August 1, 2013

Options open for those on Maine's health care exchange

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

A 25-year-old single person living in Portland would pay about $150 per month — with help from a federal subsidy — to buy one of the plans on Maine’s new health care exchange, according to one insurance provider.

A 50-year-old single smoker living in Lewiston, meanwhile, would pay $369 per month with a subsidy.
In both cases, the policy holders would have to spend $5,000 of their own money for most health services before the insurance carrier starts paying the costs.

A full-scale analysis of newly released insurance rates available through Maine’s exchange is not yet possible because of incomplete information. However, one insurer — Maine Community Health Options co-op — released a few examples of plan costs and a benefit sheet to the Press Herald on Thursday, giving a first glimpse of the costs and coverage. 

MCHO and Anthem Blue Cross Blue Shield are the two insurance providers offering plans on the exchange. The two submitted rates to Maine that were released on Wednesday. Those rates will go before the federal government for approval.

Wednesday’s filing was for regulatory purposes and did not have information for consumers, but in the coming weeks consumers will be able to do comparison shopping for insurance on www.healthcare.gov, officials said.

Individuals — often the self-employed or others without health benefits — can start buying insurance on Oct. 1, one of the main components of the Affordable Care Act. Those who don’t buy insurance will be forced to pay a penalty. Less than 10 percent of the overall insurance market will be buying  insurance on the exchange, according to the Maine Bureau of Insurance.

How the new plans compare to existing benefits on the individual market is difficult to determine, and Kevin Lewis, CEO of Maine Community Health Options, said he didn’t even try. “It would probably take an army of actuaries to figure that out,” Lewis said.

Lewis said in many ways it’s irrelevant, because the high-deductible plans on the existing individual market are so different from the requirements of the Affordable Care Act, which goes into effect in January, that the comparisons would be meaningless.

“We just tried to offer the best product that we could at the best price, within the framework of the Affordable Care Act,” Lewis said.

An Anthem spokesman did not respond to a request for information on Thursday.

Lewis provided a few scenarios, including examples of what are known as bronze-level plans to be offered by Maine Community Health Options. The bronze plans feature lower premiums but less generous benefits than silver and gold plans offered on the exchange.

Premiums will vary depending on such factors as the policyholder’s age, whether they smoke and where in the state they live. Premiums will be higher in more rural northern areas of the state, for example.

In one other example, a family of four in Bangor with a $40,000 income would pay about $165 per month with a subsidy for a bronze plan, and would have a $10,000 deductible, according to the information about Maine Community Health Options plans. In the case of this family, the subsidy would cover most of the $865-a-month premium because of the low income.

Subsidy amounts for the family and other examples are based on the Kaiser Family Foundation website.

The subsidies will be available for those earning between 100 and 400 percent of the federal poverty line, and subsidies to reduce out-of-pocket costs for deductibles, co-pays and other costs are also available to those earning up to 250 percent of the federal poverty line.

Plans are also required to have a capped out-of-pocket cost, at $6,350 for some plans.

Trish Riley, a senior fellow with the Muskie School for Public Service at the University of Southern Maine, said that in general the plans on the current individual market offer thinner benefits and higher deductibles than what will be offered on the exchange.

“It (the Affordable Care Act) has better protection for the consumers, and better benefits,” said Riley, former director of the Governor’s Office of Health Policy and Finance under Gov. John Baldacci.

Lewis said the co-op, which was formed with a federal loan, is attempting to lower health care costs by offering services that should help reduce costly hospital visits. For instance, those with chronic illnesses like asthma, diabetes and hypertension will receive generic drugs at no cost, Lewis said.

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