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Maine health insurance exchange

Mainers have 40 plan options for 2015

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Good news for Maine’s health insurance marketplace: competition is expanding, and premiums rates are holding steady or declining slightly.

According to the Maine Bureau of Insurance, Maine Community Health Options (MCHO), Anthem Health Plan of Maine, and Harvard Pilgrim Health Care will offer about 40 individual polices through the exchange when 2015 open enrollment begins on Nov. 15. These three insurers will also offer policies to small businesses through the SHOP exchange. Harvard Pilgrim is new to the Maine marketplace in 2015.

Aetna also sells health insurance in Maine, but is selling policies off the marketplace only. Mega, a Texas-based insurer, is withdrawing from the Maine market and has notified about 7,000 Maine residents that they will need to seek new coverage for 2015.

Average premiums will drop slightly or remain constant for the upcoming year. MCHO, which won a large percentage of 2014 enrollees, plans to keep its rates flat for 2015. Anthem’s rates will drop an average of 1.1 percent.

Estimate what you’ll pay in 2015

A 2015 rate calculator, which includes data for plans available both on and off the marketplace, is available on the Bureau of Insurance website.

A review of 16 major markets — including Portland, Maine — by the Kaiser Family Foundation shows that premiums for the second-lowest cost silver plan for individuals will decrease by 0.8 percent on average. In the Portland area, Kaiser estimates a 4.4 percent drop. The second-lowest-cost silver plan is important because it serves as the guide in establishing the dollar amount of the federal tax credit an individual is eligible to receive.

Estimate what you’ll pay in 2015

A 2015 rate calculator, which includes data for plans available both on and off the marketplace, is available on the Bureau of Insurance website.

A review of 16 major markets — including Portland, Maine — by the Kaiser Family Foundation shows that premiums for the second-lowest cost silver plan for individuals will decrease by 0.8 percent on average. In the Portland area, Kaiser estimates a 4.4 percent drop. The second-lowest-cost silver plan is important because it serves as the guide in establishing the dollar amount of the federal tax credit an individual is eligible to receive.

Consumer advocates are cautioning those who purchased policies in 2014 NOT to use the auto-renewal option. Policies that were the lowest cost or a good fit in 2014 may not be the best option for the same person in 2015. Experts encourage consumers to go back to the exchange to evaluate the options for the upcoming year or to get help from a navigator.

Uninsured rate dropped after 2014 open enrollment

According to a Gallup survey, Maine’s uninsured rate dropped 2.8 percentage points over the course of the 2014 open enrollment and stands at 13.3 percent as of midyear. More than 44,250 Maine residents enrolled in qualified health plans (QHPs) during the 2014 open enrollment period. In addition to QHP enrollment, 7,103 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP). Ninety percent of those selecting a QHP qualified for subsidies to help pay the cost of their premiums, compared to 85 percent nationally.

History of the Maine marketplace

Maine’s health insurance marketplace is operated by the federal government. Gov. Paul LePage announced the state’s decision against a state-run model in November 2012. In a letter to then Health and Human Services (HHS) Secretary Kathleen Sebelius, LePage said the Affordable Care Act has “severe legal problems” and state-run exchanges will be “actually controlled” by the federal government. LePage’s administration did explore creating a state-run exchange. The governor appointed an advisory committee, and in September 2011 that committee recommended that Maine implement a state-run exchange. The committee also issued recommendations as to how the exchange should be structured and governed. However, Maine ultimately joined the Supreme Court case that attempted to overturn the Affordable Care Act, and the state legislature failed to pass exchange legislation in both 2011 and 2012.

Democrats in the Maine Legislature pushed for Medicaid expansion during the 2014 session, but could not overcome Gov. LePage’s ongoing opposition on the issue. LePage has vetoed five Medicaid expansion bills.

LePage has not only rejected Medicaid expansion, he’s also led efforts to tighten eligibility criteria. That move resulted about 14,500 adults with dependent children and about 10,000 childless adults to lose Medicaid coverage at the end of 2013. As of January 2014, Medicaid eligibility for non-disabled Maine adults is limited to parents with incomes below 105% of poverty, or about $24,700 a year for a family of four.

The fall elections offer hope for a turnaround on Medicaid expansion. The issue is a factor in this fall’s three-way governor’s race, and LePage is considered vulnerable in his re-election bid.

Uninsured rate dropped after 2014 open enrollment

According to a Gallup survey, Maine’s uninsured rate dropped 2.8 percentage points over the course of the 2014 open enrollment and stands at 13.3 percent as of midyear. More than 44,250 Maine residents enrolled in qualified health plans (QHPs) during the 2014 open enrollment period. In addition to QHP enrollment, 7,103 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP). Ninety percent of those selecting a QHP qualified for subsidies to help pay the cost of their premiums, compared to 85 percent nationally.

Consumer advocates are cautioning those who purchased policies in 2014 NOT to use the auto-renewal option. Policies that were the lowest cost or a good fit in 2014 may not be the best option for the same person in 2015. Experts encourage consumers to go back to the exchange to evaluate the options for the upcoming year or to get help from a navigator.

History of the Maine marketplace

Maine’s health insurance marketplace is operated by the federal government. Gov. Paul LePage announced the state’s decision against a state-run model in November 2012. In a letter to then Health and Human Services (HHS) Secretary Kathleen Sebelius, LePage said the Affordable Care Act has “severe legal problems” and state-run exchanges will be “actually controlled” by the federal government. LePage’s administration did explore creating a state-run exchange. The governor appointed an advisory committee, and in September 2011 that committee recommended that Maine implement a state-run exchange. The committee also issued recommendations as to how the exchange should be structured and governed. However, Maine ultimately joined the Supreme Court case that attempted to overturn the Affordable Care Act, and the state legislature failed to pass exchange legislation in both 2011 and 2012.

Democrats in the Maine Legislature pushed for Medicaid expansion during the 2014 session, but could not overcome Gov. LePage’s ongoing opposition on the issue. LePage has vetoed five Medicaid expansion bills.

LePage has not only rejected Medicaid expansion, he’s also led efforts to tighten eligibility criteria. That move resulted about 14,500 adults with dependent children and about 10,000 childless adults to lose Medicaid coverage at the end of 2013. As of January 2014, Medicaid eligibility for non-disabled Maine adults is limited to parents with incomes below 105% of poverty, or about $24,700 a year for a family of four.

The fall elections offer hope for a turnaround on Medicaid expansion. The issue is a factor in this fall’s three-way governor’s race, and LePage is considered vulnerable in his re-election bid.

Maine health insurance exchange links

HealthCare.gov
800-318-2596

Enroll207

State Exchange Profile: Maine
The Henry J. Kaiser Family Foundation overview of Maine’s progress toward creating a state health insurance exchange.

Maine Quality Forum

 Maine Bureau of Insurance – Federal Health Care Reform