OHP: Oregon Health Plan. What are your stories? (Cove: 2015, health insurance)

[AndyPanda]

Hello. I'm an Oregon resident who recently quit my job and, to my horror, found my husband and myself on Oregon Health Plan, open card. Seems we lost our regular health insurance through Cover Oregon after I quit. My question is for anyone who has had OHP. How was/is it? Did you get decent care? Was it hard to make appointments? Did they ever deny care? I would like to hear your stories, both good and bad. Thank you!

[Nell Plotts]

Did you have health insurance through your employer and failed to sign up under COBRA?

Soon you can look at insurance offerings through the Affordable Care Act to see if there is something there you can afford and prefer.

I have never used OHP or know anyone who has. Thank you lucky stars that you have some health insurance coverage as not long ago you would have had no option.

[PNW-type-gal]

The OP can sign up for coverage under ACA (signups for Jan 1 2015 start Nov 15) and the job change makes the OP eligible for coverage immediately under one of the ACA plans, although I don't know how premium subsidies work in this case. The Oregon Health Plan is Oregon's version of Medicaid, so income must be under a certain level.

Also, I don't think you are eligible for COBRA if you voluntarily quit, so that probably wasn't an option. If the OP was on an ACA qualified plan through a business then yes, the coverage is through the business and can't be continued after leaving, the OP would need to sign up for an individual plan.

I don't mean to sound cold, but what did the OP expect when he/she quit a job that was the sole source of health insurance?

[Metlakatla]

Originally Posted by AndyPanda

Hello. I'm an Oregon resident who recently quit my job and, to my horror, found my husband and myself on Oregon Health Plan, open card. Seems we lost our regular health insurance through Cover Oregon after I quit. My question is for anyone who has had OHP. How was/is it? Did you get decent care? Was it hard to make appointments? Did they ever deny care? I would like to hear your stories, both good and bad. Thank you!

To my horror, a lot of people who apparently need to can't even get on the OHP. I'm not sure how you suddenly "found yourself" there; I think it's something people have to apply for.

[DRS1989]

Medicaid tends to have low imbursement rates; therefore, it can be hard for beneficiaries to find a primary care physician. That's why Medicaid recipients end up in the emergency rooms at disproportionately high rates.

[Larry Caldwell]

You have to have a PCP on the OHP. It's one of the requirements. A big part of the cost savings is preventive medicine, taking care of problems before they escalate to an ER visit. Kitzhaber was an ER doc in Douglas County, and saw the incredible waste that comes from inadequate preventive care. It's the reason he pushed through the OHP.

There is no Medicaid in Oregon, it's all handled through the OHP, which covers about twice as many people as straight Medicaid would. Besides requiring a PCP, another cost saving measure is health care rationing. There's a list, and below a certain line it won't pay for treatment. If you are going to die anyway, all it pays for is palliative care, no heroic measures like the Medicare "blank check" policy. Basically, if your chances of surviving 5 years are less than 50/50, you need to look for another source of medical funding. It also won't pay for experimental treatments.

About 10 years ago there was a teenage girl who needed a heart/lung/liver transplant, and OHP wouldn't pay for it. The guy who owns Shilo Inns stepped up and footed the bill, and the girl died anyway. There was all sorts of public outrage about "unfeeling bureaucracy," but the fact is that the girl was always going to die. She would have been better off on palliative care, but instead she died chopped up in a recovery room. Meanwhile, the $875,000 dollars that the OHP didn't spend on junk medicine went for prenatal care that prevented hundreds of birth defects, and saved the lives of many children that would have died without a pediatrician. Someday, Medicare is going to have to come to the realization that spending billions of dollars in futile treatments within 30 days of the end of life is a waste of money. Everybody dies sooner or later.

[bler144]

Any separation from employment makes one COBRA-eligible, but with COBRA you're generally responsible for picking up the premium - your employer won't be paying it. If you were on a cadillac plan under your previous job it's liable to be spendy. COBRA was most useful in cases of pre-existing conditions, which the ACA more or less made moot.

Change in employment is a 'qualifying event' that would let you enroll in Cover Oregon even outside of the open enrollment period, though how they would measure your income for determining subsidy I'm not certain; likewise you could apply for OHP.

As Met said, you do have to apply for OHP - I'm not sure how you just found yourself there. Perhaps you have raging parties where you get blackout drunk and do crazy things like apply for public insurance?

[Brett]

I don't have any OHP horror stories, but I have some from getting injured in the 90s with no health insurance. It took me years to crawl out of that financial hole. Be happy you have something, focus on gettin a job with better health insurance if that's your priority.

Personally I don't entirely love my job, but the health care is excellent and I have five kids. They could pretty much beat me every day when I clocked in and I wouldn't quit.

[Larry Caldwell]

Originally Posted by Brett

I don't have any OHP horror stories, but I have some from getting injured in the 90s with no health insurance. It took me years to crawl out of that financial hole. Be happy you have something, focus on gettin a job with better health insurance if that's your priority.

Personally I don't entirely love my job, but the health care is excellent and I have five kids. They could pretty much beat me every day when I clocked in and I wouldn't quit.

Yeah, so do I. Five hours on the operating table, ten days in intensive care, and two months of being disabled after they discharged me kept me poverty stricken for years. In retrospect, I should have filed bankruptcy and dumped the expense on someone else, but I paid the whole bill myself.