Laughlin Insurance Market Report

October 2025

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.

The Marketplace Open Enrollment and Medicare Annual Election Periods are 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 would like 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 of Medicare plans available in your area.

Paris Laughlin, Stuart Ouellette, Katie Hernandez, 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 Hernandez, 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 2026, or to explore any other options available in your area.

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

Marketplace

Marketplace Updates for 2026

Each year there are usually changes in marketplace rules, procedures, plan offering, and rates. 2026 will be having numerous changes, and we are here to help you understand the changes, and renew in the plans that work best for you. Below is a list of the expected marketplace changes for 2026. We are always here for you at each Open Enrollment and throughout the year to help you with your marketplace needs.

Out‑of‑Pocket Maximum: The maximum out-of-pocket limit will be $10,600 Individual, $21,200 Family
$5 Minimum Premium for Auto‑Renewed $0 Plans: If your plan auto-renews without a premium due to subsidies, you’ll now pay at least $5/month—unless you log in and actively reconfirm your eligibility
No More Bronze-to-Silver Auto-Conversions: Marketplace auto-renewals will now keep you in your current plan—even if you qualify for Cost-Sharing Reductions (CSR)
Low-Income Year-Round Enrollment Ends: The year-round Special Enrollment Period for people earning up to 150% of the Federal Poverty Level is eliminated for 2026
Non-HSA branded bronze and catastrophic plans may become HSA eligible
Eligibility Documentation may be Required: Marketplaces may have require verification of income, and evidence of coverage loss for special enrollments
Limited Subsidy Access for Certain Immigrant Groups: Lawfully present immigrants earning below 100% of the Federal Poverty Level, who are ineligible for Medicaid due to their status, will no longer qualify for premium tax credit
End of Monthly Special Enrollment Period: The year-round Special Enrollment Period (SEP) for low-income individuals is paused
Denial of Advanced Premium Tax Credit eligibility for those who fail to reconcile or file taxes for just one year
DACA recipients are ineligible for Marketplace plans, premium tax credits, and cost-sharing reductions
Gender-affirming care, sex-trait modification procedures, are no longer mandated as an Essential Health Benefit (EHB)
Removal of the Enhanced Premium Tax Credit is planned, but the final decision has not been confirmed
Agent/Broker requirements: Multi-factor login and integration, 30-minute system time-out, and updated consent and attestation documents

Health Insurance Rate filings for 2026

Individual and Small Employer health insurance rates renew annually. Rates are filed by carriers to the Insurance Commissioner, there is a period of public comment, and then final rates are approved in about September for the coming year. You can preview the proposed 2026 health and dental plan rates, and see approved average rates, when they are approved, at the Rate Review tool HERE.

2026 Health Savings Account (HSA) Updates: What You Need to Know

Health Savings Accounts (HSAs) can save money on health care and lower your taxable income. Bronze plans that were not HSA-compatible before will now qualify. With an HSA-qualified plan, you get 100% covered preventive care in-network. Other covered services are subject to the deductible until the out-of-pocket maximum is reached. HRA savings account contribution limits are increasing. If your enhanced premium tax credits are reduced or eliminated, then making tax-deductible HSA contributions could help some individuals lower their adjusted gross income (AGI), and stay eligible for subsidies. Talk to your agent of your tax advisor to see if this strategy could work for you. Your bank or credit union may offer an HSA savings account product, or you can use HSA Bank, who is a popular choice for their online banking, education and support.

Marketplace Failure to reconcile

If you received premium tax credits to help pay for your Marketplace health insurance, the IRS requires you to reconcile, them when you file your taxes each year. This means that you, or your tax advisor will use your IRS Form 1095-A form data and complete the IRS Form 8962 with your tax return. If you don’t reconcile, you risk losing your advanced premium tax credits for the following year. If you do not reconcile your tax credit, and lose your advanced premium tax credit, then you can usually reinstate the advanced premium tax credit by catching up on your tax filings, and updating your marketplace application. We are here to help you year-around, and at each Open Enrollment, with any of your marketplace needs.

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

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 2026, Project Access Now will support Marketplace consumers who meet their guidelines. Your Agent will help you determine if you are eligible for this unique program. If you have been enrolled in the program for 2025, please contact us at your earliest convenience to determine your 2026 eligibility, and re-enroll in the program if you qualify. Project Access Now will take 2026 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

Medicare Advantage Market Exit

Some Medicare Advantage Plans have been discontinued for 2026, and leaving many counties in Oregon for 2026. We are here to help you find a replacement plan.

If you are enrolled in a Medicare Advantage plan that is discontinuing or leaving your area for 2026, or another Medicare plan that is leaving for 2026, then you will need to select a new plan for 2026. 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 2026 options, so you can have the plan that works best for you form what is available in your area for the new year.

New Medicare Advantage Options in Tillamook County

New Medicare Advantage plans may be coming to Tillamook County for 2026, including options for those with both Medicare and Medicaid. Contact our office to learn if there are Medicare Advantage Plans available to you in Tillamook County.

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, 2026 start date. 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

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. Medicare Supplement plans may be available without Medical underwriting, for some Beneficiaries who have Medicare Advantage Plans leaving their areas for 2026. 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

Employers

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 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. 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

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. 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 2026, a job-based health plan is expected to be considered affordable if your share of the monthly premium for the lowest-cost plan offered by the employer is less than 9.96% 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 available 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

More employers are giving workers money to buy their own health insurance

Individual coverage health reimbursement arrangements, or ICHRAs, a type of health plan in which employers provide nontaxed contributions to employees to pay for medical expenses, including monthly insurance premiums. ICHRAs were created by the government in 2020, and have been gaining in popularity each year since. The majority of ICHRA adoption is from small businesses with 20 or fewer employees, most of which are offering health coverage for the first time. We have identified a popular and affordable provider for ICHRA plans, so contact us if you would like to learn more about ICHRA, if you want to adopt a program for your business.

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 have been updates to the eligibility and benefit for 2026. 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.

Life and Disability Insurance

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 find the policy that works for you. Read More

Request a Life Insurance Quote

Disability Insurance

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. 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. We offer many different carriers and options for disability insurance. Read More

Complete the Disability Quote Questionnaire for your Agent and we will follow up with a quote.

Disability Quote for Paris Laughlin

Disability Quote for Stuart Ouellette

Disability Quote for Rachel Laughlin

Disability Quote for Katie Hernandez

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.

HealthSherpa Medicare is our online comparison tool for Medicare plans in Oregon. This tool allow us to review Medicare plans in your area, check to see what plans your providers contract with, estimate pharmacy costs, and more.

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.

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.

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