AUGUSTA, Maine — State insurance regulators have released a comparison of two dozen health plans that some Maine consumers can expect to buy this fall under the Affordable Care Act.
The side-by-side summary, released late Saturday night by the Maine Bureau of Insurance, gives consumers a first look at how the costs and benefits for the various plans compare. It details plans likely to be sold on Maine’s federally run health insurance exchange, an online marketplace in which consumers and small businesses will be able to shop for coverage under the health reform law.
The plans must now be approved by the federal government before enrollment begins Oct. 1. If approved, the plans will take effect on Jan. 1, 2014.
Last Wednesday, the state insurance bureau approved the rates and submitted hundreds of pages of documents to satisfy a federal deadline. Over the weekend, the bureau followed up with a more consumer-friendly summary of the filings.
While older Mainers and those living in rural areas will pay proportionally more for health coverage, as they do now, the new plans proposed by two carriers will offer a wide range of premiums and cost-sharing options.
“There are going to be real choices for people … It’s really going to take some thinking about what your priorities are and what your unique situation is,” said Mitchell Stein, policy director for the Augusta-based advocacy group Consumers for Affordable Health Care.
The new summary reflects individual plans, or policies for consumers who buy their own insurance, rather than get coverage through an employer. The bureau will soon release a corresponding summary of plans available to small businesses, the other group eligible to shop on the exchange.
Individual plans in Maine often carry steep deductibles — some topping $10,000 — but the new plans have a maximum deductible of $6,350, the limit for out-of-pocket costs under the health reform law. Stein highlighted that as a benefit for consumers, while Joel Allumbaugh, an insurance broker and health policy expert at the conservative Maine Heritage Policy Center, has said it will force insurers to charge much higher premiums.
Basic monthly premiums for the new plans range from about $100 for a bare bones “catastrophic” plan to about $1,450 for a more comprehensive plan with fewer out-of-pocket costs, according to the summary.
The “base rates,” however, reflect only a starting point for how much consumers will actually pay. In practice, rates could be higher or lower depending on each consumer’s age, where they live, whether they smoke, and which plan they select. Many consumers, even some middle-class families, also will get federal subsidies to help offset the costs of their coverage, so they’ll pay less in premiums.
For the most part, people who have health insurance through their employer and those covered by public insurance such as Medicaid and Medicare — groups that make up the majority of Maine’s population — won’t be shopping for insurance on the exchanges.
The Maine Bureau of Insurance estimates that about 5-8 percent of Maine’s population will shop on the exchanges. That includes the uninsured, individuals who buy their own coverage and small businesses.
Some may choose not to use the exchange and instead remain uninsured or buy a plan directly from a carrier outside of the insurance marketplace.
The two carriers selling policies on Maine’s exchange are Anthem, which has partnered with the MaineHealth system, and the nonprofit Maine Community Health Options, a new player in Maine’s insurance marketplace.
In Maine and the rest of the country, the exchange plans differ little in which benefits they cover but vary on the proportion of costs that consumers must kick in.
By federal law, the plans must cover a wider range of benefits than most individual plans today, including items seldom covered now, such as prescription drugs and maternity care.
Insurers are offering four types of plans, ranging from the cheapest “bronze” plans to silver, gold and platinum plans. Premiums vary among those four types, with platinum and gold plans generally costing more than bronze plans but saddling consumers with fewer out-of-pocket costs.
In Maine, neither Anthem nor Maine Community Health Options is offering a platinum plan.
The consumer-run Maine Community Health Options, based in Lewiston, will its plans statewide. Consumers who buy an Anthem individual policy will have access to one of two types of plans, depending on where they live. Anthem has proposed a “point of service” plan for northern Maine that includes all hospitals in the region and an HMO plan for southern Maine that excludes some hospitals and covers only in-network care.
While Anthem has been criticized for leaving some hospitals out of the network for its HMO plan, the trade off is that the base rate for the bronze version of that plan is quite low at just under $200 monthly, Stein said. That beats Anthem’s other plan, with a base rate of $266, and the rate of $214 for the comparable Maine Community Health Options plan, which allows consumers to visit a wider range of providers.
Consumers interested in those plans will have to weigh the cost of the monthly premium against the freedom to see the providers of their choice, Stein said.
Insurers selling policies in Maine already vary their prices depending on where consumers live, with rural residents generally paying more than those in urban areas. But changes under the Affordable Care Act will moderate that some, he said.
“The very most expensive geographic areas will be not quite as expensive and the very cheapest geographic areas will be not quite as cheap,” Stein said.
Another difference is Maine Community Health Options will take the unusual step of charging smokers and nonsmokers the same rates. Anthem will charge smokers 30 percent more.
To pick one of many examples from the summary, a 40-year-old woman living in Portland who doesn’t smoke would pay a monthly premium, before any subsidies, of $373.72 for a gold plan from Maine Community Health Options. She’d pay $376.74 for the comparable Anthem plan. If she smoked, the MCHO plan would cost her the same while the Anthem plan would jump to $489.76.
If she lived in Machias, she’d pay $495.50 for the MCHO plan and $525.69 for the Anthem plan as a nonsmoker.
That’s just the premiums she’d face. The benefits also vary, including deductibles, co-insurance and expenses for emergency room and office visits.
Both Anthem and Maine Community Health Options also will offer “catastrophic” plans available only to residents under age 30 and people facing financial hardship who are exempted from the law’s mandate to buy coverage. Catastrophic plans have the cheapest premiums but don’t qualify for federal subsidies.
The new summary of Maine’s exchange plans came as U.S. Health and Human Services Secretary Kathleen Sebelius criticized some states for forecasting that health insurance costs will skyrocket under the Affordable Care Act, often called Obamacare. Sebelius, President Barack Obama’s top health care adviser, did not name the states, but labeled the forecasts as “factually incorrect” and vowed that the administration would set the record straight in September.
Maine appears not to be among the states in Sebelius’ sights. The insurance bureau hasn’t released a comparison of rates from before Obamacare to now or announced whether rates in general will rise or fall.
Comparing existing individual health plans to the new plans is problematic. Most existing plans limit coverage in ways the new plans can’t under Obamacare, or require consumers to pick up more of the cost.