Laughlin Insurance Market Report

July 2025

Market Report

Oregon and Washington

Greetings Laughlin Insurance Customers and Referral Partners

Our Newsletter is designed for our customers and referral partners, and for anyone who can benefit from our specialized programs and services. Each edition provides 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 the Agency. Thank you for being a valued customer or partner! We are dedicated to providing you with with a volume of quality solutions, exceptional service, and affordable coverages.

Marketplace Updates

Developing News. There are numerous changes expected for individual health insurance marketplace for 2026 and beyond. We will soon be completing our annual agent marketplace recertifications for Oregon and Washington and will have all of the details ready to share with you during your annual renewal and re-enrollment from Nov 1 - Jan 15.

Below is a list of updates that we are expecting from regulatory agencies that will impact individual health insurance markets:

The temporary pandemic related enhanced individual marketplace health insurance premium subsidies introduced under the American Rescue Plan Act and Inflation Reduction Act are scheduled to expire on December 31, 2025. Without congressional action, this change will impact marketplace consumers whose 2026 household gross income will be between about 401% and about 999% above the federal poverty guidelines. Health insurance plans will not automatically terminate if the enhanced premium tax credit is removed, but higher than usual rate increases are expected for those in this income range. Check the calculator HERE.
The mid-year special enrollment for those within 150% of the federal poverty guidelines will be removed
Pre-enrollment special enrollment coverage loss verification will be required for more people who apply for marketplace plans mid-year with a special enrollment event, like losing group health plan coverage from a job.
Stricter income document verification requirements for those receiving the advanced premium tax credit
New coverage may be denied if past due premium is not paid
Non-Health Savings Account Bronze level plans and Catastrophic plans may be eligible for pairing Health Savings Accounts
Affordability threshold is expected to increase from 9.02% to 9.95%
Maximum out of pocket limit will be $10,600 Individual $21,200 family
Significant cuts to unlicensed marketplace navigator funding, so more consumers will be seeking the assistance of licensed & marketplace certified health insurance agents and brokers
Recipients of the advanced premium tax credits who fail to reconcile their prior year's tax credit on their tax returns will lose their eligibility for the advanced premium tax credit and may need to get the tax credit refunded at year end, if they are eligible, or if consumers catch up on tax filings, then the advanced premium tax credit may be restarted during the year.

Tips for 2026

Review the 2026 individual health insurance plans, options, rates, and tax credits starting November 1st at the links below
Bookmark our Oregon health insurance marketplace shopping start page HERE
Bookmark the Washington Health Plan finder Browse & Compare page HERE. If Paris or Katie are your agents, then they will still show as your agent for the new year. If we are not your current agent, then you can request us as your agent from your dashboard menu. Look for Laughlin Insurance from the agent listing.
Actively shop and renew to verify your income, review subsidy eligibility, and avoid auto-renewal surprises
Consider bronze plans and health Savings Account eligible plans
Plan on premium increases
Schedule an annual review and re-enrolment with your agent
Washington has a state-run marketplace and may have different rules
Financial help is still expected from hospitals for those with household gross income below ab out 400% of the federal poverty level, usually subject to cash on hand eligibility and other requirements

Starting in 2027

Removal of the extended open enrolment period, with one open enrollment period from Nov 1 - Dec 15
Annual auto-renewal may be removed requiring active re-enrollment
Monthly $5 fee for auto-renewed "0" plans until consumers re-verify eligibility

2026 Increased Contribution Limits for Dependent Care FSA's in 2026

Effective for tax years beginning after December 31, 2025, the annual contribution limit for dependent care FSAs will increase from $5,000 to $7,500. For taxpayers who are married filing separately, the limit will rise from $2,500 to $3,750. This is the first permanent adjustment to these limits since they were established by Congress in 1986, aside from a temporary increase provided under the American Rescue Plan Act of 2021. This change will provide working families with greater flexibility to cover childcare expenses, helping to reduce the financial burden of dependent care. Please note that these new limits are not indexed for inflation going forward.

