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Maine health insurance marketplace 2022 guide
Maine's new state-run exchange platform, CoverME, is now in use; enrollment grew by more than 10% for 2022
Maine exchange overview
Maine transitioned to a fully state-run exchange in the fall of 2021, so residents no longer use HealthCare.gov. Maine debuted standardized health plans in the fall of 2021 and the overall average rate change for 2022 amounted to a decrease of more than 2%.
Enrollment grew by more than 10% for 2022, and is higher than it’s been since 2019.
Frequently asked questions about Maine's ACA marketplace
Maine residents no longer use HealthCare.gov to enroll in individual/family health coverage. The state-run exchange, CoverME, is now the platform that residents use instead. More than 66,000 Maine residents enrolled in coverage through Maine’s exchange during the open enrollment period for 2022 coverage, which was an increase of more than 10% over the year before.
Maine is one of three states that transitioned away from HealthCare.gov in the fall of 2021 in order to operate their own state-run exchanges. Maine residents who already had coverage through HealthCare.gov had an account waiting for them on CoverME and were able to claim it in the fall of 2021 and then complete the process of selecting or renewing a plan for 2022.
Starting in the fall of 2020, Maine took on more oversight of the exchange, with a transition to a state-based exchange using the federal enrollment platform (ie, the state still used HealthCare.gov). But Maine transitioned to a fully state-run exchange as of the 2022 plan year. CMS granted conditional approval for the fully state-run exchange in September 2021.
The state is also working on a variety of other reforms, including a merged risk pool for individual and small group plans, and standardized health plans. Legislation to get the ball rolling on the state-run exchange and merged risk pool was enacted in Maine in March 2020.
Maine has one of the few remaining ACA-created CO-OPs (Community Health Options, or CHO), which is one of only three CO-OPs (nationwide) offering coverage as of 2022.
The open enrollment period for 2022 coverage ran from November 1, 2021 to January 15, 2022. Outside of open enrollment, a special enrollment period is necessary in order to enroll or make changes to your coverage. In most cases, a qualifying event is necessary in order to trigger a special enrollment period, but there are some special enrollment periods that don’t rely on a specific life event. Learn more in our comprehensive guide to special enrollment periods.
Three insurers offer exchange plans in Maine:
- Community Health Options
- Harvard Pilgrim HMOs
All three of the insurance companies have statewide service areas, so Maine’s exchange enrollees can all select from among plans offered by three insurers.
In 2019, there are three insurers offering plans in Maine’s exchange: Community Health Options, Harvard Pilgrim, and Anthem. But as has been the case in most states, insurer participation in Maine’s exchange has fluctuated over the years.
In 2014, Community Health Options and Anthem offered plans in Maine’s exchange. Community Health Options was a brand new plan at that point (a CO-OP created under the ACA), and yet it garnered 83% of Maine’s exchange market share in 2014.
In 2015, Harvard Pilgrim joined Community Health Options and Anthem, so there were three participating insurers in the Maine exchange.
In 2016, coverage was initially available from all three insurers, but Community Health Options stopped enrolling individual market members for 2016 in December 2015, and enrollment was frozen until 2017 enrollment began in November 2016. For the second half of open enrollment, and for all special enrollment periods throughout 2016, only Anthem and Harvard Pilgrim offered coverage. But the CO-OP still had the majority of the 2016 individual market share in Maine, despite ceasing enrollment mid-way through open enrollment for 2016.
Community Health Options once again offered plans in Maine’s exchange as of 2017, along with Anthem and Harvard Pilgrim (Aetna had planned to enter the exchange in Maine for 2017, with plans available in nine of the state’s 16 counties. But three months prior to the start of open enrollment for 2017 coverage, Aetna announced that they were abandoning their expansion plans).
On September 27, 2017, Anthem announced that they would exit the exchange in Maine at the end of 2017, and would not offer on-exchange plans in 2018. Anthem allowed existing members to switch to off-exchange plans (without subsidies) if they wanted to renew with Anthem instead of switching to a plan from another insurer. But for new 2018 enrollees, Anthem only offered one gold plan (off-exchange) in Aroostook, Hancock and Washington Counties. Anthem had about 28,000 individual market enrollees in 2017, but according to their rate filing, they expected that to decrease to about 5,600 in 2018, all of whom would have off-exchange coverage.
