More people buy private health insurance plans as thousands lose Medicaid coverage

The number of people buying private health insurance policies on the federal marketplace rose slightly this year in Oregon as thousands lost Medicaid coverage.

The Oregon Health Authority said in its annual marketplace report published Tuesday that nearly 146,000 people bought a private plan for 2024, marking an increase of more than 2% over last year when nearly 142,000 people bought their health insurance through the marketplace. 

Some of those new enrollees are likely people who have lost Medicaid coverage, officials said. Last April, the health authority began unwinding the enhanced Medicaid coverage provided by the federal government during the pandemic. It stepped up the federal match rate by 6%, and in exchange, states agreed not to boot anyone off the free health insurance for low-income residents regardless of their income. 

But that benefit ended last spring, and since last April, health officials have been unwinding coverage for people who no longer qualify. Medicaid, which provides free health care, mental health care and dental coverage, is generally available to those up to 65 years old with a household income up to 138% of the federal poverty level – nearly $21,000 a year for an individual or about $43,000 a year for a family of four.

Oregon Health Authority figures show that among the 1.5 million on Medicaid during the pandemic, nearly 109,000 who no longer qualified were referred to the marketplace. Health authority officials tried to steer them toward buying a plan by sending tens of thousands of notices in 14 languages, sending tens of thousands of emails and text messages and making tens of thousands of calls. 

Amy Coven, a health authority spokeswoman, said the agency doesn’t know how many of those people actually bought insurance on the marketplace because the federal government hasn’t released those figures.

The marketplace offers the only opportunity to obtain federal subsidies toward premium payments. The annual report said that just over 80% of those who signed up received a federal subsidy, with the average person receiving about $525 in federal tax credits. The average net premium was about $164 a month.

Still, only a small fraction of those who have lost their Medicaid coverage appear to have bought private health insurance: The number of people buying plans on the marketplace through mid-January, when open enrollment ended, only increased by about 3,550 people compared to the year before. 

Coven said that small increase does not mean that tens of thousands who lost Medicaid are now uninsured.She said that results from an email and text survey to those no longer on Medicaid indicated that 70% found other health insurance.

“Only a small portion of respondents reported that they felt coverage was too expensive,” Coven said in an email. 

Six companies offered plans on the marketplace this year – BridgeSpan, Kaiser Permanente, Moda, PacificSource, Providence and Regence – and everyone, regardless of where they live, had at least 26 plans to choose from, the report said.

Most people in Oregon receive health insurance through their job, Medicaid, Medicare and Veterans Affairs. Before the pandemic, 6% of Oregonians had no health insurance but that decreased to 4.6% in 2021, according to the latest survey. 

Health authority officials are gearing up to expand Medicaid benefits this summer to people who make between 138% and 200% of the federal poverty level – just over $30,000 a year for individuals and $62,400 for a family of four – under a federal waiver. The so-called Bridge Plan will offer the same free health and dental benefits as regular Medicaid, but recipients will not qualify for long-term services or the new climate and housing benefits that are being rolled out. Residents can sign up through the ONE system.