Oregon Health Insurance Marketplace

Name

Oregon Health Insurance Marketplace

Legal name

Oregon Health Insurance Marketplace

Website

https://healthcare.oregon.gov

Company type

Public

Founded year

2013

Operating status

Operating

Headcount range

11–50 employees

Ownership category

akta.pro rank

Product category

Health Insurance Exchange

NAICS

Agencies, Brokerages, and Other Insurance Related Activities (5242)

SIC

Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

ACA Marketplace (On-Exchange) Individual Plans (FSAIAEAA)

akta.pro secondary industries

Small Group Health Insurance (2–50/100) (FSAIAFAD), Dental Insurance (FSAIAHAA), Individual Dental Insurance (FSAIAEAE)

Keywords

• Health insurance exchange
• State health marketplace
• SHOP small group coverage
• Medicare counseling services
• Tribal health benefits

Headquarters

HQ city

Salem

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Insurance Carrier Assessments: The Marketplace is funded through assessment fees levied on qualified health plans and stand-alone dental plans sold through the Marketplace. Assessment rates are established annually under ORS 741.105 and Senate Bill 65 (2021). The assessment rates for 2025 are $5.50 per member per month (PMPM) for qualified health plans and $0.36 PMPM for stand-alone dental plans. This funding supports Marketplace operations and enrollment support activities.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels9 records

Core offering

The Oregon Health Insurance Marketplace is the official state health insurance exchange connecting Oregon residents to private individual and small-group health plans, stand-alone dental plans, and financial assistance programs (premium tax credits and cost-sharing reductions). It operates a centralized application, plan comparison, and enrollment platform — currently via the federal HealthCare.gov platform — and supports consumers through free in-person assistance from certified community partners and licensed insurance agents. Enrollment is offered during open enrollment and qualifying life-event special enrollment periods, with additional Medicaid/OHP Bridge and tribal member programs integrated into the consumer experience.

Product overview

The Oregon Health Insurance Marketplace is a state-level health insurance exchange that operates as a hub connecting Oregonians to health coverage options through a partnership with the federal HealthCare.gov platform. The core Marketplace facilitates enrollment in individual health plans, dental coverage, and small business coverage through six health insurance carriers and six dental carriers. The ecosystem includes financial assistance programs (premium tax credits and cost-sharing reductions), special programs for tribal members, premium assistance programs, hospital financial assistance guidance, and Medicare counseling through the SHIBA program. The marketplace also provides tools including a window shopping plan comparison tool, SHOP premium calculator for employers, multilingual assistance in 15+ languages, and a Small Business Health Care Tax Credit program. A significant infrastructure transition is underway to build a state-based marketplace platform to replace the federal platform by 2026.