Anthem’s announcement was not surprising to anyone who had read their 2018 rate filings, as the insurer clearly stated that their plan was to exit the exchange if cost-sharing reduction (CSR) funding did not continue. The filing described exactly what Anthem ultimately did, including the switch to a gold-level off-exchange plan in Rating Area 4 (Aroostook, Hancock and Washington Counties).
The Maine Bureau of Insurance had asked the state’s three insurers to provide backup filings to be used if CSR funding wasn’t committed for 2018. Harvard Pilgrim and Community Health Options proposed higher rates (details below), but Anthem said that their backup plan was to exit the exchange.
So for 2018, only Harvard Pilgrim and Community Health Options offered plans in Maine’s exchange.
But Anthem confirmed in 2018 that they would return to the exchange in 2019 if the then-proposed reinsurance program was finalized, and it was. So Anthem rejoined the exchange in 2019. All three insurers have continued to offer plans in the exchange for 2020, 2021, and 2022.
- Anthem: Average rate decrease of 3%
- Harvard Pilgrim: Average rate increase of 1.1%
- Maine Community Health Options: Average rate decrease of 5.4%
For perspective, here’s a summary of how premiums have changed in Maine’s exchange in prior years:
- 2015: Average premiums were the same or slightly lower than 2014 rates. Maine Community Health Options, which won a large percentage of 2014 enrollees, kept its rates flat for 2015. Anthem’s rates dropped an average of 1.1%. Harvard Pilgrim was new to the exchange for 2015, so had no applicable rate increase.
- 2016: Average rate increase of about 0.7%. For Community Health Options, rate changes ranged from an average 1.73% decrease to a 0.54% increase (note that Community Health Options plans for 2016 were no longer for sale in the individual market after December 26, 2015, and in hindsight, the rates that were approved for 2016 were too low). Anthem BCBS, which had most of the remaining market share, had average rate changes that ranged from a 1.1% decrease to a 5.49% increase. Harvard Pilgrim’s average rates decreased slightly for 2016.
- 2017: Average rate increase of 23.5%. As was the case in most of the country, rate increases were much more significant for 2017 than they had been in the prior two years. Anthem increased their average rates by 18%, Community Health Options (which had the bulk of the exchange market share) increased their average rate by 25.5%, and Harvard Pilgrim HMOs increased their average rate by 21.1%.
- 2018: Average rate increase of about 25%. The cost of cost-sharing reductions (CSR) began to be added to on-exchange silver plan premiums as of 2018 (this has continued to be the case). Regulators in Maine initially approved rate increases that were based on the assumption that the federal government would continue to reimburse insurers for the cost of CSR. But in October 2017, just two weeks before the start of open enrollment for 2018 coverage, the Trump administration announced that the federal government would no longer fund CSR (but insurers were still obligated to provide CSR to eligible enrollees). Anthem left the exchange at the end of 2017 due to the lack of federal funding for CSR. Community Health Options and Harvard Pilgrim continued to offer plans, but they both added a substantial additional premium increase to silver plans to account for the cost of CSR.
- 2019: Average increase of 1%. Because Maine’s reinsurance program was approved and implemented, Anthem rejoined the exchange as of 2019. The Maine Bureau of Insurance had insurers file two sets of rates for 2019: One based on the assumption that the reinsurance program would be implemented, and the other based on the assumption that it wouldn’t. The rate filings are available via SERFF, and the Bureau of Insurance included the SERFF filing number for each insurer. The Maine Bureau of Insurance posted an overview of the state’s new reinsurance program. At ACA Signups, Charles Gaba calculated a weighted average rate increase of 1% for Maine’s individual market for 2019. It’s noteworthy that Community Health Options’ rate filing indicated that 5 percentage points of their rate increase were due to the repeal of the individual mandate penalty after the end of 2018, and another 5 percentage points were due to the Trump administration’s new rules expanding access to short-term plans and association health plans. So without those changes, CHO would have implemented a significant rate decrease instead of a slight rate increase.
