Oregon health plan · 2026

KP Oregon Standard Silver Plan · 71287OR0420003

Kaiser Foundation Health Plan of the Northwest offers this marketplace health insurance plan (Plan ID 71287OR0420003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: EPO CSR: 87% AV Level Silver Plan Issuer: Kaiser Foundation Health Plan of the Northwest
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 87.96%. Expect to pay roughly 12.04% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 87.81% (12.19% member share on average). Learn about AV methodology.

2026 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$257 – $1317

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$3,350

$6700 per group

Review MOOP rules

Office visits

Primary care $15.00
Specialist $40.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $25.00

View formulary tiers

$424 / mo before subsidies

≈ $5088 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1293 / mo before subsidies

≈ $15516 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1524 / mo before subsidies

≈ $18288 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1036 / mo before subsidies

≈ $12432 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

$0.00

Emergency Room Services

10.00% Coinsurance after deductible

Durable Medical Equipment

10.00% Coinsurance after deductible

Advertisement

Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Oregon). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 87% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00

Emergency Room Services

10.00% Coinsurance after deductible

Durable Medical Equipment

10.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 71287OR0420003
Coverage year 2026
State Oregon
Issuer Kaiser Foundation Health Plan of the Northwest
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 71287OR0420003-05
Available variants

Standard Off Exchange Plan · 71287OR0420003-00

Standard On Exchange Plan · 71287OR0420003-01

Open to Indians below 300% FPL · 71287OR0420003-02

Open to Indians above 300% FPL · 71287OR0420003-03

73% AV Silver Plan · 71287OR0420003-04

87% AV Silver Plan · 71287OR0420003-05

94% AV Silver Plan · 71287OR0420003-06
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Oregon 6393
PCPs in Oregon 587
Telehealth support Data pending
Nationwide providers 8986
6,393 doctors statewide 587 PCPs 54 OB/GYN

Provider network(s)

Providers Oregon All US states
All 6393 8986
PCP 587 782
Allergy 1 1
OB/GYN 54 64
Dentists N/A N/A

Drug coverage overview

2,712 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 1,824
SPECIALTY 501
NON-PREFERRED-BRAND 387
Prior authorization Drugs
Required 1,061
Not Required 1,651
Step therapy Drugs
Required 0
Not Required 2,712
Quantity limits Drugs
Has Limit 692
No Limit 2,020

Customer highlights

What stands out for members

  • Issuer: Kaiser Foundation Health Plan of the Northwest · Plan ID 71287OR0420003 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 71287OR0420003-05 (87% AV Silver Plan) currently displayed.
Advertisement

Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Year

Diabetes Education

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 3.0 Hours per Year

Covers three hours of education per year if there is a significant change in condition or treatment; covers one diabetes self-management education program at the time of diagnosis.

Home Health Care Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Laboratory Outpatient and Professional Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met

Preventive Care/Screening/Immunization

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Primary Care Visit to Treat an Injury or Illness

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met

Rehabilitative Occupational and Rehabilitative Physical Therapy

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limit does not apply to treatment of mental health conditions.

Rehabilitative Speech Therapy

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

30 visits per condition per calendar year. Visit limit does not apply to treatment of mental health conditions.

Specialist Visit

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Telehealth - Primary Care

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Telehealth allows a Member, or person acting on the Member’s behalf, to interact with a Participating Provider who is not physically at the same location. We cover telehealth Services at the same cost share as in-person when all of the following are true: The Service is otherwise covered under this EOC. The Service is determined by a Participating Provider to be Medically Necessary. Medical Group determines the Service may be safely and effectively provided using telehealth, according to generally accepted health care practices and standards.

Telehealth - Specialist

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Telehealth allows a Member, or person acting on the Member’s behalf, to interact with a Participating Provider who is not physically at the same location. We cover telehealth Services at the same cost share as in-person when all of the following are true: The Service is otherwise covered under this EOC. The Service is determined by a Participating Provider to be Medically Necessary. Medical Group determines the Service may be safely and effectively provided using telehealth, according to generally accepted health care practices and standards.

Urgent Care Centers or Facilities

$40.00
Tier 1 in-network $40.00
Out-of-network $40.00

X-rays and Diagnostic Imaging

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Zero Cost Share Preventive Drugs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Dialysis

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Durable Medical Equipment

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

$5,000 limit on non-Essential Health Benefit Durable Medical equipment.

Emergency Room Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 10.00% Coinsurance after deductible

Emergency Transportation/Ambulance

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 10.00% Coinsurance after deductible

Hospice Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Respite care provided in a nursing facility subject to a maximum of five consecutive days and to a lifetime maximum benefit of 30 days.

