ability to earn an income. What would happen if you weren't able to work for months at a thme? Disability Income Insurance pays a portion of your income when you become too sick or injured to work. It's an essential building block to your fiancial plan. You rely on your income. You use it to pay your bills, provide for yourself and your family. The average long-term disability claim lasts a little less than three years. Most people don't have three years of emergency savings, so how will you earn the income you need? Disability Income insurance protects your ability to earn an income and your future earnings potential. Disability Income Replacement Plans may be purchased as individuals, and employers may also purchase group disability insurance for employees, and for business partners. Contact us today to get a disability quote and to apply for coverage. Read More

Income Related Monthly Adjustment Amount (IRMAA)

If you are approaching Medicare age, or if you are already on Medicare, and have higher than average income, then this information may be of interest to you. The Medicare Income Related Monthly Adjustment Amount (IRMAA) is an additional premium that you may pay in addition to the standard Medicare Part B Premium. The rates are based on your Gross Income, from two years ago. We can help you to review the income and rate guidelines. Some Medicare Beneficiaries may want to customize their taxable incomes during the two years prior to becoming Medicare eligible, and may be able to minimize IRMAA rates, with support form their Financial and Tax Advisors. Read more

Paid Leave Oregon

Paid Leave Oregon allows employees in Oregon to take paid time off for some of life’s most important moments that impact our families, health, and safety.

On July 30, 2024, Paid Leave Oregon filed Permanent Administrative Orders for 20 administrative rules relating to appeals, assistance grants, benefits, and equivalent plans with the Secretary of State’s Office. The effective date of these rules is August 1, 2024. There havfe been updates to the eligibility and beneft for 2025. You can find the permanent rules on the Secretary of State’s website, and on our rulemaking website. We’re also including a link to the Batch 11 permanent administrative order. You can contact Paid Leave Oregon at paidleave@oregon.gov, or you can contact our rules coordinator at Rules@employ.oregon.gov, and we will do our best to help.

1095 Tax Forms

It will soon be time to gather tax forms related to health insurance, and include them in your tax filing. If you are an Individual Marketplace consumer, then it is recommended that you keep tax returns current to avoid potential disruption of the Advanced Premium Tax Credit (APTC), or Cost Sharing Reduction benefits (CSR). Read more

Featured Agency Programs

WiredEnroll is our popular online Small Employer quoting and enrollment system that allows us to provide Small Employers with live, web based, group health insurance and dental options from participating carriers, and then enroll business owners and their employees in group health insurance and dental plans, electronically. If you are a small business with 50 or fewer employees, and would like a comparison of health insurance options, let us know, and we can have quick turn-around on rates and options. Contact us for proposals.

HealthSherpa is our online comparison and Marketplace enrollment tool for individual health and dental plans in Oregon. This tool allow us to review marketplace plans in your area, check to see what plans your providers contract with, estimate pharmacy costs, incorporate the Advanced Premium Tax Credit, if available, and enroll you electronically in the health and dental plans you want, by phone with your agent. Feel free to shop and compare HERE.

Medicare Center is our online comparison tool for Medicare Advantage and Prescription Drug plans. This tool allows us to review Medicare plans in your area, check to see what plans your providers contract with, estimate pharmacy costs, and more. This platform also allows us to send the electronic Medicare Scope of Appointment Forms to your email, which is a simplified way of completing this required Medicare form.

Individual Disability Insurance Quoting Portal is a good way to see how much disability income replacement benefits you may be eligible for. The premium may be about 2%-5% of your gross income, but the benefits can replace the majority of your pre-disability income, to retirement age, upon disability from illness or injury. We offer numerous leading carriers. Request a quote HERE.

Washington Health Plan Finder is the online health insurance marketplace that we use to help those in Washington, to compare individual health and dental plans, and enroll in you the plans you want, with the advanced tax credit, if you qualify. Browse & Compare plans HERE.

Employer Benefits Programs Custom Web Sites. We are now making a handy catch-all employer benefit programs landing page for employer customers. The web page includes documents, forms, and links for employees including; benefit summaries, enrollment forms, premium contribution details, notices, provider search links, and more. If you are one of our current employer customers, be sure to give the web page link to your employees. We update these landing pages as needed and at each renewal. Contact us for free custom benefit website and support.

Coredocuments.com is a compliance document vendor for employers. They provide ERISA Wrap Document, 125b Pre-tax program services, and other compliance services for employers for reasonable fees. There are a lot of administrators that offer different levels of service and fees, but Core Documents is an affordable solution for your compliance needs. We can help employers with Core Document programs and setup.

Standard Insurance Equivalent Oregon Paid Medical and Family Leave programs can be a good alternative to the state program. Standard Insurance is a leader in this space as the first approved program in the state. An equivalent plan has less bureaucracy and may have quicker payouts to those on a claim. There is a reasonable added premium to have a private equivalent plan, and most employers who have had the equivalent plans over the last year, are keeping it for the new year.