Health Insurance 101
Understanding and Accessing Health Insurance
Understanding health insurance can be hard, but Project Access NOW is here to help. This guide explains where to go when you are sick—like seeing a regular doctor, going to urgent care, or heading to the emergency room.
You can also find phone numbers for health insurance providers and more. We even explain tricky insurance terms like “deductible” and “premiums” to help you understand your policy and bills.
Where To Go For Medical Help
If you are experiencing a life-threatening medical or psychiatric emergency, call 911 immediately or go to the nearest emergency room.
Contacts and Resources
Important contacts and resources are listed below. You can also contact Project Access Now Payment Support team here.
Key Terms
Advance Premium Tax Credits (APTCs)
Credits that lower your monthly premium based on income and household size.
Coinsurance
After paying your full deductible, you may pay coinsurance for doctor visits (excluding preventative services).
Copay
The amount you pay for services like doctor visits or medications. It is a set (small) amount determined by your plan.
Deductible
The amount you pay each year for healthcare before your insurance plan begins to pay. This varies by plan.
In-Network / Out-of-Network
In-network services are covered by your plan; out-of-network services are not covered and will cost much more.
Marketplace
A national service for enrolling in private insurance, often used if you make too much money for Oregon Health Plan.
Medicare
A national program for people 65 and older or those with specific disabilities.
Oregon Health Plan (OHP)
Oregon’s Medicaid program for those with low incomes. You cannot have a Marketplace plan and OHP simultaneously without being penalized.
Out-of-Pocket Cost
The cost you pay for your healthcare, including: copay, deductible, and coinsurance.
Premium
The monthly cost of your health insurance plan, which must be paid even if you do not visit a doctor.
Preventative Services
Regular check-ups or flu shots that are free when using an in-network provider.