- 2020: Average rate decrease of about 1.6%. Maine regulators approved average rate decreases for Anthem and Harvard Pilgrim, and a slight increase for CHO. Initially, all three insurers had proposed modest rate increases, but they revised their filings in July 2019, with Anthem and Harvard Pilgrim proposing rate decreases instead, which were approved by state regulators.
- 2021: Average rate decrease of about 13%. Rates for Maine’s three individual market insurers were approved by the Bureau of Insurance in late August, with an overall average rate decrease of 13.1%. Without Maine’s reinsurance program, premiums would have increased by 5% to 15%. Although rates were fairly stable nationwide for 2021, with small average decreases in many areas, Maine’s overall average decrease was much more significant than we saw in most states. But Maine’s rate decreases in the first two years its reinsurance program was in effect (2019 and 2020) were much less significant than the initial rate decreases we’ve seen in many of the other states that have implemented reinsurance programs. So it could just be that the reinsurance program had a delayed impact in Maine, with the major rate decrease coming a few years in, as opposed to right out of the gates.
During the open enrollment period for 2022 coverage, 66,095 people enrolled in plans through Maine’s exchange, using the new CoverME enrollment platform. That was an increase of more than 10% from the year before, when 59,738 people enrolled
Enrollment is still lower than it was in 2018/2019, but that’s Maine expanded Medicaid in early 2019, so enrollment in private individual market plans was expected to decline. People with income between 100% and 138% of the poverty level are eligible for premium subsidies to purchase private plans in the exchange if the state has not expanded Medicaid, whereas they’re eligible for Medicaid instead once the program is expanded.
According to the initial actuarial analysis of Maine’s 1332 waiver for reinsurance, the number of people insured in Maine’s individual market was projected to decrease by about 19% in 2019, due to the expansion of Medicaid that voters approved in the 2017 election. But Medicaid expansion didn’t officially happen until after open enrollment for 2019 individual market coverage ended.
Maine residents were able to start enrolling in expanded Medicaid in early 2019, and more than 13,000 people had done so by March 2019 — but that had increased to nearly 85,000 by late 2021, due in part to the impact of the COVID pandemic. Some of those new Medicaid enrollees likely had income between 100% and 138% of the federal poverty level and enrolled in QHPs through the exchange during open enrollment in the fall of 2018, but subsequently switched to Medicaid.
Here’s a summary of Maine’s QHP enrollment over the years since the exchange opened for business in the fall of 2013 (all numbers are based on plans purchased during open enrollment; attrition throughout the year means that effectuated enrollment declines throughout the year):
- 44,258 people enrolled for 2014.
- 74,805 people enrolled for 2015.
- 84,059 people enrolled for 2016. Like many other states, 2016’s enrollment was the highest that Maine’s exchange has had to date.
- 79,407 people enrolled for 2017. As was the case in many states, enrollment declined for 2017 due to a variety of factors, including sharply higher premiums for people who didn’t receive premium subsidies and the nascent Trump Administration’s decision to cut advertising funding for the exchange in the final days of open enrollment (President Trump took office January 20, 2017, and open enrollment ended that year on January 31, 2017).
- 75,809 people enrolled for 2018. Average enrollment once again declined nationwide (particularly in states that use HealthCare.gov) for 2018. Premiums grew significantly for people who don’t get premium subsidies, and there was considerable uncertainty about the status of the individual mandate penalty and the ACA itself (after months of GOP-led repeal efforts in 2017). In addition, the Trump administration sharply reduced funding for exchange marketing and enrollment assistance just before the start of open enrollment for 2018 coverage.
- 70,987 people enrolled in private plans for 2019.
- 62,031 people enrolled in private plans for 2020. The sharp drop-off in enrollment was expected, given that Medicaid was expanded in Maine in 2019.
- 59,738 people enrolled in private plans for 2021. Continued transitions to Medicaid, coupled with the COVID-related provision that ensures that people do not lose their Medicaid coverage until after the COVID pandemic emergency period ends, have resulted in a further decrease in private plan enrollment.
