Increased Premiums Expected for Most
Open Enrollment for the purchase of qualified individual/family health insurance will run from November 1, 2025 to January 15, 2026. If you enroll in a plan between November 1 and December 15, your plan will be effective January 1, 2026. If you enroll between December 16 and January 15, your plan will be effective February 1, 2026. For those of you who buy your own health insurance through healthcare.gov or directly from insurance companies, this is likely the only opportunity for you to buy or change an Affordable Care Act (Obamacare) qualified health plan.
Special Enrollment Periods are available for people who lose coverage due to life-changing events such as job loss or moving out of the plan’s service area. Please note that you will not be able to enroll in a qualified insurance plan after the open enrollment period unless you first lose coverage and enroll within 60 days of the event.
After months of delay tied to federal policy uncertainty, health insurance rates for individual and small group plans have been finalized. The announcement provides clarity for consumers across the state, though many Oregonians will see higher premiums next year.
In the individual market, six companies submitted rate change requests ranging from an average 3.9% increase (PacificSource) to 12.9% (Kaiser Permanente), for a weighted average increase of 9.7%. That’s slightly higher than last year’s average request of 9.3%.
The finalized rates come as consumers face a major shift in federal health policy. Expanded subsidies under the Affordable Care Act known as Enhanced Premium Tax Credits are set to expire on Dec. 31, 2025, unless Congress votes to renew them.
Without these subsidies, many Oregonians who buy insurance through the marketplace will see less premium assistance (tax credits) and significantly higher monthly premiums. State officials estimate that about 126,000 Oregonians currently purchase plans through the marketplace. Without federal action, some households could face premium increases of 300% to 400%.
For 2026:
- All Bronze plans offered in the individual market will be Health Savings Account (HSA) qualified, allowing consumers to contribute to a special savings account that can be used to pay for eligible medical expenses with pre-tax dollars.
- Some plans continue to offer the first three primary care doctor office visits for $5 per visit.
- Check to be sure that your doctors remain in-network. Doctors can leave certain networks and insurance carriers can change their networks as well.
- Other than increased premiums and higher deductibles, co-pays, and out-of-pocket maximums, your plan may not have changed much.
- The shopping tool developed specifically for Oregon may provide more Oregon-friendly plan information. You can access this site at www.OregonHealthCare.gov/WindowShop. You can also get a quick eligibility determination that may help you know if you should continue to healthcare.gov to buy Marketplace coverage.
Helpful Hints
- Establish your primary care doctor before you get sick. It can take 6 weeks or longer to get an appointment with a new primary care doctor. If you have not established your primary care doctor and need to see a provider quickly, you may need to seek treatment at an urgent care clinic.
- Many insurance carriers are now offering tele-medicine and express care options at low or no cost for the treatment of minor ailments. Be sure to review what your plan offers before you get sick or injured so you know when and how to use these services.
- Stay in-network. Most individual plans offer in-network coverage only – except in the case of an emergency. If you go to an out-of-network provider in a non-emergency situation, you’ll likely pay the full cost of that service.
- Review the benefits your plan offers. Many of the insurance carriers offer benefits not included in the summaries you look at when you’re selecting your plan.
In Conclusion
Remember, agents and brokers are available to you at no cost. Feel free to reach out for a second opinion if you are unsure of the person you are working with or the product they are offering. We are local, we know the market and we’re happy to help you.
As always, our goal is to help you Select Wisely, so please give us a call to schedule a time to review your health insurance options. We look forward to hearing from you.
