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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.

Navigators in Maine reported the second open enrollment got off to a much better start than the first, and the demand for help was high as the Dec. 15 cutoff for having coverage on Jan. 1, 2015, approached.

More than 4 million people have submitted applications and more than 2,466,000 people have selected a qualified health plan (QHP) through as of Dec. 12. The federal government hasn’t released state-specific enrollment yet.

2015 rates and insurers

According to the Maine Bureau of Insurance, Maine Community Health Options (MCHO), Anthem Health Plan of Maine, and Harvard Pilgrim Health Care are offering about 40 individual polices through the exchange. These three insurers are also selling 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, withdrew from the Maine market and has notified about 7,000 Maine residents that they will need to seek new coverage for 2015.

Average premiums for 2015 are the same or slightly lower than 2014 rates. MCHO, which won a large percentage of 2014 enrollees, is keeping its rates flat for 2015. Anthem’s rates dropped 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.

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. The November election offered hope for a turnaround on Medicaid expansion, with two challengers supporting expansion and LePage was considered vulnerable. However, LePage was returned to office.

Maine health insurance exchange links


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