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Questions and Answers about Maine’s 2011 Healthcare Reform Law

(Provided by the Maine Bureau of Insurance – current as of September 14, 2011)
Q – When can I buy insurance from health insurers over state lines?
A – Starting on January 1, 2014, “regional insurers,” licensed in Rhode Island, New Hampshire, Massachusetts, or Connecticut, will be able to sell the same individual health insurance policies in Maine that they sell in their home states, and those policies will not be subject to Maine’s benefit requirements.  Maine-based insurers and Maine-licensed HMOs will also be able to sell the individual policies sold in the four regional states by their affiliated insurers based in those states, and any products sold in Maine by regional insurers.  For more information:  24-A MRSA §§ 405-A through 405-C.

Q – What consumer protections will be available to people who buy a policy under the laws of another state?
A – The policy will be subject to all relevant laws of the other state, and the insurer will be required to comply with Maine’s unfair trade practices laws, Maine’s premium rating laws, Maine’s requirements for handling grievances and complaints, and Maine’s requirements for adequate provider networks.  It will also be subject to applicable federal laws, which starting in 2014 will include the right to buy any policy offered in Maine without regard to your health status.  For more information:  24-A MRSA § 405-A(2).

Q – I live in rural Maine; how will the new law affect me?
A – Rural Mainers may be affected in several ways. 

First, the law provides more flexibility for insurers to vary premium rates according to the cost of health care services in your area.  For more information:  24-A MRSA § 2736-C(2)(C-1) and 24‑A MRSA § 2808-B(2)(C-1).

Second, the new law gives insurers greater flexibility in contracting with networks of participating providers.  This may have an impact on the number of hospitals or other medical providers you can choose in your area.  For more information:  24-A MRSA §4303(1).

Third, health insurers might offer you more incentives to use providers based on the quality of their services or their cost.  However, insurers may not require you to use those providers.

 Q – Which insurers in Maine will sell me health insurance?
A – As of August 2011, if you are not eligible for Medicare and want to buy individual health insurance for yourself or your family, the options available are Anthem, MEGA (HealthMarkets), and DirigoChoice (offered by Harvard Pilgrim Health Care).  If you are an employer looking to insure your small group (up to 50 people) or large group (51+ people), more options are available – please check or call the Bureau at 1-800-300-5000 for more detailed information.  Our web site will be updated if these options change.

Q – Will my insurance premiums change because of this new law?
A – An insurer’s overall rates depend on the insurer’s medical claims experience and costs.  Your own premium will also depend on factors such as your age and where you live. The new law will give insurers more flexibility to vary premiums according to age, geography, and tobacco use.  The changes in age rating will be phased in over time, and will allow insurers to charge lower rates for younger consumers than they can currently charge – relative to others buying the same coverage – and higher rates for older consumers.  However, because of all the other factors that can affect an insurer’s rates, the ultimate impact on premiums cannot be predicted with any certainty.  For more information:  P.L. 2011, Chapter 90, Part A; P.L. 2011, Chapter 364, §§ 1 through 16.

Q – Can I still buy a policy if I have a pre-existing condition?  Will it cost me more?
A – Yes, you can still purchase a policy if you have a pre-existing condition.  No, that condition cannot be used to increase your premiums.  Neither can your claims history, nor any other factor related to health status, except for your age.  For more information:  24-A MRSA §§ 2736‑C(2) & (3) and 2808-B(2) & (4).

Q – My insurance company told me that I have to fill out a health statement because of a new law called MGARA, is this true?
A – Maine’s healthcare reform law created the Maine Guaranteed Access Reinsurance Association (MGARA). MGARA lowers individual health insurance premiums by helping insurance companies pay the costs of insuring individuals with more expensive medical conditions. The health statement is designed to help your insurance company determine whether you should be reinsured by MGARA. Your insurance company cannot deny you coverage or raise your rates because of your health statement answers, and your responses will remain confidential as required by federal and Maine law.

Q – I heard that the new law creates a high risk pool.  Is that correct?
A – The new law establishes the MGARA, but this is not a high-risk pool.  It is a mechanism for insurers to share the costs of covering people with expensive medical conditions.  People whose policies are reinsured get the same policies from the same insurers at the same rates as everyone else.  As noted above, under Maine law, having a pre-existing health condition cannot affect your ability to buy coverage or the price you pay for that coverage.  For more information:  24‑A MRSA Chapter 54-A (§§ 3951 through 3961).

Q – Can I renew my current policy or do I need to purchase a new one?
A – You do not need to purchase a new policy.  However, some consumers might be able to buy new policies at a lower cost.  For more information:  24-A MRSA § 2736-C(2)(I), 24‑A MRSA § 2808-B(2)(H).

Q – What is the new assessment on insurance policies?  Who pays it?
A – The assessment is up to $4 per covered person per month, which is $48 per person per year, or $192 for a family of four.  It is paid by health insurance companies so it is built into the premiums.  However, an existing assessment to fund the Dirigo Health Agency is being phased out between now and 2014, so the net effect on your premium may be less.  The assessment payments will be sent from the insurance companies to the Maine Guaranteed Access Reinsurance Association to help pay for people with very high medical costs, with the goal of lowering premiums for everyone.  If the $4 per person per month isn’t enough to cover the Association’s costs, an additional $2 per person per month may be assessed.  For more information:  24-A MRSA §§ 3957(1) and (5).

Q – Are there opportunities for small businesses in the new law?
A – Employers with 20 or fewer employees may be eligible for a tax credit if they establish wellness programs.  To qualify, each employer’s wellness program must offer health education plans, behavioral change programs, and incentive awards for employees that regularly exercise.  The credit is $100 per employee or $2000 total – whichever is less – per tax year, beginning on or after January 1, 2014.  An employer requesting this credit is responsible for all record keeping.For more information:  36 MRSA § 5219-FF.



Last Updated: October 22, 2013