This guide provides an overview of the Maine Health Insurance Exchange including the history of the exchange, how the exchange will operate, and exchange information for Maine residents and small businesses.
Maine Health Insurance Exchange Introduction
Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).
Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchanges.
All states have three options for setting up a state health insurance exchange for 2014:
- Build a state-based exchange
- Enter into a state-federal partnership exchange
- Default to a federally-facilitated exchange
Maine will default to a federally-facilitated health insurance exchange, however Maine will be involved in the plan management functions and navigator program.
Maine Health Insurance Exchange - History
In November 2012, Maine Governor Paul LePage announced to federal officials that Maine would default to a federally-facilitated health insurance exchange. This came after legislation to establish a state-based health insurance exchange failed in 2011 and 2012. However, Maine will maintain control of all plan management functions including contracting with carriers, reviewing insurance plan rates and plan compliance with ACA.
Maine Health Insurance Exchange - What is It?
The Maine Health Insurance Exchange will be operated through a federally-run health insurance exchange, also referred to as the Health Insurance Marketplace. As mentioned previously, Maine will maintain control over plan management. Starting in October 2013, Maine residents will be able to access information about all the plans available through the Exchange. The SHOP Exchange will also be available to small businesses with 100 or fewer employees. Coverage from the Exchange starts in January 2014.
According to an estimate by healthcare.gov, 144,959 or 13% of Maine’s non-elderly residents are uninsured.
Maine Health Insurance Exchange - What Plans will be Available?
All plans offered through the Maine Health Insurance Exchange will meet the ACA definition of a Qualified Health Plan (QHP). The plans will be offered by level of coverage for essential health benefits (EHB), to allow consumers to compare plans on an "apples to apples" basis. The four "metal" levels are: Bronze (plan pays 60%), Silver (plan pays 70%), Gold (plan pays 80%) and Platinum (plan pays 90%).
This week, The Bangor Daily News reported that only two insurance providers had filed to offer plans through the Exchange: Maine Community Health Options, and a collaboration between Anthem Blue Cross and Blue Shield and MaineHealth. (Read article here.) The plans will go through a formal review process and plans will be finalized by the October 2013 opening.
Maine Health Insurance Exchange Navigator Program
Although Maine is defaulting to the federally-run exchange, on April 13, 2012, the Governor signed legislation restricting the Navigator program in the state (LD 1497). The program would allow brokers to act as Navigators in the exchange, but would require others who want to serve as Navigators to register or obtain a limited license, with the criteria for certification to be determined by the superintendent of insurance.