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Understand your health insurance

You and your health insurance

Health coverage, or health insurance, helps cover your medical bills when you seek medical care. Ensuring you have the right health coverage for you and your family can make a huge difference. Everyone needs medical care at some point. Health coverage can protect you from unexpected expenses. 

2027 health insurance and enrollment information

Where to get help:

  • ​​​Contact your insurance agent or connect with a licensed agent near you at OregonHealthCare.gov/GetHelp.
  • Contact your health plan – information is on the back of your member card.
  • Contact the Senior Health Insurance Benefits Assistance (SHIBA) program at 800-722-4134 (Monday-Friday, 8 a.m. to 5 p.m.) or visit shiba.oregon.gov. Help is also available 24 hours a day, seven days a week from Medicare at 800-Medicare (800-633-4227) or visit medicare.gov/plan-compare.
  • If you received a notice that your plan is not renewing next year, you have a special enrollment period to purchase a Medicare supplement insurance policy with guaranteed issue (no medical underwriting). For details, refer to the notice or contact the resources above for information and assistance.
  • The Division of Financial Regulation (DFR) does not regulate Medicare Advantage plans, but it will take a complaint involving agent conduct.​

  • ​Contact your insurance agent or connect with a licensed agent near you at OregonHealthCare.gov/GetHelp.
  • Oregon Medicare supplement plan information is also available at shiba.oregon.gov/get-help/Pages/medigap.aspx​.
  • Contact DFR to file a complaint involving a Medicare supplement plan or agent conduct.
  • DFR regulates Medicare supplement insurance products.

​​​​Most people in Oregon get their health insurance through their employer. If you are not offered coverage through a job or a public program, such as the Oregon Health Plan (OHP) or Medicare, you may be eligible to enroll through Explore Health, Oregon’s health insurance marketplace, during the annual open enrollment period.

​If you miss open enrollment, you may qualify for a special enrollment period if you experience a qualifying life event, such as getting married, having a baby, or involuntarily losing other coverage. This allows you to enroll or change plans mid-year, typically within 60 days after the date of your life event.

​Oregon has a network of health coverage experts ready to help people enroll. You can find an expert in your area by going to OregonHealthCare.gov/GetHelp​ or by calling the Oregon Health Insurance Marketplace at 855-268-3767 (toll-free).​

Changes to individual health plans for 2027

Some health insurance plans offered in Oregon’s individual market in 2026 will not be available in 2027.

To help prevent a gap in coverage, the Oregon Health Insurance Marketplace has matched affected enrollees with a plan from another insurance company through a “crosswalk.” You can find these plan matches in the tables below. These plans may be used for automatic reenrollment if you do not choose a new plan.

To find your 2027 plan match and learn more about your coverage options, visit the Oregon Health Insurance Marketplace's automatic reenrollment webpage. If you are matched to a new plan for 2027, you can still choose a different plan, if done during open enrollment.

We encourage consumers whose plans are changing to review and compare their 2027 coverage options before enrolling. Pay close attention to provider network changes.

You can now get an early look at health coverage options for 2027 with the launch of the Explore Health Plan Guide, a new online tool designed to help people prepare for open enrollment. The plan guide helps users explore individual health and dental plans available in their area and compare costs, benefits, and coverage. Users can also enter their prescription medications and doctors to find which plans may best meet their health needs. The tool also provides an assessment for potential eligibility for Oregon Health Plan (OHP) benefits and financial help through the Marketplace, including an estimate of the amount of financial assistance someone may qualify for. To explore the plan guide or learn more about open enrollment, visit ExploreHealthOR.gov. Buying health insurance for yourself and your family can be confusing. Explore Health offers an easy-to-use tool to help you preview the coverage options and savings available to you. Enrollment partners are available to guide you through the application and enrollment process. Learn more at ExploreHealthOR.gov. Local licensed agents are also available to help with Marketplace enrollment or obtaining coverage directly with an insurance company. You must go through the Marketplace to receive financial assistance.

