Some Oregonians will get $500 Obamacare checks. Who qualifies?

After a punishing year for Oregonians who buy their own health insurance, the Trump administration is promising some of them $500 rebates just as premiums are set to climb even higher.

President Donald Trump announced last week that the government plans to send the one-time checks to nearly one million people in 30 states, including Oregon, who buy health plans through HealthCare.gov, the federal Affordable Care Act marketplace commonly known as Obamacare.

The White House says the checks will go only to people who pay the full cost of their coverage and receive no federal subsidies. That generally means middle- and higher-income Obamacare enrollees, many of whom saw their insurance costs rise by thousands of dollars after more generous Covid-era tax credits expired at the end of last year.

For some, the higher cost pushed health insurance out of reach. About 140,000 Oregonians bought their own health insurance earlier this year, many because they’re self-employed or don’t get coverage through work. Enrollment fell by more than 15% from a year earlier, a decline state regulators largely attribute to the loss of those subsidies. Those who dropped coverage altogether won’t benefit from the refunds.

Many who kept their individual health plan won’t get a check, either. About 60% of Oregon marketplace enrollees received federal help paying their premiums this year and wouldn’t qualify under the White House’s description of the program. Federal officials haven’t said how many Oregonians will get a rebate.

For those still buying their own insurance, $500 won’t provide much relief against what’s coming next. Premiums will rise an average of 21.6%, more than double the nearly 10% average increase for 2026. And they’ll have fewer choices.

Oregon insurance regulators told lawmakers last week that several forces are pushing rates higher. Chief among them are higher costs for hospital care, doctors, prescription drugs and other medical services. Some insurers spent more on claims and expenses for individual plans last year than they collected in premiums, according to regulators.

Falling enrollment creates another challenge. As insurance gets more expensive, younger and healthier people are more likely to drop it, Jesse O’Brien, a policy manager with the Oregon Department of Consumer and Business Services’ Division of Financial Regulation, told lawmakers. That leaves insurers with fewer customers and, on average, bigger medical bills to cover.

Regulators had initially proposed trimming insurers’ requested increases to an average 16% for individual plans but ultimately approved higher increases after insurers reported bigger-than-expected financial losses and revised their requests.

Providence Health Plan and PacificSource Health Plans are leaving the individual market at the end of this year, cutting the number of insurers selling those plans from six to four. Together, they covered nearly 48,000 people as of the end of June. Moda Health is also retreating from parts of the state, forcing about 4,000 more people to switch plans.

The shake-up also affects people who get health benefits through small employers. Moda Health is leaving the small group market, which covers businesses with 50 or fewer employees, affecting roughly 22,000 people. Health Net is pulling out of small-group market and other commercial plans covering about 9,000 people.

All told, regulators say close to 100,000 Oregonians will have to find new health plans for 2027.

State regulators don’t expect Trump’s promised $500 checks to soften next year’s premium increase. The payments are tied to prior plan years, not what consumers will pay in 2027, said Jason Horton, a spokesperson for the Department of Consumer and Business Services.

The Trump administration says the money will come from fees insurers paid to sell plans through HealthCare.gov, costs the White House says were passed along to consumers through premiums. Federal officials said the government collected more than it needed to run the marketplace, leaving a surplus.

The administration blames the Biden administration for the surplus and has described the payments as refunds of Obamacare “overcharges.” The Associated Press reported that some of the unspent money may date to Trump’s first term.

Exactly who will get the money and whether consumers have to do anything to receive it are still unclear. Federal officials haven’t said which years of Obamacare coverage will determine eligibility or which years generated the fees the White House says it collected in excess. In Oregon, the share of enrollees receiving federal subsidies has varied year to year, according to federal data.

Oregon, meanwhile, is about to leave the federal marketplace whose fees are funding the checks.

Starting Nov. 1, Oregonians shopping for individual coverage will use Explore Health, the state’s new online marketplace. The launch marks Oregon’s return to a state-based exchange more than a decade after the spectacular failure of Cover Oregon, the $300 million system the state abandoned in 2014.

Oregon will still charge insurers a fee to sell plans through its marketplace and is now deciding how much to charge for 2027. Regulators say running its own exchange will give the state more control over enrollment and outreach and, eventually, more options for making coverage affordable.

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