With open enrollment approaching for individuals, Oregon insurance officials are warning consumers about the risk of buying a low-cost plan that offers limited benefits.

So-called “self-funded” limited partner plans promise low premiums but often only cover preventive care such as checkups and annual health screenings, according to a consumer warning issued by the Department of Consumer and Business Services.

“Oregonians should exercise caution before enrolling in a limited partner plan,” the release said. “Consumers often end up with higher out-of-pocket costs due to uncovered medical bills.”

These plans are not officially sanctioned by federal or state governments and are not available on the marketplace website where people can shop for individual coverage for next year. Open enrollment for individuals starts Nov. 1 and runs through Jan. 15 for people who do not have health coverage through their employer, Medicare or the Oregon Health Plan.

As of June 30, nearly 135,000 people in Oregon were enrolled in an individual plan under the 2010 Affordable Care Act, which tried to increase coverage through subsidies. Only 74 policyholders had a noncompliant plan.

This year the subsidies shrunk and, along with an increase in premiums, the number of people enrolled in individual coverage dropped.

That number could fall again next year when Oregonians buying their own health insurance will pay nearly 22% more on average for coverage.

Regulators worry that consumers who are trying to curb costs could be tempted by these self-funded plans, which often refer to consumers as “limited partners” or “employees” to avoid falling under consumer protection regulations.

“With open enrollment rapidly approaching, it’s important to know what the difference is between these plans and standard plans,” the release said.

They are not compliant with the Affordable Care Act, which stipulates certain coverage and protections, and do not offer comprehensive coverage. But they might be marketed as such, regulators warned.

ACA-compliant plans are available through a licensed insurance agent or through the Oregon Health Insurance Marketplace or at HealthCare.gov, as well as directly from certain insurers. Consumers should beware that some websites with similar addresses to HealthCare.Oregon.gov offer non-compliant plans, so look for the .gov address, regulators said.

“If a deal looks too good to be true, it probably is,” said Oregon Insurance Commissioner TK Keen said in a statement. “If a health insurance policy offers unusually low premiums and low deductibles yet promises full or unlimited coverage, be skeptical.”

Some potential warning signs include:

• A salesperson marketing limited partner plans or other “ERISA plans” directly to consumers.
• A salesperson claiming they do not need a license because their product is not insurance or is exempt from regulation.
• A salesperson offering to sign you up outside open enrollment or without being eligible for a special enrollment period.
• A plan that seems abnormally cheap or refers to “stop-loss” insurance.
• A group issuing coverage with minimal requests about an applicant’s health.
• A company that asks for a large amount in premium costs upfront. 
• A company that delays or denies claims or makes excuses for not paying. 

Some companies that are known to market limited partner or self-funded plans include:

• Socios Buenos, LP or Vista Health
• Affordable Benefit Choices LLC
• LP Management Services LLC
• Aither Healthcare Competitive Health
• NXT Level Health
• Multiplan PHCS Network
• Verdegard Administrators, LLC, formerly known as Hawaii Mainland Administrators, LLC
• Pioneer Health/Innovative Healthcare Solutions
• ClearShare Health and Clearwater Benefits LLC
• Emergency Management Alliance
• Premier Health Solutions
• Strategic Limited Partners, LP
• The Vitamin Patch, LLC

Before buying insurance, ask for the agent’s full name and National Producer Number, which can be verified here.

Anyone who suspects they’ve been misled can contact the state’s consumer advocates at 888-877-4894 or email [email protected].

This republished story is part of OPB’s broader effort to ensure that everyone in our region has access to quality journalism that informs, entertains and enriches their lives. To learn more, visit opb.org/partnerships.

News Source : https://www.opb.org/article/2026/09/25/oregon-warning-low-cost-health-plan/