It’s more important than ever to compare health insurance plans

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AUGUSTA – Maine Insurance Superintendent Eric Cioppa has an urgent message for Maine residents who purchase their health insurance coverage on the Individual Market: “Take the time to compare your options, and do it before Open Enrollment ends on December 15.”

“As most people are well aware, there has been quite a bit of turmoil in the insurance market this year. This has resulted in higher rates, and also in fewer choices,” Cioppa stated.

Just Two Insurers Selling Marketplace Plans

Anthem, one of the three insurers that sold individual and family plans on the ACA Marketplace in 2017, has chosen not to renew that business in 2018. Anthem will continue to sell plans off the Marketplace, but these plans cannot be purchased with premium subsidies (otherwise known as Advance Premium Tax Credits, or APTCs) and do not provide Cost Sharing Reductions (CSRs) to eligible low-income consumers. Community Health Options and Harvard Pilgrim will continue to offer plans both on and off the Marketplace.

The Impact of the CSR Issue on Silver Plans

It remains uncertain whether the federal government will continue to fund the CSR subsidies, which automatically lower the deductibles and other cost sharing for Silver Plans purchased on the Marketplace by individuals with incomes between 100 and 250 percent of the Federal Poverty Level. If federal funding is discontinued, these extra benefits will have to be funded by increasing the premiums for those Silver Plans that are sold through the Marketplace.

“The important thing for consumers to know is that because the CSR program has not been funded, Silver Plans might no longer be the best choice for many consumers, particularly those who are not eligible for CSRs,” Cioppa said.

Cioppa said that the bottom line is that the complicated pricing structure makes it more important than ever for consumers to look carefully at all costs involved in the plan they choose:

• the premium payment (including any premium subsidy they may receive to help cover the cost);

• the deductible amount that will have to be paid before the insurance company begins to pay;

• the co-insurance amount that they will need to pay after the deductible is met; and

• any co-payments to see primary care providers or specialist, as well as for medications.

“Also, consumers should determine whether a particular plan covers their medical providers and prescriptions. If individuals and families need help doing their homework, calling the Bureau is a good place to start.”

Additional Information and Resources

Consumer Health Care Division: Bureau staff members are available to answer questions Monday through Friday from 8 a.m. to 5 p.m. and can be reached by dialing 1-800-300-5000 or 207-624-8475 (TTY please use Maine Relay 711). Emailed questions can be sent to insurance.pfr@maine.gov.

Other Sources of Assistance: Find an insurance broker or agent, a Marketplace Navigator or Assister near you, along with other information, at www.enroll207.com. Consumers can also contact the insurers directly.

A rate calculator at www.maine.gov/insurance created by the Bureau will be posted in mid to late October, which will make it easy for users to find out which plans they can purchase and an estimate of their rates. The calculator does NOT apply potential premium subsidies. Individuals who purchase plans through the Marketplace will be able to calculate their estimated tax credit at www.healthcare.gov.

Changing Companies/Plans: Individuals who purchased a 2017 Individual (or Family) plan will receive a letter from their insurance company about any and all changes.

• Individuals who had Marketplace plans with Anthem will need to select a new Marketplace plan with Community Health Options or Harvard Pilgrim, or purchase an off-Marketplace plan with Anthem, without premium subsidies.

• Individuals with an off-Marketplace plan through Anthem, Community Health Options, or Harvard Pilgrim, who do not select a new plan and continue to make payments, will automatically be re-enrolled into their existing plan. If the plan has been discontinued by the company, the policyholder will be automatically re-enrolled into the plan that is most similar to their current one.

Updating Information for Subsidy and Tax Purposes: Those who purchased a 2017 plan through the Marketplace will receive a notice urging them to update their income and household information, to ensure accurate calculation of tax credits for 2017.