Market Report
Oregon and Washington
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We continue to monitor health insurance markets, and other types of insurance and related programs for you. We have reviewed the 2024 health insurance carriers, options, rates, and changes, and are ready to help you with your annual review, changes, or updates, if you need us. Our licensed and Marketplace Certified Agents are prepared and ready to help, and our comparison and enrollment systems have proven to be reliable for many years.
Individual Marketplace Health Insurance has been stable in recent years, including minimal rate changes for many, increased advanced/refundable premium tax credits, but the out of pocket maximum will be increasing for the 2024. Health insurance tax credits for those with higher income was introduced in 2022.
Medicare Advantage Prescription Drug Plans (MAPD) are still showing stable premiums, reasonable out of pocket costs, and extras like dental, vision, hearing. Plan options include HMO, HMO-POS, and PPO. Members can make changes during the Annual Election Period.
Medicare Supplement (MediGap) plans continue to be a choice for some who want low out of pocket costs, and larger selection of providers. Medicare Supplement premiums are usually higher than Medicare Advantage, and rates increase annually, due to age, starting about age 69.
Medicare Prescription Drug plans (PDP) are numerous in many areas, and still have low premium options.
"We do not represent every plan available in your area. Currently, we represent 8 organizations in 2 states which offer 45 plans (plan availability depends on the zip code in which you reside).
Contact Medicare.gov, 1-800-MEDICARE, or your local state health insurance program (SHIP) to get information on all of your options."
Featured Agency Programs
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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.
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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, and enroll you electronically in the health and dental plans you want, including financial help make your premiums more affordable, if you quality.
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Individual Disability Insurance Quoting Portal is a good way to see how much a disability income replacement plan may cost you. 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. Request a quote HERE.
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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. The Browse & Compare feature was recently reactivated HERE.
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Employer Benefit Programs Custom Web Sites. We are now making customer benefit web sites for our employer customers. The web sites have the traditional employee packet materials including benefit summaries, forms, provider search links, notices, and more. These web sites give our employer customers, and their employees, quick and easy access to all that they need to understand and use their programs.
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Employer Health Insurance and Dental
Millions of people have employer sponsored health insurance, and group health insurance continues to be a popular benefit among employees, and a useful tool for employers to attract and retain employees. Group health insurance is mandatory for employers with 50 or more full-time employees, but group health insurance is not mandated for employers with fewer than 50 full-time employees. Group health plans can be more affordable than expected, if employers consider some of the smaller network options, and plans with higher deductibles and copays. Additional cost savings can be found for many small employers with the Small Business Health Care Tax Credit, and favorable IRS tax treatment. Some employers sponsor a basic health plan, split the premium with employees, and then offer buy-up options for employees who want, or need higher levels of coverage. Many employers are asking employees to work at least 30 hours per week over 60 days, to be eligible, but there are a variety of eligibility and contribution options for employers. We have quick and easy group quotes available at your request, and employers may purchase group health and dental plans at any time of the year.
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Employer Compliance
Employers who provide Health Insurance, Dental, and other benefits to employees, are required by the Employee Retirement Income Security Act (ERISA), and the Affordable Care Act (ACA), to distribute certain documents to employees about their rights within the benefit plans. Employers may also need to perform certain non-discrimination testing, retain certain documents, and follow certain procedures. ERISA provides protections for participants and beneficiaries in employee benefit plans, including providing access to plan information. The US Department of Labor (DOL) is responsible for administering and enforcing these provisions of ERISA. The risks for non-compliance include business disruption, penalties starting at about $110 per day per employee, and may also trigger a DOL audit. Insurance company contracts, certificates and benefit summary do not meet the DOL requirements and the requirements apply to employers with one employee. We offer easy and affordable ERISA and IRS favorable tax treatment compliance services from various administrative partners, so contact us for a compliance advisement, and to review your compliance options, so you can have the compliance status that you need.
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Employer Coverage Affordability
In 2023, a job-based health plan is considered "affordable" if your share of the monthly premium in the lowest-cost plan offered by the employer is less than 8.39% of your household income. The lowest-cost plan must also meet the minimum value standard. If you’re the employee, affordability is based on only the premium you’d pay for self-only (individual) coverage. For coverage starting January 1, 2023, if you’re offered job-based coverage through a household member’s job, affordability is based on the premium amount to cover everyone in the household. Total household income includes incomes from everybody in the household who’s required to file a tax return. If the premiums aren’t considered affordable for the employee and the household, they may qualify for savings in a Marketplace plan. But, if the premium is considered affordable for the employee, but not for other members of the household, then only the other household members may qualify for savings. Contact us if you would like to review your group health insurance premiums, to see if they are considered affordable.
