Your carrier is leaving Oregon. Here is what happens next.

If a notice arrived saying your health insurance company is leaving Oregon or pulling back, I understand the alarm. I help people find health insurance every day in Hillsboro, and I have been hearing from a lot of them.

Here is what is going on and what I would do in your position.

What is happening

Three major carriers in Oregon's individual market are leaving or cutting back: Providence Health Plan, PacificSource, and Moda Health. Prices for medicine and doctors are rising too fast, and local carriers cannot absorb huge bills like the cost of expensive new medicines. The state tried to help, but it does not have enough money to stop carriers from leaving.

The result is that Oregon families have fewer choices, and thousands of people have to find new plans.

What the notice means for you

Your current plan runs through the end of its plan year. You are not dropped mid-year. The notice is telling you that you need a new plan for the next one.

Open enrollment is your window to replace it. Open enrollment runs from November 1 through January 15, and you need to enroll by December 31 for coverage that starts January 1. Do not wait for the last day.

The marketplace itself is also changing this year, since Oregon is moving from HealthCare.gov to its own marketplace, Explore Health. I explain it in Oregon is leaving HealthCare.gov, here is what Explore Health means for you.

Do not let your coverage lapse. A gap means you are paying for care out of your own pocket, and it can be hard to fix after the fact.

How to pick a replacement

I go through the same checks with every client.

First, check your doctors and your hospital. Look up each one in the new plan's network. If a provider you rely on is not in it, that plan is a poor fit no matter the price.

Second, check your prescriptions against the plan's formulary. Coverage matters most for costly drugs. For common generics, GoodRx can sometimes beat a plan's copay, so price those both ways.

Third, compare the out-of-pocket maximum, not just the premium. It is the most you could pay in a bad year. I explain how the deductible, coinsurance, and out-of-pocket maximum work together in how individual health insurance works.

Fourth, expect your premium tax credit to be recalculated. It depends on your household income and is recalculated when you apply on Explore Health, so the price you see for a new plan may differ from what you pay now.

If you already received a renewal letter instead, see your renewal letter came, here is what to compare.

Let me do the comparison

I can do this comparison with you. There is no fee to work with me. Tell me which doctors and prescriptions matter most, and I will show you which plans keep them.

What I think should change

Individual coverage should not fall apart every time a few large claims land on a local carrier. I do not want the government to run everything. I want a safe system. I think Congress can get there with three steps:

• Set a fair national floor for health plans.
• Help pay for catastrophic claims, so local carriers do not close their doors.
• Keep local carriers free to build plans that fit our towns, since they know our doctors and hospitals best.

You are a constituent, and you can write to your representatives in Congress and ask them to act.

Next step

Send me your notice through the contact page and I will do the comparison for you.