- 66,095 people enrolled in private plans for 2022. Medicaid enrollment has continued to increase in Maine: As of mid-2020, there were about 55,000 people enrolled under Maine’s Medicaid expansion guidelines, and that had grown to more than 89,000 as of January 2022.
Yes. As of 2022, Maine offers a 60-day special enrollment period due to pregnancy (note that this is not an opportunity to switch from one plan to another; it only applies to people who are not already enrolled in a health plan through CoverME).
There are only a handful of other states that offer a special enrollment period due to pregnancy. The birth of a baby is always a qualifying event that creates a special enrollment period. In most states, however, pregnancy itself is not a qualifying event (although a person who is pregnant will qualify for Medicaid at higher income levels and will count as two people for the purpose of Medicaid eligibility determination, making that coverage more available during pregnancy).
Maine lawmakers have been working to create an “easy enrollment” program, although it is not yet in effect. The idea was pioneered by Maryland, which debuted a system in 2020 that lets uninsured residents check a box on the state tax return, allowing their relevant data to be shared with the state’s health insurance exchange. If the person is determined to be eligible for Medicaid, CHIP, or subsidized health insurance in the exchange, they are notified and provided with enrollment assistance (including a special enrollment period if they’re eligible for exchange coverage, since open enrollment ends before the tax filing season begins). Several other states have since created their own easy enrollment systems, or are considering doing so.
Maine’s legislation is LD1390, which passed both chambers of the state legislature in 2021, but was then carried over to the 2022 session. If enacted, it would create an easy enrollment system that would utilize Maine’s state tax return to facilitate enrollment in Maine Care (Medicaid) and qualified health plans through CoverME. For people who are eligible for a plan through CoverME, the legislation calls for a special enrollment period that would begin the date the tax return is filed and end 35 days after the marketplace notifies the person of their eligibility to enroll.
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In August 2019, Maine Governor Janet Mills notified CMS that her administration intended to transition Maine to a state-based marketplace using the federal platform (SBM-FP) as of the fall of 2020, for enrollment in 2021 coverage (as of 2021, Maine had one of six SBM-FPs).
The letter of intent that Mills sent to CMS indicated that the state would also consider switching to a fully state-run exchange at a later date, and filing instructions provided to insurers in April 2021 confirmed that the state-run marketplace would be in place for the 2022 plan year. CMS granted conditional approval for the fully state-run exchange (CoverME) in September 2021, and it has been in use since November 1, 2021.
Maine has also modified its reinsurance program model. The reinsurance program was previously fairly unique, in that it included a prospective reinsurance model based on specific medical conditions rather than just total claims costs. When an individual market enrollee had one of the conditions covered under the reinsurance program, the carrier ceded the coverage to MGARA (Maine’s reinsurance program), paid MGARA a premium, and MGARA covered the claims.
MGARA also provided retrospective reinsurance for high claims, but under Maine’s new approach, the state has transitioned to only the retrospective reinsurance model that’s used in most of the other states that have reinsurance programs (ie, the reinsurance program will step in if and when an enrollee’s claims reach a certain point, regardless of the specific medical condition). This was a change that could be done administratively by the state, so it did not require an amendment to the existing 1332 waiver. Maine opted to move ahead with this change as of 2022.
Maine also plans to merge its individual and small group markets, and extend MGARA to cover the small group market as well as the individual market. The state had planned to make that change in 2022 as well, but has opted to delay it until 2023. The delay is due to the impacts of the COVID pandemic as well as the American Rescue Plan’s additional premium subsidies; the state needs additional time to sort out how they will affect the merged market and the amount of federal pass-through funding available via the 1332 waiver. But the modification of the reinsurance program to cover a merged individual and small group market will require an amendment to the state’s existing 1332 waiver. Details about that process will be available on the state’s website and the federal 1332 waiver website.
The state-run exchange and merged individual/small group market stem from legislation (LD2007) that was signed into law in March 2020. The new law is comprehensive and far-reaching, calling for a variety of health care reforms in the state. It includes the following provisions:
- The creation of a state-run health insurance in Maine. Officials have noted that a state-run exchange will allow the state to customize its outreach to uninsured residents, better communicate with insurers and enrollment assisters, and give the state better access to exchange data. As noted above, Maine has its own exchange as of November 1, 2021.
