In Oregon, the cost of health care and the structure of insurance coverage create a complex landscape where many fall through the cracks — even as some major reforms aim to bridge those gaps. Below is an overview of how much is typically spent, who qualifies for public coverage under Oregon Health Plan (OHP), where gaps remain, and what broader patterns in coverage, access, affordability, and barriers to care look like today.

Costs and Spending on Health Care in Oregon

Recent data show that personal health-care spending in Oregon has risen significantly over the past decade. In 2023, per-person annual spending on health care in Oregon exceeded US $9,000, up from about $6,577 in 2015 — an increase of nearly 40%. Oregon.gov

Because of such high costs, many Oregonians face real financial pressure: 15% report delaying or avoiding care because of cost, 12% have used “most or all” of their savings to pay medical bills, 6% report struggling to afford necessities because of health-care costs, and 4% say they have rationed medications to make them last longer. Oregon.gov

On the private insurance front, recent premium increases reflect broader inflation in health care: a 2025 rate filing for individual market plans in Oregon shows hikes averaging 9.7%. The Lund Report+1 The average monthly premium for many individual plans hovers around what the small-group or marketplace plans set, giving a sense of what someone not covered by public insurance might expect to pay. Oregon Division of Financial Regulation+1

These rising costs — premiums, deductibles, out-of-pocket care, medications — combine to create a heavy financial burden for many residents in Oregon.

Who Has Coverage — Insurance Coverage in Oregon

Despite the high cost of care, insurance coverage rates in Oregon are relatively high: as of 2023, about 97% of residents reported having health insurance. Oregon.gov Of those insured, more than 30% (about 32%) are covered by OHP (which includes the traditional Medicaid coverage under Oregon’s public health program). Oregon.gov+1 Another 46% rely on group coverage (often employer-based), with smaller shares covered by Medicare, individual plans, or other kinds of coverage. Oregon.gov

This suggests that public insurance remains a backbone of coverage for low- and moderate-income populations in Oregon, while employer-based insurance serves many others. Still, having “coverage” doesn’t always guarantee that care is affordable or accessible.

OHP: Eligibility, What It Covers, and Recent Changes

OHP — Oregon’s version of Medicaid — provides free medical, dental, prescription, and behavioral health care to eligible individuals. Enrollment is open year-round. Oregon.gov+1

Eligibility depends largely on income (as well as household size, age, immigration status, and other factors). According to recent guidelines:

• For adults (19–64) under the standard OHP program, a single individual qualifies if monthly gross income is about $1,800 or less; for a two-person household, the limit is about $2,433/month; for larger households, limits increase accordingly. Default+1

• Children, pregnant individuals, caretakers, and other special categories have different (often higher) income thresholds. Default+2NASHP+2

In July 2024, Oregon launched a new benefit under OHP called OHP Bridge — a “Basic Health Program” designed to cover adults with income slightly above the traditional Medicaid eligibility limits. OHP Bridge provides medical, dental, and behavioral health care — with no premiums, copays, coinsurance, or deductibles. Oregon.gov+2United States of Care+2

Under OHP Bridge, adults making between 138% and 200% of the federal poverty level (FPL) may qualify (assuming they meet other criteria, like immigration or citizenship status, and do not have access to affordable other insurance). United States of Care+1 For example, as of the most recent thresholds: a single adult earning up to approximately $30,120 per year may qualify; for a family of four, up to about $62,400 per year. AllCare Health+2Oregon Capital Chronicle+2

This expansion intends to reduce the “coverage gap” — people who earn too much for traditional Medicaid but too little to comfortably afford marketplace or private insurance. Oregon Capital Chronicle+2United States of Care+2

Because OHP (and OHP Bridge) covers a broad range of services without cost to members, for many low- and moderate-income Oregonians it offers a critical safety net. Oregon.gov+2Oregon.gov+2

Gaps, Affordability Problems, and Barriers Despite Coverage

Even with high insurance coverage and expanded public options, many Oregonians still struggle with affordability, access, and underinsurance. Several factors contribute to this:

• Rising costs overall. As noted, per-person health expenditures have climbed rapidly; medical cost growth has outpaced many people’s income growth. Oregon.gov+1

• Private insurance remains expensive. With premium increases of nearly 10% in 2025 for individual plans, and out-of-pocket costs on top of that, many who do not qualify for OHP or OHP Bridge must shoulder a hefty burden. The Lund Report+2opb+2

• Financial instability from medical costs. As of 2023, 12% of people in Oregon reported using most or all their savings to pay for medical bills; 6% struggled to afford essentials because of their medical costs; 4% rationed medications. Oregon.gov

• Delays or avoidance of care. Because of cost concerns, 15% of people in Oregon reported delaying or avoiding health care. Oregon.gov

Thus, even when insured, many Oregonians may lack real access to care — especially preventive, routine, or ongoing care — if costs are too high or unpredictable.

The “Middle Gap”: Who’s Too Rich for OHP but Too Poor for Private Insurance

The creation of OHP Bridge acknowledges a long-standing “middle-income squeeze”: people whose income slightly exceeds traditional Medicaid/Medicaid expansion limits, but who may not have access to affordable employer-based plans and might find marketplace plans financially burdensome. United States of Care+2Oregon Capital Chronicle+2

Before Bridge existed, many in this group would either go uninsured, be underinsured, or pay expensive premiums/deductibles. With Bridge, however, eligible adults (up to 200% FPL) can have coverage without out-of-pocket costs — a potential major improvement for affordability and access. Oregon.gov+2AllCare Health+2

That said, the eligibility criteria still exclude people above 200% FPL (or those with “affordable” other insurance), meaning there remains a portion of the population vulnerable to high costs. And even for those insured, systemic cost pressures continue to threaten access and stability.

Why This Matters: Coverage ≠ Guaranteed Access or Affordability

In theory, high rates of insurance coverage combined with public programs like OHP should result in broad access to care. In practice, though, that’s not always the case. The data from Oregon show that:

• Insurance alone does not eliminate out-of-pocket burdens or prevent care avoidance. Oregon.gov+2Oregon.gov+2

• Rising costs affect not just premiums but overall medical spending, leading to debt, savings depletion, medication rationing, and skipped care. Oregon.gov+1

• People in the “middle zone” (too wealthy for Medicaid, too poor for affordable private insurance) are especially vulnerable — though OHP Bridge helps, not everyone may qualify or remain eligible. United States of Care+2Oregon Capital Chronicle+2

For many Oregonians, access to reliable, affordable, comprehensive health care remains fragile — contingent on shifting incomes, changing program eligibility, and rising costs.

Sources

• Oregon Health Authority — 2024 report on health-care costs and impacts on Oregonians. Oregon.gov

• Oregon Health Insurance Coverage Summary (2023). Oregon.gov+1

• Oregon Health Plan (OHP) official eligibility and benefits information. Oregon.gov+2Oregon.gov+2

• Oregon Health Plan plus OHP Bridge eligibility thresholds. Bend Health Insurance+4Default+4Oregon.gov+4

• Recent 2025 rate filings showing individual market premium increases in Oregon.