The health insurance market in Maine offers many plan choices to businesses with 50 or fewer full-time equivalent employees.

The Small Business Health Options Program (SHOP) Marketplace can provide answers to your questions. A broker can provide assistance as you weigh the options (use the Licensee Lookup tool in the left menu to confirm that a broker or agent is licensed to sell insurance in Maine). Following are some considerations when shopping for small group coverage:

Premiums. How will you divide the cost between you and your employees? Keep in mind that if you have fewer than 25 employees, it’s possible you could qualify for a SHOP tax credit.

Cost Sharing. Depending on the plan, the insurance company will pay a certain amount of medical expenses and you and your employees will pay the rest. The Affordable Care Act (ACA) has created standardized levels of coverage into metal levels — Bronze, Silver, Gold and Platinum – to more easily compare plans. In general, plans with lower cost-sharing will have higher premiums, and plans with lower premiums will have higher cost-sharing.

Cost Sharing Metal Levels
Plan Level Actuarial Value  - This is the estimated % of total costs your insurance plan will pay for covered services Your Expected Cost Share – The amount of covered services you will have to pay

Gold

80%

20%, up to maximum OOP

Silver

70%

30%, up to maximum OOP

Bronze

60%

40%, up to maximum OOP

Networks, Prescription Formularies, Exclusions and Limitations. Each plan has a network of health care providers and hospitals. Think about whether the network will adequately serve you and your employees, based on where these providers are located. Each plan also has a drug formulary that can be viewed before purchasing; the formulary lists which drugs are covered and how much you and your employees will have to pay for each. Also consider whether any procedures are excluded by the policy and whether limits exist on the number of times you or your employees can see certain providers.

Service. A company’s track record is an important consideration; a company that provides superior customer service may be worth additional cost. The Bureau’s Health, Disability and Long-Term Care Insurance Complaint Comparison provides the rate of consumer complaints received by some of the companies selling health insurance in Maine. Other small business owners or individuals may also be able to recommend an insurance company, based on the service they’ve received.