- As of 2021, state-regulated health plans have to fully cover a member’s first primary care visit and behavioral health care visit each year. The 2nd and 3rd primary care and behavioral health visits have to be covered with only a copay (no deductible or coinsurance). There is an exception for HSA-qualified high-deductible health plans, in order to comply with IRS rules that prohibit those plans from covering anything other than preventive care before the minimum deductible is met.
- The state’s existing reinsurance programs (MGARA, which took effect in 2019) will be extended and expanded so that it will cover the small group market as well as the individual market, assuming the federal government approves this change (the draft 1332 waiver to address this is here; Maine’s overall progress on this process can be seen here).
- By 2023, insurers in Maine will merge their individual and small group plans into a combined risk pool (Massachusetts currently does this; Vermont did prior to 2022; DC has a modified version of a merged risk pool; in the rest of the states, individual and small group plans are in separate risk pools). This was originally slated for 2022, but has been delayed until 2023 so that regulators can get a better idea of the impact of the COVID pandemic and the American Rescue Plan’s subsidies, and how they might affect premiums, reinsurance costs, and federal pass-through funding.
- There’s a clause in the legislation noting that this provision would only be implemented if the state’s individual market reinsurance program (MGARA) is extended and expanded to include the entire pooled market (this would require federal approval, which Maine is seeking), and that projections determine “that average premium rates would be the same or lower than they would have been absent the provisions of this section.” An initial actuarial analysis was conducted in the summer of 2020, with the results published in late August. The analysis projects that individual market premiums would increase slightly while small-group premiums would decrease slightly (note that this is not what we would typically expect to see in a merged market scenario, but Maine’s reinsurance program changes the numbers quite a bit: It’s already stabilizing the individual market, and would have a stabilizing effect on the small group market if they’re merged and the reinsurance program applies to both markets; in addition, Maine’s small group market has seen declining enrollment and increasing premiums in recent years, so regulators hope the merged market will help to stabilize the small group market in the state). A second actuarial analysis was published in late 2021, indicating that both individual and small group premiums are expected to be lower with the merged risk pool in place.
- The creation of standardized plan designs (dubbed “clear choice designs”) designed to make it easier for consumers to compare health plans from different insurers. The Clear Choice plans are available as of the 2022 plan year in the individual market, but delayed until 2023 in the small group market. Maine’s Bureau of Insurance held several public meetings about the Clear Choice plans. In late 2020, the state published an outline of the regulatory specifics that apply to Clear Choice plans and the other alternative plans that insurers are allowed to offer.
Approved 1332 waiver implemented reinsurance and reactivated MGARA
In 2011, Maine implemented the Maine Guaranteed Access Reinsurance Association (MGARA) to provide reinsurance coverage for the individual market. The program was funded by reinsurance premiums paid by insurers, as well as a $4 per member per month assessment on all health insurance plans in the state (except state and federal employee benefits plans).
MGARA helped to stabilize Maine’s individual market starting in 2012, and kept premiums lower than they would otherwise have been. The program was suspended at the end of 2013, to make way for the ACA’s reinsurance program that took effect in 2014. But the ACA’s reinsurance was temporary, and only lasted for three years, through the end of 2016.
Now that the federal reinsurance program has ended, more than a dozen states have implemented their own reinsurance programs, using 1332 waivers to receive federal funding. The idea is that reinsurance results in lower premiums across the board, which means premium subsidies are also lower.
That reduces the amount that the federal government has to spend on premium subsidies in the state, and the 1332 waiver allows the federal savings to be passed on to the state, in order to fund the reinsurance program. The result is lower premiums and more people insured, since coverage becomes more affordable for people who aren’t eligible for premium subsidies and have to pay full price.
In 2017, Maine enacted LD659, which reauthorizes MGARA, but on the condition that the state had to submit and receive federal approval for a 1332 waiver that provides federal pass-through funding for the state’s reinsurance program.
