Maine health insurance tips


Maine insurance law and regulation

The Maine Bureau of Insurance Web site contains a link to the page for health insurance as well as information to help consumers file a complaint about an unresolved insurance problem. The Web site has not yet developed resources to help individuals find commercial low cost health plans like mini-med or core coverage, specific illness policies, Supplemental Accident Insurance and basic health insurance.

The state insurance department can be reached by telephone at (207) 624-8475 or by mail at #34 State House Station Augusta, ME 04333-0034. The state children’s health insurance plan (CHIP) Web site is MaineCare.

News that affects your health insurance and planning

May 19, 2022 – After news surfaced that Maine’s largest hospital network, MaineHealth’s Main Medical Center in Portland, was severing ties with the state’s largest health insurance company, Anthem blue Cross Blue Shield, some legislators were alarmed. The dispute was over payments for care. Now, more than a month later, a local news report indicates that the issue will be easily resolved. It might help to know that the indemnity and supplemental health plans lined from this web site do not relay on a network contract and coverage is valid and equal anywhere. Personal assistance in talking through small business health plan strategies is available through OnlineAdviser services.

June 16, 2019 – Status of alternative non-ACA health plans: Maine does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage and permits insurers to sell non-compliant transitional policies in the individual market. Maine does not limit the sale of short-term coverage more strictly than the federal government.

June 6, 2019 – Starting in September, nurses and other qualified non-physician health professionals in Maine will be permitted to perform abortions through oral medicines and aspiration, a suction procedure under a new law. This change is endorsed as safe by independent peer reviewed research published in the American Journal of Public Health.

March 23, 2019 – A report by the Maine Public Health Institute and the National Association of Chronic Disease Directors titled “Advancing Tobacco Prevention and Control in Rural America” concludes that residents of rural Maine communities suffer a disproportionate health effect from tobacco use. Higher than average tobacco use, especially in rural areas, is the leading cause of preventable death. To make the problem even tougher for these people affected, health insurers increasingly charge much higher premiums to smokers than non-smokers.

December 15, 2018 – Kevin Lewis, president and CEO of Lewiston, Maine Community Health Options, said his organization’s data contradicts the notion that young people are dropping out of the ACA insurance market because of the elimination of the so-called individual mandate. He offers an alternate explanation to declining enrollment figures suggesting that more people are keeping their current plans that do not require re-enrollment.

The history of health care planning in Maine (Information is outdated and links may be expired)

1/1/2015 Maine insurance companies must pay for more cancer and autism treatments beginning today.  Assessment and treatment of autism spectrum disorders for children up to 10 years old are now covered. Prior law only required coverage for autistic children ages 5 and under. Cancer treatment drugs taken orally are now covered if the insurers already cover equivalent chemotherapy treatments administered intravenously.

12/6/2014 Online health insurance marketplace rates will, on average, be lower in 2015 compared to last year. In addition to the two insurance companies in the marketplace last year – Anthem and Maine Community Health Options, this year Harvard Pilgrim is also available.

2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.

7/26/2013 Affordable Smart Term Life Insurance is now available to most Maine residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.

3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.

2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Anthem Health Plans of Maine and Aetna are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.

1/12/2012 Value Access Guarantee is no longer available in Maine.

10/17/2011 State law H 1140 enacted as Public Law 2011-364 on 6/16/2011 permits insurance companies to set the premium rate for smokers at 20% higher than the non-smoker premium.

5/17/2011 Insurance commissioner Kofman resigned citing differences with the Governor in bringing about affordable insurance solutions to Maine’s residents. Generally, she proposes more government regulation of insurance while the Governor wants less. At her initial appointment in 2008 Kofman said “The biggest issue for the state is health insurance and that will be one of my top priorities — to help policymakers try to figure out ways to address affordability and coverage issues.” Over the past few years the number of affordable health plans available to consumers have declined in Maine under strict interpretation while they greatly expanded in other states. The governor and a majority of the state’s legislators have concluded that increased government intervention is not in consumers’ best interests. We believe this resignation will help speed up the return of consumer choice among health insurance plans available in Maine.

5/8/2011 Maine’s House of Representatives approved an ambitious health care reform bill to overhaul Maine’s health insurance system and create a new one designed to foster more competition. The changes for individual health plans would be phased in over four years. The bill also would authorize the renewal of short-term health insurance policies for a period not to exceed 24 months, instead of the current 12-month limit. By 2014, the bill would allow Maine residents to purchase insurance across state lines in four New England states: Connecticut, Massachusetts, New Hampshire or Rhode Island. In addition, it would establish an individual market reinsurance pool to be funded through a covered lives assessment capped at $4 per month, per person. The bill is likely to pass the Senate. We support this legislation and believe that it will result in more consumer choice and lower overall prices of health insurance in Maine.

12/16/2010 Governor’s Office of Health Policy and Finance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.

In its initial federal grant request for the insurance exchange project the Office of Health Policy and Finance said that it would: 1) Continue and complement the current efforts of the Health Reform Steering Committee, comprised of key State officials, and the Advisory Council on Health Systems Development (ACHSD) to provide oversight and stakeholder input on issues related to implementation of the Affordable Care Act, 2) Support the development of a detailed implementation plan for the Exchange, 3) Create a stakeholder process to answer policy and implementation questions in the areas of program integration, business operations, and technical infrastructure, and 4) Evaluate and model various options for Maine’s Exchange and develop implementation plan.

The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.

5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Maine is now available at Freedom Benefits.

4/20/2010 The state legislature passed additional mandates that now require current insurance plans to provide coverage for prosthetics containing a microprocessor, children’s early intervention services, autism spectrum disorders, and prohibit overall coverage limits on policies. The cost of the mandates is not immediately known but we estimate this will raise the cost of all policies by 3% to 4% per year based on historical patterns and data previously published by Freedom Benefits. Supplemental Accident Insurance and limited benefit policies like those listed above in the “Most Affordable” section are generally not affected by the new state mandates. This is one reason for the lower premium rates for these commercial insurance plans. The state legislature was unable to pass the proposed Maine Health Care Plan to provide more affordable basic coverage so a “Short Term Medical Insurance” or a limited benefit plan may provide the best temporary coverage for Maine residents.

4/7/2010 Some Maine consumers benefited briefly by legislation drafted with a loophole that allowed them to drop private insurance and join the taxpayer-paid Dirigo health plan. The plan was intended to provide coverage for the uninsured. Instead, the uninsured ignored it but residents raced to drop their private health insurance to obtain the taxpayer-paid health plan. Now the party is over; Maine acknowledges that virtually all of the $155 million spent on the Dirigo plan since 2005 failed to provide the intended results. The majority of those covered by Dirigo will be dropped and pushed back to the commercial insurance market resulting in at least a temporary rise in the number of uninsured Maine residents.