There has been a lot of talk lately about health insurance options in Maine. Some of it reflects the truth and some of it does not.
Anthem’s roots in the state go back 75 years. For more than two decades, we have been the only insurer to offer unsubsidized major medical health insurance to individuals who purchase coverage on their own and we work continually to help manage health care costs on behalf of those we serve.
Health care affordability is a major challenge for individuals and small businesses in Maine, and the status quo in our state is not working. Rather than stand by idly as new requirements result in new costs for our consumers, we are stepping up by taking an innovative approach to give Mainers access to the quality care they deserve. We are proud of our efforts and the results.
To help keep premiums manageable, Anthem is partnering with MaineHealth and other top-notch providers to give consumers relief from the increasing cost of health care.
Under the Affordable Care Act, more people will have access to health insurance and plans will have more benefits than in the past, with lower deductibles and lower out-of-pocket maximums. And subsidies are available for those who need financial assistance.
But these new benefits come with a cost. One of our solutions is to offer coverage through our Guided Access network, a new network that reduces costs — with premiums more than 12 percent lower than the same products would be with a broader network — and provides excellent service. The Maine Bureau of Insurance recently approved this network for customers who choose to purchase Anthem’s individual or small group plans for 2014 on Maine’s health insurance exchange.
That is good news for Mainers.
We recognize that our members may have some questions about how the new network might affect them. Here are some important facts.
The Guided Access products will be available to those who choose to buy them in the individual and small group markets.
These products are intended for those impacted the most by changes in the Affordable Care Act. The products will also be available to “grandfathered” members who purchased their health insurance plans prior to March 23, 2010, although they are not required to change their coverage. We believe that the products will meet the needs of many and we are proud to offer them. Our research shows that consumers want to have these choices — that they are willing to buy products with a more focused network if it costs less.
The new network will not apply to those who purchase health insurance through large employers, those on Medicare, or federal employees and retirees.
Businesses with 50 employees or fewer will have the option of purchasing products on the exchange that feature the new network or buying off-exchange products that use a broad network.
Although Central Maine Medical Center and affiliates are not in the new network, St. Mary’s Regional Medical Center in Lewiston, which received the top surgical safety rating of any Maine hospital from Consumer Reports, is in the new network.
In case of emergency, any member can and should seek services at the closest medical facility. That urgent care is covered by Anthem wherever the member receives that care.
It is important to note that our cost-cutting efforts are not limited to the development of a new network. Anthem has led the way in using technology to expand patient access to doctors and nurses 24 hours a day, seven days a week. We are also working to put the “primary” back in primary care by compensating doctors to spend more time with patients through a revolutionary program that aims to improve care quality. Over time, that, too, will help control medical costs.
And, earlier this year, Anthem launched the state’s first comprehensive commercial Accountable Care Organization — yet another Anthem innovation designed to lower the cost of health care while improving overall quality.
Ultimately, as the health insurance landscape changes and costs increase, it is incumbent on all of us — insurers, providers, employers, and others — to work together to keep costs down and ensure access to quality care. We look forward to engaging in an open — and honest — dialogue with all those interested in the future of health care coverage in Maine.
Dan Corcoran is president and general manager of Anthem Blue Cross and Blue Shield in Maine.
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