Micheil Wallace (00:00):
Uh, the window shopping tool is a fantastic resource for you. It’s available on our website, OregonHealthcare.gov/windowshop. And it’s an excellent way to go in and compare plans, um, for individuals and families, um, with a pretty streamlined process. When you go into the tool, um, entering in just some very basic information and it’ll give you a really great, um, kind of snapshot of what you could potentially expect, uh, with different kinds of plans, uh, when you go to shop. So it’s a, it’s a great tool, uh, to look at, uh, maybe on the, on the front end of, of meeting with, uh, an agent or a community partner, uh, to kind of give yourself a good sense as to what might be available and prepare you with some, maybe additional questions to ask.
Marina Cassandra (00:50):
Another thing that’s really great about this tool, if I might add is just by putting in some basic information, like Michael said about your household size income, et cetera, you can also get a really close estimate on what your tax credits might be and what your cost sharing reductions might be. And those will be reflected in the plans that you, that come up in your search. And so it’ll show you the net premium amount that you’re likely to pay for those grants and what it could cost you, um, in a, in a good health year versus a bad, health year, including your premium, which is not something that you you’ll find anywhere else.
Micheil Wallace (01:29):
Uh, it’s a great point, Marina. Thank you. So, as we, we’ve kind of discussed, uh, this is, uh, an example of a, of a screenshot, uh, on the window shopping tool. Um, it gives you a kind of a sense as to that comparison with respect to the, the plan and the savings you might expect. Um, so really, uh, good in reference to the point that you made Marina as far as, uh, what folks might expect in looking at the tool.
Marina Cassandra (01:57):
I didn’t even see there too, so that the monthly premium here is 57 cents after a $386 subsidy. So that’s what this person was estimated to be receiving based on the information entered in the initial tool.
Collin Gabriel (02:12):
Micheil Wallace (02:12):
Thank you, Marina, my eyes, my eyes, unfortunately, aren’t good enough to see if the actual information that’s displayed
Collin Gabriel (02:21):
Well and what the good year balanced and bad years, are those estimations of like, if you were to have to use the services an excessive amount versus not use them at all, is that kind of how that would work?
Marina Cassandra (02:33):
Collin Gabriel (02:35):
I see, ok.
Micheil Wallace (02:35):
So in a good year, you’d be paying $57 or sorry, 57 cents a month. And if you only go in for, you know, basic things that maybe are covered by a copay and probably a pretty, um, small copay, you probably would never reach your annual deduct your, um, your deductible or out-of-pocket maximum, which in this case at the same kind of silly. Um, but if you had a catastrophic year, you know, if you had, um, hospitalization or a bad accident or high-risk, um, birth, um, you could hit your out of pocket maximum, but then, you know, you would be spending, um, your, that, that, bad year would be that $8,700 because they’d hit their maximum. But, you know, also it should be a little bit more than that because they paid a half a dollar a month for premium.
Micheil Wallace (03:30):
And one quick question. So on the out-of-pocket maximum of $8,700, if this plan included a co-insurance as well, would that out of pocket maximum, uh, take into account the co-insurance if there was like an 80 20 or something like that.
Marina Cassandra (03:46):
Right. So anything that’s a co-insurance or co-pay or the deductible, all of those things that are paid after the premium are considered out of pocket expenses and they do apply to the out-of-pocket limits.
Collin Gabriel (03:59):
Oh, I see. Okay. Well then that, that kind of makes co-insurance not quite so scary. I always remember, um, reviewing those plans, like, you know, a while back and thinking, wow, this, this could mean that you, I mean, there’s really no way to estimate what the fees could be, because you don’t know how much it’s going to cost. If you find out you have something serious, like cancer or something like that, um, there’s just this percentage there, but your, but, uh, the out-of-pocket maximum is almost like a, um, I don’t want to call it a safety blanket, cause that’s a big number, but yet at the same time, you know, that that’s kind of like the limit of where you’re going to go within a year.
Marina Cassandra (04:37):
Exactly. That if all the worst things happen and, um, and, and you know, of course these are for covered services. So if you go out of network and pay for your favorite doctor out of pocket, that’s not going to apply to your maximum. So these are all in network costs. I
Micheil Wallace (04:53):
See. That’s great to know.
Marina Cassandra (04:56):
But I do think it’s worth mentioning that, you know, the details of that also, if you click on the view plan details, you’ll get more information on, um, the kind of network they have, the providers that and prescriptions that might be covered. Uh, you’ll get a lot more information on that you can also, I know, um, when you’re actually shopping on healthcare.gov to actually enroll, you cannot enroll through the shopping tool. This is just to get a really close estimate of what you’re eligible for. Uh, the plans are real plans that we have in Oregon. You can also click on this compare tool for a couple of them and you can see them side by side, so you can really get a much better idea.
Collin Gabriel (05:39):
And is this, uh, they have, uh, something similar similar to this on healthcare.gov as well when you’re actually enrolling for the plans. This would be just, if you don’t want to necessarily, um, establish a profile yet or anything like that, it’s just a way to kind of look around and see what, what your options are.
Marina Cassandra (05:56):
This is a preferred method for so many reasons. Um, number one, we are very up to date on the information in Oregon. This is Oregon specific healthcare.gov is kind of general and they don’t always get updated the way we want. Um, sometimes I have a case come across my desk where somebody said, Hey, you know, the healthcare.gov website that my, my physician was covered, and now I’m being billed. So it’s really important to, you know, this is, again, this is not a shopping tool, but it’s a window shopping tool. You can get some pretty accurate information and what you’re eligible for, and then use healthcare.gov to actually enroll.
Collin Gabriel (06:38):
Marina Cassandra (06:38):
back to you. Michael,
Micheil Wallace (06:40):
Thank you Marina. So licensed insurance agents, uh, from my perspective, uh, knowing where to find the help, uh, is as important as anything we’ve covered today. Um, insurance agents can give you plan advice. They’re licensed, certified and insured. They do earn a commission on private plans, but that’s not passed on to you as the consumer. And there’s no additional charge for marketplace assistance, but the Oregon marketplace, we have what we call partner agents, partner agents are agents that have gone through a competitive process to become partners with us. They’ll be indicated as such with a little gold sun shaped icon on our, uh, get help or find local help tool. Rather
Marina Cassandra (07:32):
The find local tool is available at our website at oregonhealthcare.gov. You can either click on the banner at the top or at the, um, icon at the bottom. When you click on this, you will be taken to a page where you can enter your zip code or address to find the closest one near you. Or if you have specific language needs, you can select an assister or agent who speaks that language. And you can search for multiple types of coverage. So you can search for an agent who sells Medicare plan, for example, or a CBO volunteer who can help answer your questions about Medicare. So they have assisters’ agents and CBO volunteers. And if you need, you know, you can specify the kind of help you need and it’s all free and local.
Micheil Wallace (08:23):
So we are definitely here to help, um, help is available. It’s local and it’s free to you. Um, please visit OregonHealthcare.gov/gethelp to locate an agent in your area that helps small businesses or contact our team. We’re available at 8 5 5 2 6 8 3 7 6 7 Monday through Friday 8:00 AM to 5:00 PM, excluding state recognized holidays, and also email us at firstname.lastname@example.org or reach us on the web at oregonhealthcare.gov.