Dental Health Services offers this marketplace health insurance plan (Plan ID 25486OR0020003) 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.
Marketplace enrollment for 2025 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.
Standard High Off Exchange 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.
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.
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).
Emergency coverage only- for the relief of pain, swelling, and bleeding.
Out of Service Area Coverage
Yes
Out of Service Area Coverage Description
Emergency coverage only- for the relief of pain, swelling, and bleeding.
Service Area ID
ORS001
State Code
OR
Cost sharing & actuarial values
Issuer-provided metadata for this variant.
Begin Primary Care Deductible Coinsurance After Number Of Copays
0
Inpatient Copayment Maximum Days
0
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group
per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person
per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out
Not Applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group
$750 per group
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person
$375 per person
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual
$375
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group
per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person
per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual
Not Applicable
Additional attributes
Issuer-provided metadata for this variant.
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
EHB Apportionment for Pediatric Dental
0.93
First Tier Utilization
100%
Import Date
2024-05-22 20:01:49
Guaranteed Rate
Guaranteed Rate
New/Existing Plan
Existing
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
per group not applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Person
per person not applicable
Medical EHB Deductible, In Network (Tier 1), Individual
Not Applicable
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
2025-01-01
Plan Expiration Date
2025-12-31
Plan Type
EPO
QHP/Non QHP
Both
Source Name
SERFF
Plan ID
25486OR0020003
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?
SmartSmile Plus - EC (25486OR0020003) is a High EPO from Dental Health Services in Oregon for the 2025 coverage year.
Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.
Does SmartSmile Plus - EC 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 SmartSmile Plus - EC HSA-eligible and does it include dental or vision coverage?
HSA eligibility is not published; check the Summary of Benefits or ask the issuer.
Dental add-ons: Adult, Child.
Vision coverage is not listed for this plan.
Does SmartSmile Plus - EC support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Is there out-of-country coverage for SmartSmile Plus - EC?
Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency coverage only- for the relief of pain, swelling, and bleeding.
Does SmartSmile Plus - EC 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 coverage only- for the relief of pain, swelling, and bleeding.
How do I enroll in or manage payments for SmartSmile Plus - EC?
Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.
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.