In March 2018, the state published an actuarial analysis of the proposed 1332 waiver, and accepted public comments on the proposal until May 2, with two public informational meetings in April. Following the public comment period, Maine submitted a 1332 waiver proposal to CMS on May 9. CMS determined on June 8 that the application was complete, and opened a public comment period from June 8 to July 8. Federal approval was granted on July 30.
The state re-activated MGARA as of January 2019, providing reinsurance in the individual market (on and off-exchange), using federal pass-through funding in addition to re-activating the $4 per member per month assessment on all health insurance plans in the state. For 2019, federal pass-through funding for Maine’s reinsurance program was initially estimated at $65 million, but was subsequently revised slightly lower, to $62.3 million. The change was primarily due to Maine’s Medicaid expansion, which took effect in early 2019 and switched low-income residents with income between 100 and 138% of the poverty level from subsidized private plans to expanded Medicaid (in other words, the federal government no longer has to fund premium subsidies for those individuals, so the state doesn’t get pass-through funding to account for the smaller subsidies that those individuals would have received if they hadn’t transitioned to Medicaid).
Insurers filed two sets of rates for 2018, since rate filings were due before they knew whether the 1332 waiver would be approved. With reinsurance, the average proposed rate increase was 6.17%, and without reinsurance, it would have been 9.58%. The actuarial analysis of the waiver proposal notes, however, that despite the lower premiums with MGARA in effect, the rate of premium increases in Maine’s individual market over the next decade is still expected to outpace inflation.
Under Maine’s new reinsurance program, which has received approval for federal pass-through funding through 2023, MGARA covers 90% of claims that are between $47,000 and $77,000, and it will pay 100% of claims that range from $77,000 up to $1 million (this is considerably more generous than the reinsurance programs in some other states; Wisconsin, for example, has a reinsurance program that pays 50% of claims that are between $50,000 and $250,000).
Maine’s program initially also included a condition trigger; when an enrollee has claims associated with one of eight high-cost medical conditions (uterine cancer; metastatic cancer; prostate cancer; chronic obstructive pulmonary disease (COPD); congestive heart failure; HIV infection; renal failure; and Rheumatoid Arthritis), their claims would be ceded to MGARA (the insurer gives 90% of the enrollee’s premiums to MGARA, and MGARA then pays a portion of the claims for that enrollee). But as described above, has eliminated this prospective model of having insurers cede coverage to MGARA when enrollees have specific conditions. Instead, as of 2022, the state has switched to a purely retrospective reinsurance model, based only on claims costs.
Adding the cost of CSR to silver plans means premium subsidies are much larger than they were in 2017 — but they dropped a little in 2019 with Anthem's return to the exchange
Because Maine’s insurers have added the cost of CSR to their silver plan premiums (as have most insurers across the country), premium subsidies are much larger than they would otherwise have been. The larger subsidies keep the after-subsidy cost of the benchmark silver plan roughly consistent with 2017 (since that’s the whole point of premium subsidies), but it makes bronze and gold plans more affordable than they were in 2017 for people who are eligible for premium subsidies.
As an example, a 50-year-old in Portland who earns $35,000 in 2019 can get a 2019 bronze plan for as little as $68/month after premium subsidies (and the subsidy is $400/month for this individual; not that subsidies vary based on income and the cost of the benchmark plan for each applicant).
In 2017, a 50-year-old in Portland earning $35,000 would have had to pay $214/month for the lowest-cost bronze plan after premium subsidies, because the subsidy would have been just $119/month.
But it’s noteworthy that there were even more bargains to be had in 2018. A 50-year-old Portland resident earning $35,000 in 2018 could get a bronze plan for as little as $26/month, after a $445/month premium subsidy. The subsidies are smaller in 2019 — although still much larger than they were in 2017 — because Anthem rejoined the exchange and took over the benchmark spot (second-lowest-cost silver plan) with a slightly lower-cost plan. Statewide, there was a 5 percent decrease in the cost of the benchmark plan for 2019 in Maine’s exchange, which translates to smaller premium subsidies.
