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Posted by on Aug 21, 2013 in Maine | 0 comments

Maine’s Health Insurance Marketplace


Where do I go to compare my health insurance options and purchase coverage?

Maine received approval to perform plan management functions, even though the state has a federally facilitated exchange and consumers will use the website to compare plans and enroll in coverage. The Maine Bureau of Insurance (BOI) will license carriers, review rates, and verify carrier compliance with exchange eligibility requirements, state law mandates, and essential health benefits. The BOI has approved rates, but the Centers for Medicare and Medicaid (CMS) must also approve the rates before they can be implemented.

Will there be many options for health insurance on the exchange?

In Maine, only two insurers, Maine Community Health Options and Anthem Blue Cross Blue Shield, will be offering individual and small group health insurance plans on the health insurance marketplace.

What health coverage options will be available for Maine consumers through the online marketplace?

Maine Community Health Options is the state’s new CO-OP. The CO-OP is developing a statewide network of providers and currently has partnerships with Maine Cost Memorial Hospital, Central Maine Health Care, Millinocket Regional Hospital, and York Hospital. Full Access PPO products with names like Community Advantage, Community Choice, and Community Preferred will be available at the gold, silver, bronze metal levels, as well as the catastrophic level for qualifying individuals.

Anthem Blue Cross Blue Shield

Guided Access regional products will be available at the gold, silver, bronze metal levels, as well as the catastrophic level for qualifying individuals. Anthem’s Guided Access HMO product will be available in southern Maine to Androscoggin, Cumberland, Franklin, Kennebec, Know, Lincoln, Oxford, Sagadahoc, Waldo, and York counties. Anthem has collaborated with MaineHealth to form a narrow network: Anthem-MaineHealth. Anthem’s Guided Access POS product will be available in northern Maine to Aroostook, Hancock, Penobscot, Piscataquis, Somerset, and Washington counties. Consumers can expect the network associated with the POS product to look similar to the current broad POS network.

Will premiums be the same statewide?

The state of Maine is broken up into groups of counties to form four Geographic Rating Areas, which are used to determine health insurance premiums. Some areas have higher health costs than others; this means someone may experience higher health insurance premiums in one rating area than they would in another area within the same state. Here are the four rating areas for Maine:

1 Cumberland, Sagadahoc, York
2 Know, Oxford, Kennebec, Lincoln
3 Androscoggin, Franklin, Waldo, Penobscot, Piscataquis, Somerset
4 Hancock, Aroostook, Washington

New information is being released every day. Follow this blog to receive updates as new information is released in Maine.

Jillian Carlile
Research Analyst & Health Exchange know-it-all

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