Differentiator

Problem solved

Functional benefit

Products and services

• Oregon Health Insurance Marketplace The official Oregon state health insurance exchange helping Oregon residents compare and enroll in private individual health plans, access premium tax credits and cost-sharing reductions, and connect with public programs such as OHP and Medicare. Open enrollment and qualifying life-event special enrollment periods are supported, with free in-person assistance available.
• Small Group Health Coverage (SHOP) Year-round health insurance coverage for Oregon small businesses with 1-50 employees, including certified plans eligible for the Small Business Health Care Tax Credit. Employers purchase directly from participating carriers with Marketplace confirmation of plan certification for tax credit eligibility.
• Stand-Alone Dental Plans Separate dental coverage options available through six dental carriers via the Marketplace, often purchased alongside a medical plan or independently by consumers seeking dental coverage.
• Senior Health Insurance Benefits Assistance (SHIBA) Free, confidential Medicare counseling delivered by trained volunteers to help Oregonians aged 65+ or with qualifying disabilities understand Medicare Advantage, Medigap, and prescription drug plan options and apply for Extra Help programs.
• Tribal Health Benefits Program Specialized savings and enrollment options for American Indians and Alaska Natives who are members of federally recognized tribes, including zero cost-sharing plans, flexible enrollment available any time of year, and access to tribal premium sponsorship programs coordinated through the Tribal Health and Human Services Cluster.
• Premium Assistance Programs Local premium assistance programs, including Project Access NOW (Clackamas, Multnomah, Washington counties) and Project Access Network (Marion, Polk counties), that help qualifying consumers pay Marketplace health insurance premiums.
• Premium Tax Credits and Cost-Sharing Reductions Financial assistance available to eligible Marketplace enrollees: premium tax credits reduce monthly premiums on a sliding scale based on income, and cost-sharing reductions lower out-of-pocket costs such as copayments, coinsurance, and deductibles for qualifying enrollees.
• Special Enrollment Periods Mid-year enrollment opportunities outside open enrollment, triggered by qualifying life events including marriage, birth or adoption, loss of other health coverage, relocation to Oregon, and divorce.
• Small Business Health Care Tax Credit Program Tax credit offering up to 50% of premium costs for qualifying small businesses with fewer than 25 full-time equivalent employees earning average salaries of $62,000 or less. Marketplace certifies plans and facilitates eligibility verification.
• Multilingual Assistance Services Free in-language help for accessing health coverage and understanding Marketplace options, delivered in 15+ languages to support Oregon's diverse population.

Segments5 records

Ideal customer profiles5 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Partnerships

16 partnerships are on record, tiered core.

• BridgespancoreTechnology or IntegrationHealth insurance carrier offering individual Marketplace plans in Oregon for 2025 and 2026 plan years. Customers can find in-network providers through the Bridgespan provider directory.
• Kaiser PermanentecoreTechnology or IntegrationHealth and dental insurance carrier offering individual Marketplace plans in Oregon for 2025 and 2026 plan years. Operates integrated healthcare delivery system.
• Moda HealthcoreTechnology or IntegrationHealth insurance carrier (Moda Health Plan) offering individual Marketplace plans in Oregon for 2025 and 2026 plan years. Provides medical and dental coverage options.
• PacificSource Health PlanscoreTechnology or IntegrationHealth insurance carrier offering individual Marketplace plans and stand-alone dental plans in Oregon for 2025 and 2026 plan years.
• Providence Health PlancoreTechnology or IntegrationHealth insurance carrier offering individual Marketplace plans in Oregon for 2025 and 2026 plan years.
• Regence BlueCross BlueShield of OregoncoreTechnology or IntegrationHealth insurance carrier offering individual Marketplace plans in Oregon for 2025 and 2026 plan years. Customer service available 24/7.
• Delta Dental of OregoncoreTechnology or IntegrationDental carrier offering stand-alone dental plans through the Marketplace for 2025. Customer service: 888-217-2365.
• Cascade AIDS ProjectcoreChannel Partner/ Reseller/ DistributorCommunity partner organization serving Clackamas, Multnomah, and Washington counties. Provides free enrollment assistance for Marketplace coverage, specializing in LGBTQ+ health coverage needs.
• Project Access NOWcoreChannel Partner/ Reseller/ DistributorCommunity partner serving Clackamas, Multnomah, and Washington counties. Offers premium assistance programs and free enrollment help.
• Asian Health and Service CentercoreChannel Partner/ Reseller/ DistributorCommunity partner serving Clackamas, Multnomah, and Washington counties. Provides culturally and linguistically appropriate enrollment assistance for Asian American communities.
• Immigrant and Refugee Community Organization (IRCO)coreChannel Partner/ Reseller/ DistributorCommunity partner serving Baker, Clackamas, Malheur, Multnomah, and Washington counties. Provides enrollment assistance for immigrant and refugee communities.
• Oregon Latino Health CoalitioncoreChannel Partner/ Reseller/ DistributorCommunity partner serving Clackamas, Multnomah, and Washington counties. Focuses on Latino/Hispanic health coverage access.
• Department of Consumer and Business Services (DCBS)coreStrategic or Co-development PartnerDCBS Director serves as ex-officio member of the Health Insurance Marketplace Advisory Committee (HIMAC). Department regulates insurance in Oregon and collaborates on marketplace governance.
• Oregon Health Authority (OHA)coreStrategic or Co-development PartnerOHA administers the Oregon Health Insurance Marketplace. The Health Policy Analytics Division Director serves as ex-officio member of HIMAC. OHA oversees OHP, Marketplace operations, and state-based marketplace transition.
• Tribal Health and Human Services ClustercoreStrategic or Co-development PartnerPartnership between nine federally recognized tribal governments in Oregon and OHA, DCBS, and Department of Human Services dedicated to increasing health and well-being of tribal members. Provides framework for tribal premium sponsorship programs and special tribal enrollment options.
• Centers for Medicare & Medicaid Services (CMS)coreStrategic or Co-development PartnerFederal agency overseeing HealthCare.gov platform. Oregon currently operates as State-Based Marketplace using Federal Platform (SBM-FP). CMS requires annual certification training for assisters and agents. Oregon submitted Initial CMS Blueprint Application in June 2025 for full state-based marketplace.

