Let the shopping around begin.
The state has released numbers that, for the first time, allow Mainers to compare individual insurance plans proposed for the upcoming Affordable Care Act’s health insurance exchange, or marketplace.
In some cases, similar plans had almost identical price tags. In others, the difference was hundreds of dollars a month.
A 60-year-old smoker in Farmington, for example, would pay Maine Community Health Options about $690 a month for a middle-of-the-road plan. He would pay $1,144 — another $450 a month — to Anthem Blue Cross Blue Shield for the same level of insurance.
But Anthem, whose plans tended to cost more per month, downplayed the difference.
“At the end of the day, the premium doesn’t tell the whole story,” said Anthem spokesman Christopher Dugan. “The consumer really needs to understand all the different pieces.”
Individuals and small groups can start purchasing insurance from the exchange Oct. 1. The insurance takes effect Jan. 1, 2014. Individuals who earn between 100 percent and 400 percent of the federal poverty level can get federal subsidies to offset the cost of insurance bought through the exchange.
The Maine Bureau of Insurance approved exchange plans from two insurance companies: MCHO, a new nonprofit insurance co-op based in Lewiston, and Anthem, the state’s largest health insurer. Anthem has partnered with MaineHealth, the state’s largest health-care organization, for its plans. One of those plans — the one offered in central and southern Maine — has caused some controversy because it is a narrow network plan that strictly limits the doctors and hospitals patients can use.
The federal government still must approve the plans for the exchange.
Saturday night, the Maine Bureau of Insurance released some comparisons of the plans proposed by Anthem and MCHO for individuals. Additional figures for those individual plans were released Monday.
A bureau spokesman said figures for small group plans are expected “soon.”
The comparison for people who want individual insurance — most likely to be those who don’t have insurance now or who are self-employed — shows Anthem’s plans are the cheapest choice for non-smokers who live in Cumberland, Sagadahoc and York counties and who want a catastrophic or basic-level plan. The difference is as little at $3.40 a month and as much as $18.57 a month.
MCHO plans are cheaper for all others, including smokers, older people and those living in central and northern Maine. The difference ranges from a few dollars a month to more than $450 a month.
The Affordable Care Act requires insurance plans to have some of the same components, such as free preventative care. Other components, including co-pays, annual deductibles and out-of-pocket maximums, are up to the insurance company.
Both Anthem and MCHO tout their benefits apart from monthly cost.
MCHO, for example, offers free care for certain chronic conditions and three free visits a year to a behavioral health specialist.
“We’re pleased to have the range of options that we do and think it’s a well-balanced and thoughtful approach to meeting community needs and consumers’ needs,” Executive Director Kevin Lewis said.
Anthem has no or low co-insurance compared to MCHO, meaning policyholders pay signficantly less for care after they have met their annual deductable.
“Different customers might want to buy different plans depending on how they see themselves using their insurance,” Dugan said.
A spokesman for the Bureau of Insurance echoed the sentiment. The state’s comparison, he said, was meant to be helpful, not comprehensive.
“Consumers should keep in mind that variables exist, so precise ‘apples-to-apples’ comparisons are difficult,” Doug Dunbar said in an email. “Consumers are always encouraged to thoroughly discuss plan options with the insurance companies, their insurance agent and others.”
Consumers with specific questions or concerns can call the bureau at 1-800-300-5000.
The bureau expects to post the comparison of plans online at www.maine.gov/insurance.
More coverage
- Lewiston Mayor Macdonald opposes Anthem plan
- Anthem’s plan unique in Maine, more common elsewhere
- Local hospitals highly rated by consumer group
- State approves MaineHealth/Anthem insurance plan
- New health insurance co-op in Lewiston readies for business
- Bureau of Insurance releases more Anthem documents
- Maine’s health insurance exchange likely limited to two companies
- State releases some Anthem information
- Central Maine Healthcare files suit against the state
- CMMC excluded from proposed Anthem health plan
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