Inpatient Hospital Services (e.g., Hospital Stay)

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Inpatient Physician and Surgical Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Outpatient Services

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met. Mental health other services (non-office visits) are the same cost share as mental health office visits. For more information refer to your EOC.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient Rehabilitation Services

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limit does not apply to treatment of mental health conditions.

Outpatient Surgery Physician/Surgical Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Radiation

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Skilled Nursing Facility

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Year

Substance Abuse Disorder Inpatient Services

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Substance Abuse Disorder Outpatient Services

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

$5 copay for the first three in-network primary care provider, other practitioner, outpatient mental/behavioral health, or outpatient substance abuse disorder visits combined per year prior to the deductible being met. Substance abuse other services (non-office visits) are the same cost share as mental health office visits. For more information refer to your EOC.

Transplant

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

10.00%
Tier 1 in-network 10.00%
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

One hearing aid per hearing impaired ear if prescribed, fitted, and dispensed by a licensed audiologist with the approval of a licensed physician. Coverage will be provided every 36 months as medically necessary for the treatment of a member's hearing loss.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Eye Exam for Children

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Well Baby Visits and Care

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Medical Service Drugs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Non-Preferred Brand Drugs

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Preferred Brand Drugs

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Specialty Drugs

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Insulin: $35 max out of pocket for 30 day supply prior to deductible

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hormone Therapy

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Limit: 5.0 Visit(s) per Lifetime

Visit limit does not apply to treatment of mental health conditions.

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prosthetic Devices

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Acupuncture

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 12.0 Visit(s) per Year

Allergy Testing

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cosmetic Surgery

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Cosmetic or reconstructive surgery must take place within 18 months after the injury, surgery, scar, or defect first occurred unless medically necessary.

Eye Glasses for Children

$0.00
Tier 1 in-network $0.00
Out-of-network 100.00%

Gender Affirming Care

Coverage details pending

Gender affirming care is covered when determined by a provider as medically necessary and follows accepted standards of care. Please check with the insurance carrier for coverage information, including any limitations and exclusions.

Habilitation Services

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Visit limit does not apply to treatment of mental health conditions.

Imaging (CT/PET Scans, MRIs)

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Non-Preferred Generic

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Preferred Generic

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Cosmetic or reconstructive surgery must take place within 18 months after the injury, surgery, scar, or defect first occurred unless medically necessary.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

10.00% Coinsurance after deductible
Tier 1 in-network 10.00% Coinsurance after deductible
Out-of-network 100.00%

Covered for patients with diabetes mellitus.

Treatment for Temporomandibular Joint Disorders

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Variant attributes

KP Oregon Standard Silver Plan · Variant 71287OR0420003-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

71287OR042

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

71287OR0420003-05

Plan Marketing Name

KP Oregon Standard Silver Plan

Plan Variant Marketing Name

KP Oregon Standard Silver Plan 87% CSR

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

87.96%

Issuer ID

71287

Issuer Marketplace Marketing Name

Kaiser Permanente

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

ORN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency medical conditions, including prescription drugs

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency medical conditions, including prescription drugs

Service Area ID

ORS001

State Code

OR

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.8780761485206761

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

10.00%

SBC Scenario, Having a Baby, Coinsurance

$900

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$1,175

SBC Scenario, Having Diabetes, Coinsurance

$10

SBC Scenario, Having Diabetes, Copayment

$800

SBC Scenario, Having Diabetes, Deductible

$100

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$90

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,175

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$6700 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$3350 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$3,350

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

ORF004

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

3

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Design 3

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

0.9986

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$2350 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$1175 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$1,175

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

EPO

QHP/Non QHP

Both

Source Name

SERFF

Specialist Requiring a Referral

A referral is not required for outpatient Services provided in the following departments: Cancer Counseling, Chemical Dependency Services., Mental Health Services., Obstetrics/Gynecology, Occupational Health., Ophthalmology, and Optometry (routine eye exams), and Social Services.

Plan ID

71287OR0420003

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Oregon?

KP Oregon Standard Silver Plan (71287OR0420003) is a Silver EPO from Kaiser Foundation Health Plan of the Northwest in Oregon for the 2026 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does KP Oregon Standard Silver Plan support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is KP Oregon Standard Silver Plan HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does KP Oregon Standard Silver Plan support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with KP Oregon Standard Silver Plan?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for KP Oregon Standard Silver Plan?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency medical conditions, including prescription drugs

Does KP Oregon Standard Silver Plan cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency medical conditions, including prescription drugs

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.