State tells CO-OP members to hold off on new policies

Published 12:00 am Tuesday, July 12, 2016

In a reversal of advice given last week, state officials are now telling people who have individual health insurance policies through Oregon’s Health CO-OP to wait a few days before buying new policies.

While the state’s Department of Consumer and Business Services is still taking action to shutter the embattled carrier, regulators are exploring options that may allow current policyholders to keep their plans through the end of 2016.

A special enrollment period on Healthcare.gov began Monday for Oregon’s Health CO-OP policyholders, but Berri Leslie, administrator of Oregon’s health insurance marketplace, said in a conference call that people should wait until at least Wednesday or Thursday before switching policies. That’s when the state will release more information about its progress toward a potential solution that would let people keep their policies through the end of the year.

The problem with switching plans more than halfway through the year is it cancels out any progress people made toward their deductibles, a set dollar amount a person must spend on health care services before their insurer begins to pay. Leslie said DCBS officials are trying to transition CO-OP policies to carriers that would honor the deductibles progress.

“We’re not really sure if it will come together or not — there is obviously a lot of variables — but I think it’s safe to say that everybody is just really doing all that everyone can in order to try to create a situation that holds consumers as harmless as possible,” she said.

Monday’s announcement does not apply to business owners who provide small or large Oregon’s Health CO-OP group policies to their employees; they should continue to seek alternative coverage.

As of March 31, 620 people in Deschutes, Crook and Jefferson counties were enrolled in Oregon’s Health CO-OP policies, roughly 70 percent of whom had individual policies. The company has roughly 20,600 policyholders statewide, just under 12,000 of those in individual policies.

In its announcement last week, the DCBS advised all current CO-OP members to enroll in new policies by the end of the month in order to have new coverage effective Aug. 1.

The CO-OP’s departure adds to a rapidly shrinking number of carriers selling 2017 individual market policies, those who buy for themselves or their families, in Central Oregon. Deschutes County residents will have the fewest choices of any county in the state. Only two health insurance carriers — PacificSource Health Plans and Health Net Health Plan of Oregon — will sell individual policies here. Ten counties, including Crook and Jefferson, will have three choices.

State regulators announced last week they are taking action to shutter the CO-OP after the revelation that it owes about $900,000 to the federal risk adjustment program, which pays health insurers that take on a disproportionate number of sick enrollees under the Affordable Care Act. The CO-OP expected to receive about $5 million from the program.

Like other insurers, the CO-OP lost a considerable amount of money since the Affordable Care Act removed carriers’ ability to restrict policy sales to healthy customers in 2014. The CO-OP lost $18.4 million in 2015, mostly in the individual market, according to DCBS.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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