The fluctuation in after-subsidy premiums in 2019 is even stronger at the gold plan level. While a 50-year-old Portland resident earning $35,000 would have had to pay $461/month after subsidies to buy the cheapest gold plan in 2017, they could get the cheapest gold plan for $351/month in 2018. But in 2019, it would be $413/month, due to premium fluctuations and the smaller premium subsidies in 2019.
CO-OP is one of only three still operational nationwide
Maine is one of 23 states where a CO-OP health plan was established under the ACA. Most did not survive; the CO-OP in Maine (Community Health Options, or CHO) is one of just three that are still operational in a total of five states as of 2022.
CHO has participated in Maine’s exchange from the get-go. In 2014, one other carrier — Anthem — competed with the CO-OP for individual enrollments on the Maine exchange, and the CO-OP garnered about 83% of the enrollments. In 2015, Harvard Pilgrim joined the exchange, but even with two competitors, Community Health Options still got about 80% of the 2015 enrollments.
But CHO’s tremendous growth also resulted in substantial losses. According to news reports, Community Health Options lost more than $17 million in the first three quarters of 2015, after making almost $11 million in the first three quarters of 2014. And the losses spiked in the final quarter of 2015; total losses for the year reached $74 million, although only $31 million of that was real losses from 2015; the other $43 million was money that the CO-OP set aside as a “premium deficiency reserve” to cover anticipated losses in 2016.
The Maine Bureau of Insurance stepped in as soon as the losses through the third quarter of 2015 were known. By then it was clear that the CO-OP’s 2015 premiums had been set too low, as were the 2016 premiums (which were only an average of 0.5% higher than 2015’s rates). But there was nothing that could be done to raise them at that point, since the rates were already locked in until the end of 2016.
The BOI asked the CO-OP to stop selling the underpriced plans for 2016 as soon as possible, but December 26th was the soonest CMS could remove Community Health Options’ products from Healthcare.gov (the CO-OP only accepted new individual enrollments through their own website until December 15). After December 26, Community Health Options ceased all new individual enrollments for 2016. They continued to enroll groups for 2016 though.
(Community Health Options expanded to New Hampshire in 2015, and the CO-OP ceased new individual plan enrollments in New Hampshire on the same schedule they used in Maine; for 2017, they pulled out of New Hampshire altogether). The CO-OP still had the majority of the 2016 individual market share in Maine, despite ceasing enrollment mid-way through open enrollment for 2016.
In February 2016, the BOI proposed a plan to put CHO into receivership and terminate roughly 15 to 20% of the carrier’s individual plan enrollments in order to stem the losses that were expected for 2016. The BOI was going to work with Anthem and Harvard Pilgrim to transition the terminated members to other plans, while ensuring that they wouldn’t have to meet their out-of-pocket costs again on the new plan if they had already done so early in the year with their CHO coverage. However, the federal government rejected the BOI’s proposal, citing the fact that ACA-compliant policies must be guaranteed renewable (they can be terminated, but only if all the plans are terminated — individual enrollees cannot have their plans terminated while the same plans remain in force for other members)
Enrollment was frozen until 2017 enrollment began in November 2016. At that point, the CO-OP’s average rate increase for 2017 was 25.5%, and some plan modifications were made to reduce costs (adult vision and elective abortion coverage were removed, and out-of-network deductibles were increased). Community Health Options still had the largest segment of Maine’s individual market share in 2017, but it had dropped to 42% by that point.
Community Health Options had expanded to New Hampshire in 2015, and the CO-OP ceased new individual plan enrollments in New Hampshire on the same schedule they used in Maine; for 2017, they pulled out of New Hampshire altogether.
History of the Maine marketplace
Maine’s health insurance marketplace is operated by the federal government. Then-Gov. Paul LePage announced the state’s decision against a state-run model in November 2012. In a letter to then 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.
Under Gov. Janet Mills, however, Maine is taking a different approach. As of the fall of 2020, Maine had a state-run exchange using the HealthCare.gov platform. And as of the fall of 2021, the state was fully running the exchange, with enrollees using CoverMe instead of HealthCare.gov.
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 Bureau of Insurance
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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