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 capable and friendly agents are prepared and ready to help, and our reliable 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. The "family glitch" fix now allows many Americans who are on employer health plans, to change to marketplace plans, with financial help, if the dependent premium on the employer group plan is determined to be unaffordable.
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 at about age 69. Medicare Prescription Drug plans (PDP) are numerous in many area, and still have low premium options.
Employer Health Insurance is showing some higher 2024 rate increases for small groups under 50 employees. Group health insurance rates can be impacted by the average age of enrolled employees, plan selections, network selection, and other factors. Employers can still find low cost options, with buy-up features for employees who want or need higher coverage. The Small Employer Health Insurance Tax Credit is still helping employers with a 24 month tax credit, for employers who purchase a qualified plan and meet other qualifications.
In addition to health insurance and dental plans, we offer Life Insurance, Disability Income Replacement Plans, H S A Banking, and International Travel Plans. Additional Administration and Compliance resources for employers include ERISA Wrap-Document, 125b Pre-tax programs, HRA plans, Cafeteria plans, COBRA, and Equivalent Oregon Paid Leave Programs.
We hope you will find things in our newsletter that can help you, your family and friends. We are available for you at any time during the year, and at each of the Individual, Medicare, or your Employer Annual Enrollment Periods. Please read our customer testimonials, give us your feedback, or testimonial HERE, and share this information with those who may benefit from our specialized programs and services. Thank you.
Topics of Interest
- Individual Health Insurance Open enrollment
- Medicare Annual Election Period
- Employer Health Insurance and Dental
- Employer Compliance
- Employer Coverage Affordability
- Online Account Administration for Employers
- Life Insurance
- Disability Insurance
- Project Access Now Premium Assistance Program
- Paid Leave Oregon
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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Individual Health Insurance Open Enrollment
The Individual Health Insurance Open Enrollment is coming Nov.1 to Dec.15. If you're currently enrolled through the Marketplace HealthCare.gov, or the Washington Health Plan Finder Marketplace, then you will want to make sure your information is up to date for the new year, and there are auto renewal options. If you have had changes like where you live, change of tax dependents, or a change of job or income, then you will want to call us to schedule a phone meeting with one of our agents to review and enroll you in the plan that you want with the help the is available to you. If you schedule a phone meeting with us for review, then be sure to prepare your 2024 household gross income ballpark projection, a list of your providers, and prescriptions, and keep a list of your questions. This will allow us to identify recommended plan options, and give you the answers you need to make a plan selection that best meets your needs.
NEW - Agents and Brokers assisting consumers with healthcare.gov Marketplace applications, must document consumer consent prior to accessing or updating their Marketplace information. Please complete and return the Consent For Broker Assistance Form, before your scheduled meeting with your agent. Contact Sarah Selix at (503) 282-0827 to schedule a phone meeting, if you need assistance with 2024 Open Enrollment.
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Medicare Annual Election Period
Medicare Beneficiaries can make changes to their coverage and enroll in a Medicare plan each year, from October 15 to December 7. During the Annual Election Period (AEP) you can;
- Change from a Medicare Advantage plan back to Original Medicare
- Change from Original Medicare to a Medicare Advantage plan
- Switch from one Medicare Advantage plan to another Medicare Advantage plan
- Join, drop, or switch a Medicare Part D (prescription drug) plan
If you choose to make a change during the Annual Enrollment Period, your new coverage won’t begin until January 1. If you’re happy with your current coverage, you’re not required to make a change. In most cases, your current Medicare plan will automatically renew on January 1.
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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 employees, but group health insurance is not mandated for employers with fewer than 50 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 9.12% 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 can usually 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, gender, 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 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.
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.
This is the 28th Year the United States has recognized and celebrated March as National Disability Awareness Month! We are here to help you review your private or business Disability Income Protection needs, and provide you with solutions that can meet this often overlooked gap in most peoples insurance needs.
Request Individual Disability Quote HERE
Request Group Disability Quote HERE
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Project Access Now Premium Assistance Program
Do you need help paying for your individual marketplace health insurance premiums? Project Access NOW can help! The Project Access NOW Premium Assistance program will pay health insurance premiums and other expenses for qualifying individuals. To qualify, individuals/households must have an income between 138-400% of federal poverty level, live in Multnomah, Washington, or Clackamas county, have a silver plan through the marketplace from a participating carrier, and use all of the marketplace tax credit offered.
Contact Sarah Selix to schedule a phone appointment with one of our agents who can check your legibility, and submit an application to to this program, if you qualify.
Call Sarah Selix at 503-282-0827
Email: sarah@laughlinagency.com
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Paid Leave Oregon
Oregon requires paid medical leave (PML) and paid family leave (PFL) income replacement benefits are for eligible workers who need time off from work for qualifying reasons.
Covered employers
All employers are covered except the federal government, and tribes
Coverage options
Employers may use the state or a private state-approved plan.
Cost
- The rate may not exceed 1% of an employee’s wages capped at the maximum wage base $132,900. The Oregon Employment Department will set the rate.
- Employee maximum contribution will be 60% of the total rate. Employers will pay at least 40% of the final rate. Employers may pay employee contributions.
- Employers with fewer than 25 employees nationwide, are not required to pay the employer portion of the premiums.
Employee eligibility
Employees who have contributed to the PFML Insurance Fund and have earned at least $1,000 in wages during the base or alternate base year. (First 4 of the last 5 completed calendar quarters)
- Base year: first 4 of the last 5 completed calendar quarters
- Alternate base: last 4 completed calendar quarters
Leave reasons
Caring for a family member, bonding, medical and safe leave.
Job protection
Requires continuation of health insurance benefits, and reinstatement to previous or equivalent position if employed by their employer more than 90 days.
Other protections and provisions
Minimum one work day increments required.
Benefits
Employees receive up to 100% of their average weekly wage on a sliding scale. Maximum weekly benefit = 120% of the state average weekly wage.
- 12 weeks of paid leave per benefit year
- 2 additional weeks for pregnancy-related limitations
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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, since Standard ins a leader in this space fir first approved programs in the state. An equivalent leave program, defers payments until September, allows employers to have more information about employees who are off work, to manage staffing needs, less bureaucracy by having a private plans, and payouts to those on claim is expected to be much quicker than the state program. There is a reasonable added premium to have private equivalent plan. give us a call, and we have this solution waiting for you.
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