Scale indicators4 records

Recent moves7 records

Expansion highlights5 records

Direct peers

• Massachusetts Health Connector: Massachusetts' state-based marketplace, established pre-ACA and now operating as a full SBM. Directly comparable as a state-government-run exchange offering individual, small-group, and ConnectorCare subsidized coverage.
• Nevada Health Link: Nevada's state-based marketplace offering individual ACA coverage with its own technology platform. Comparable as a state-government SBM with similar QHP enrollment, APTC processing, and dental plan offerings.
• Maryland Health Connection: Maryland's state-based health insurance marketplace operating its own technology platform. Comparable in mission, individual/small-group enrollment focus, and state-government operating structure.
• MNsure: Minnesota's state-based marketplace offering individual and small-group ACA coverage. Directly comparable as a state-government-run exchange with similar carrier-participation dynamics and QHP/dental plan offerings.
• Covered California: California's state-based health insurance marketplace operating under the ACA, offering individual and small-group coverage with its own technology platform. Closely comparable to Oregon's Marketplace in mission, regulatory structure, and carrier-participation model.
• Access Health CT: Connecticut's state-based health insurance marketplace operating its own platform. Comparable in scope (individual and small-group ACA coverage) and as a smaller-population state SBM with similar regulatory and funding mechanics.
• NY State of Health: New York's official health plan marketplace, operating as a state-based exchange with integrated public program eligibility. Directly comparable in scope (individual + small-group + Medicaid transition) and in state-government operating model.
• Connect for Health Colorado: Colorado's state-based health insurance marketplace offering individual and small-group ACA plans. Comparable in mission, SBM operating model, and carrier-participation structure, and serves a similarly sized population base.
• Washington Health Benefit Exchange (Washington Healthplanfinder): Washington state's health insurance exchange operating its own SBM technology platform. Comparable to Oregon on mission, statutory authority, and carrier-participation marketplace structure, and is a near neighbor in the Pacific Northwest.

Broad incumbents

• HealthCare.gov (CMS Federal Marketplace): The federal marketplace platform used by Oregon today (and by states that have not built their own SBM). Comparable as the incumbent exchange technology and consumer-facing enrollment platform serving Oregon until the 2026 transition is complete.

Market position

Strengths5 records

Weaknesses4 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/channel/UCYXyZDglAWbpoCy97UBycHg
• Facebookfacebook.com/ormarketplace
• LinkedInlinkedin.com/company/ormarketplace
• Instagraminstagram.com/ormarketplace
• Xx.com/ormarketplace

Revenue estimate

Valuation estimate

Number of profiles

Profiles13 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Oregon Health Insurance Marketplace