Key health insurance rules

Under federal and Oregon law:

  • People with preexisting health conditions will not be denied coverage or charged more to be enrolled.
  • Insurance companies and employers that offer dependent coverage to children must cover adult children up to age 26, regardless of whether they are married or have coverage available through an employer.
  • While small employers do not have to offer insurance, large employers with 50 or more full-time equivalent employees must offer health coverage or pay a penalty.
  • You are protected when you receive either covered out-of-network emergency services, including ground and air ambulance services, or covered nonemergency services provided by an out-of-network provider at an in-network facility.

Help paying for health insurance

If you do not have access to affordable coverage through a job or a public medical program, you likely qualify for financial help through Oregon's Health Insurance Marketplace, Explore Health.

There are two types of financial help available: premium tax credits to help pay the monthly premium and assistance with out-of-pocket costs such as deductibles and copays. 

Find out how much you can save on health coverage at ohim.checkbookhealth.org.

Buyer beware

  • To help avoid scams, we encourage you to work with local licensed agents or the Oregon Health Insurance Marketplace (Explore Health).
  • Key items to look for that you are not being sold an Affordable Care Act-compliant health plan:
    • No network
    • Being required to sign a document that states you are a limited partner or employee
    • Being sold ancillary, or additional policies, in addition to health insurance coverage
    • Statements that you are not purchasing insurance but sharing expenses
  • Read all documents thoroughly before signing
​​

  • Contact your health plan to check coverages, provider networks, and ask questions.
  • Contact your employer for health plan information, including the name of your provider to make sure billing is correct, your insurance carrier, policy number, and dates of coverage.
  • Contact your health plan to file an appeal.
  • Contact consumer advocacy at the Division of Financial Regulation (DFR) at 888-877-4894 (toll-free), email dfr.insurancehelp@dcbs.oregon.gov​, or file a complaint online.

​​​Website: Oregon.gov/oha/pebb/Pages/index.aspx

PEBB Member Services:

Email: pebb.benefits@odhsoha.oregon.gov
​Phone​: 503-373-1102

  • Contact your health plan to check coverages, provider networks, and ask questions.
  • Contact your employer for health plan information, including the name of your insurance carrier, policy number, and dates of coverage.
  • Contact your provider to make sure billing is correct.
  • Contact your health plan to file an appeal.
  • For Kaiser plans, contact consumer advocacy at the Division of Financial Regulation (DFR) at 888-877-4894 (toll-free), email dfr.insurancehelp@dcbs.oregon.gov, or file a complaint online.
​

​​Member Services:​

Website: ​O​regon.gov/oha/OEBB/Pages/index.aspx
Email: oebb.benefits@odhsoha.oregon.gov
Phone​: 503-378-6783
Toll Free: 888-469-6322

  • Contact your health plan to check coverages, provider networks, and ask questions.
  • Contact your employer for health plan information, including the name of your insurance carrier, policy number, and dates of coverage.
  • Contact your provider to make sure billing is correct.
  • Contact your health plan to file an appeal.
  • Contact consumer advocacy at the Division of Financial Regulation (DFR) at 888-877-4894 (toll-free), email dfr.insurancehelp@dcbs.oregon.gov, or file a complaint.

  • ​​​Contact your employer’s human resources department.
  • Contact the U.S. Department of Labor.
  • Federal Employees Health Benefits Program
  • Look at your insurance card. If the card states the insurance company is providing administrative services, your plan is probably self-funded.
  • Large employers in multiple states are commonly self-funded.
​

  • ​Individuals and families who are eligible for Oregon Health Plan (Medicaid) can apply at any time.
  • Contact your application assister or connect with an assister at OregonHealthCare.gov/GetHelp.
  • Contact your coordinated care organization (CCO, orhim.info/CCOs).
  • Contact the OHP Ombuds office at 877-642-0450 (toll-free) or email OHA.OmbudsOffice@odhsoha.oregon.gov​.
  • DFR does not regulate OHP, which means it cannot answer questions or handle complaints regarding OHP benefits.

Other resources:

Health plans and provider contracts Q&A



​​​​​​​​​Questions or complaints?

File a complaint online or contact us:

Consumer Hotline
888-877-4894 (toll-free)

Insurance
Email:

DFR.InsuranceHelp@dcbs.oregon.gov

Financial services
Email:​

DFR.FinancialServicesHelp@dcbs.​oregon.gov

Securities and investments
Email:​

​Securities.Registrations@dcbs.oregon.gov​

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