Mainers who buy insurance through Healthcare.gov can expect to pay less or the same amount on average each month for benefits taking effect next year, according to filings with the Maine Bureau of Insurance.
Health advocates applauded the news but urged consumers to reassess their options in the second year of the health insurance marketplace. Most people who bought insurance through healthcare.gov for 2014 will be automatically re-enrolled in the same plan in 2015. Consumers could miss out on lower costs or more attractive benefits, or get stuck with a lower government subsidy based on outdated information, health advocates warned.
On Sept. 5, the state insurance bureau approved monthly premium costs and plans for health insurers that will sell policies in Maine through the federal insurance marketplace in 2015. The federal government is expected to issue final approval.
The plans will be available during an open enrollment period kicking off on Nov. 15 and ending Feb. 15, 2015.
The marketplace, a key component of President Barack Obama’s landmark health reform law, allows consumers to shop for private health plans and, depending on income, qualify for federal financial assistance to offset their premiums and out-of-pocket costs. That financial help means many consumers will pay less than the costs the state has approved.
Healthcare.gov serves people who buy their own health coverage in the “individual market” — such as the self-employed and part-time workers — rather than get health insurance through work or government programs such as Medicare and Medicaid.
Maine Community Health Options, a member-run health insurer based in Lewiston, sold more than 80 percent of the plans Maine consumers bought for coverage in 2014, the first year of Healthcare.gov. After a troubled rollout of the site, about 44,000 Mainers signed up for coverage.
Next year, premium costs for Maine Community Health Options plans will hold steady on average.
“Our rates demonstrate our commitment to returning value to our members and doing our part to make affordable coverage available to Maine people,” Kevin Lewis, CEO of Maine Community Health Options, said in a news release. “With our competitive premiums and health-focused benefits, we are well positioned as Maine’s only member-led insurance solution to help transform and improve the health of individuals and positively affect the local economy.”
While the rates will remain the same on average, some customers could see premium drops or increases.
Maine Community Health Options will raise rates on a single plan, with relatively low membership, by just under 1 percent, according to Lewis. The monthly premium for the startup insurer’s best-selling plan will fall by about half a percentage point, he said.
The other insurer that sold plans through Healthcare.gov in the state this year, Anthem Health Plans of Maine, will reduce premium costs by 1.1 percent on average.
“We have been committed to the exchange since the beginning and thank those who purchased Anthem plans,” the company said in a statement. “We will again be offering a number of ACA-compliant products on and off the exchange in 2015 and are pleased to have filed for an average rate decrease of 1.1 percent. We look forward to welcoming new exchange members when open enrollment starts in November.”
Anthem rates are decreasing on average, though some customers will experience a premium drop as low as nearly 13 percent or an increase of up to 12.1 percent.
Harvard Pilgrim Health Care will become the third player in Maine’s marketplace in 2015, offering four individual plans.
All three insurers, plus Aetna, will also offer health plans outside of the exchange, directly to consumers and through health insurance brokers. Those plans aren’t eligible for federal subsidies.
The subsidies for Healthcare.gov plans are available to those earning between the poverty level and four times that amount, or between $23,850 to $95,400 per year for a family of four.
In Maine, premium costs — before insurers plug in factors such as consumers’ ages and geographic areas — range from $152 per month for a basic Anthem plan to $381 monthly for a Harvard Pilgrim plan with more comprehensive benefits. Consumers who qualify for subsidies could pay far less than those rates.
The plans offer varying benefits and carry different deductibles and out-of-pocket costs, such as co-pays.
Insurers may have changed their plans from last year, such as by adjusting which doctors or medications are covered. Consumers should revisit Healthcare.gov to take stock of all the options and find a plan best suited to their needs, said Emily Brostek of Consumers for Affordable Health Care, an Augusta advocacy group.
The federal government’s choice to automatically re-enroll consumers will prevent anyone from getting dumped from coverage inadvertently, she said.
But people should log on to Healthcare.gov to update any changes in their income, or risk getting stuck with an incorrect financial subsidy, she said. The subsidies are based on consumers’ projected income for 2015, but the site will pull earnings information from 2013 tax returns, which could vary greatly from the amount some people expect to make next year, Brostek explained.
Incorrect information could lead to sticker shock when premium bills arrive next year, she said.
“Go back to the marketplace, update your income, and make sure you’re in the right plan,” Brostek said.
To view a calculator that estimates monthly premiums for the various plans, visit the Maine Bureau of Insurance website at maine.gov/pfr/insurance.
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