Medicare

If you or someone you know is turning 65 soon, it is a great time to start planning for Medicare. We usually recommend preparing for Medicare at least 6 months in advance. At age 65, most people become eligible for Medicare, the U.S. government's health insurance program. We would like to help you or your friend's Medicare transition. Here's a quick guide to help prepare for this important transition:

Understanding your Medicare Options - Original Medicare (Parts A & B) covers hospital and outpatient services, but you may need additional coverage, like Medicare Advantage, Part D for prescriptions drugs, and Medicare Supplement (Medigap) coverage to help cover out-of-pocket costs

Medicare Advantage Prescription Drug Plans (MAPD - also known as Part C) is an alternative way to receive your Medicare benefits through a private insurance company that contracts with the federal government. These plans provide the same coverage as Original Medicare, and often offer additional benefits. Many Medicare Advantage plans also include Part D (prescription Drug coverage)
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 throughout 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.
Stand Alone Medicare Part D plan is a prescription drug plan (PDP) that provides coverage exclusively for prescription medications. They are designed to help cover the costs of prescriptions medications, and are often paired with a Medicare Supplement plan, or a Medicare Advantage plan that does not include prescription drug coverage

Important Enrollment Periods

Initial Enrollment Period (IEP) begins three months before you turn 65, includes the month of your birthday, and ends three months after your 65th birthday. This is when you can first enroll in Medicare without penalties.
There are other Medicare enrollment periods that may apply to you, depending on your situation and when you become Medicare eligible. If you have questions about other Medicare Enrollment Periods, you can call our office and we can answer your questions and help determine if you may be eligible.

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

There is a required form called the Scope of Appointment form that needs to be signed before discussing specific details about Medicare Advantage plans with your Agent. 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 Medicare options.

Employer Benefit Programs

Offering a true small group health plan or an Individual Coverage Health Reimbursement Arrangement (ICHRA) is an investment that benefits both employers and employees. For employers, it’s a smart business move that helps attract top talent, increase retention, improve productivity, and provide tax savings. For employees, it’s a critical benefit that enhances their overall health, job satisfaction, and financial well-being. With all these advantages, small group health plans or the ICHRA are a great way to provide value to your team while strengthening your business. Offering health benefits to employees is not required to employees with fewer than 50 full time employees but is a requirement under the ACA (Affordable Care Act) for businesses with 50 or more full time employees.

We offer most major Health Plans in the Portland Metro and SW Washington areas, for employers. We are seeing some rate increases in the true small group health insurance 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, or switching out to the ICHRA. 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. Read more

True Group Health Plan or ICHRA (Individual Coverage Health Reimbursement Arrangement)

True Group: Many employers still prefer the true group health plan with the plan of their choice for attracting and retaining talent, tax savings, employee contributions, and are ok with the administration and compliance required from group benefit program group health insurance plan sponsors, including; contracting, one billing statement, annual renewals, open enrolments, compliance documentation and communications, payroll activities, and plan administration with their broker.

Individual Coverage Health Reimbursement Arrangement (ICHRA): More small employers are finding that they prefer the ICHRA. This simplified method or helping employees fund health insurance premium, allows employers to give a fixed tax-deductible amount tax-free to employees, to use to purchase marketplace health insurance. There is just one plan document, an employee notice, reimbursement of premium, and annual renewal. There is a minimal cost to prepare the plan documents and employee notices/forms. Many employers are finding that this simplified and cost-effective approach allows them to give something meaningful to employees to go out and get the plan of their choice, and it minimized much of the administration and compliance burden of the true group health plans.

Employer Compliance

Employers who provide true group health insurance and other employer sponsored health and welfare plans 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 can connect employers with variety of Professional Vendors and Administrators. We recommend an annual compliance review. It is very important that business owners have personal awareness of their responsibility, even if they have benefit managers or payroll companies helping with compliance and plan administration, so please contact us for more information.

Federally Facilitated Marketplace

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. The affordability threshold may increase to 9.95% but is still pending. 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 available on the Marketplace. Employer Health Plan Affordability Calculator. Read more

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. Contact us today to see if you may be eligible for this special program.

Life and Disability Insurance

Life and disability insurance are essential tools for financial planning. They provide protection and security to individuals and families, ensuring that your loved ones are taken care of in the event of death or disability. Whether you’re looking to replace lost income, protect your business, or simply provide peace of mind, having the right insurance coverage can be a game-changer in safeguarding your financial future and that of your family.

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 time? 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 financial 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

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 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.