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Online Account Administration for Employers
Adding and removing employees to your benefit programs, or making 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 with your request, as your authorized representative. We can help you with employee additions or terminations when you are busy or when want our support. You will get quicker processing, and issuing of ID cards. Online Administration can also help to update your membership before your next billing statement is issued. With years of experience with membership & billing, we can show you how to get online access with your insurance carriers, and how to add us as a user, if that may help you. Many of our employer group customers are finding that this is a helpful additional service that we provide. Feel free to contact us to set up online membership & billing, if you have not already done so.
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Life Insurance
Life Insurance is a contract between an insurance company and 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.
Individuals may be able to purchase from $50,000 to $1 Million of Life Insurance coverage, and may be able to purchase a life insurance benefit that is from 1x to 10x annual gross income. Rates vary based on age, sex, health history, family history, tobacco use, and other factors. Term life insurance is usually the lowest cost. Universal Life Insurance is another option that can provide a lifetime of coverage, but premiums are usually higher than term plans. A formal application, and paramedical exam are usually required for individual life insurance and decisions from the Life Insurance underwriters usually take about a week or two.
Employers may also purchase group life insurance. The Group Life Insurance is typically flat $25,000 or $50,000 with matching Accidental Death & Dismemberment coverage. Some employers may purchase Life Insurance benefits equal to 1-3 times employee salary, or more.
Request Individual Quotes HERE.
Request group Life Insurance Quotes HERE.
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Disability Insurance
Many Americans can't afford to miss one paycheck, and most are not financially prepared to be off work if they get sick or injured. Disability insurance protects your paycheck by replacing a portion of your income if an illness or injury prevents you from performing the substantial and material duties of your occupation you have education, training, or experience to perform. Disability Income Replacement Plans may be purchased as individuals, and employers may also purchase disability insurance for employees, and for business partners.
Individuals may purchase individual Disability Income policies that may replace about 66.75% of pre-disability income, and will be tax free income. There are numerous optional riders that you can select to enhance the coverage. Request an individual disability quote HERE.
Employers can sponsor group Long-Term and Short-Term Disability insurance for employees. This program is usually paid 100% by the employer. This program typically pays about 60% of employee pre-disability gross income, and is taxable. Employees are encouraged to review group disability insurance provided by their employer, to determine if the net benefit, after taxes would be sufficient to meet their financial obligations, while they are not working. If the taxable employer disability benefit is not enough to meet financial needs, then employees may be able to get their own partial disability policy privately, so if they are disabled, they may receive an income that is closer to their pre-disability income.
Request Group Disability Quote HERE
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Paid Leave Oregon
In 2019, the Oregon legislature enacted the Paid Leave Oregon program (PLO), which was implemented on September 3, 2023. Under PLO, if a worker cannot work because of a serious health condition, or for other specific reasons, the worker can be entitled to paid medical leave. Find out more about the program, what it means for you and your family, and how to apply today HERE.
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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).
Form 1095-A is furnished by the Health Insurance Marketplaces to the IRS and to Individuals who enroll in a qualified health plan through the Health Insurance Marketplaces. The form allows individuals to reconcile the credit on their tax returns with the advanced payments of the premium tax credit, and file an accurate tax return. We can usually get this form to you at your request, if you have not already received it from the marketplace.
Form 1095-B is used to report certain information to the IRS and to taxpayers about individuals who are covered by minimum essential coverage.
Form 1095-C is filed and furnished to any employee of an Applicable Large Employer (ALE) who is a fill-time employee for one or months of the calendar year. ALE members must report that information for all twelve months of the calendar year.
Form 8962: This is the Advanced Premium Tax Credit reconciliation form that is used to reconcile your premium tax credit, on your tax return. This form will determine if you have excess APTC, or if you will have repayment for some or all of the APTC you received for the prior calendar year. There are various APTC repayment calculators.
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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 have been popular. Standard Insurance is a leader in this space as the first approved program in the state. An equivalent plan has less bureaucracy, and payouts to those on claim is expected to be quicker than the state program. There is a reasonable added premium to have private equivalent plan.
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