Bureau of Insurance Provides Guidance to Mainers Enrolling in or Renewing Health Insurance Plans as Open Enrollment Period Nears

October 14, 2015


Contact: Doug Dunbar


Augusta -

Insurance Superintendent Eric Cioppa is encouraging Maine residents and businesses to take time to consider their health insurance options as the national Open Enrollment period to purchase, renew, or change plans for 2016 approaches. Open Enrollment on the Individual Market runs from November 1, 2015 to January 31, 2016.

“Individuals and families who purchase their own health insurance should review their options each year,” Superintendent Cioppa said. “Changes in household income or size can impact whether an individual or family qualifies for tax credits. Also, Mainers should not assume that the plan they currently have is the best option for 2016. It’s important to review premium rates and cost-sharing amounts like deductibles and copays, as well as prescription formularies, and to consider whether provider networks include their doctors and other healthcare providers.”

The Individual Market in Maine for 2016 includes the companies that sold plans for 2015 -- Aetna, Anthem, Harvard Pilgrim Health Care/HPHC and Community Health Options (formerly known as Maine Community Health Options). All plans will be available on the Healthcare.gov Marketplace at (www.healthcare.gov), but can also be purchased ‘off’ the Marketplace. Those individuals who qualify will have a tax credit applied only if they purchase a plan through the Marketplace.

Individuals who purchased a plan for 2015 through Healthcare.gov will receive a notice from the Marketplace urging them to update their income and household information, to ensure accurate calculation of tax credits.

Individuals will also receive a notice from their insurance company about any changes to their current plan or the premium amount. Policyholders will be re-enrolled in their current plan if they take no action and continue to make payments. If their current plan is no longer available, they will be enrolled in a plan with slight modifications from their old plan.

Individuals with grandfathered and transitional Anthem plans (non-ACA compliant plans that were allowed to renew) may also want to consider their options during Open Enrollment.

Information about plans offered both on and off the Marketplace can be found at the Bureau of Insurance website (www.maine.gov/insurance), by calling the Bureau at 1-800-300-5000 (for TTY use Maine Relay 711), or by e-mailing Insurance.PFR@maine.gov.

-- Additional Guidance for New Enrollees, Renewing Policyholders and Small Businesses

-- New Enrollees: Individuals and families who want to purchase health insurance during the Open Enrollment period.

• The earliest coverage will start is January 1, 2016.

• To have coverage on January 1, individuals must purchase a plan by December 15.

• Plans and rates offered to Mainers on the Marketplace can be found at www.healthcare.gov.

• Individuals who qualify will only have a tax credit applied if they purchase a plan through the federally facilitated Marketplace.

• Individuals and families who need coverage before January may be able to purchase a 2015 plan if they qualify for a Special Enrollment. Qualifying events include loss of eligibility for other coverage due to job loss, divorce, aging off a parent’s plan, moving outside of the health plan service area, or change in immigration status. For a full list of qualifying events go to www.healthcare.gov. Those Renewing Their Plans: Policyholders should carefully review the information from their insurance company to make sure the plan still meets their needs.

• Individuals who purchased a plan through the Marketplace may see an adjustment to their tax credit, due to a change in the second lowest silver plan, on which all subsidy calculations are based. This could result in a rate increase.

• Some individuals and families may be re-enrolled in slightly different plans due to their existing plan being discontinued. These policyholders have the same option as all renewing individuals to purchase a different plan.

• For those who purchased plans on the Marketplace and have had changes to income and/or household size, it is very important to report those changes at www.healthcare.gov to have the correct premium tax credit applied.

• According to the IRS, individuals who receive advance credit payments in any amount, or who plan to claim the premium tax credit, must file a federal income tax return, even if they are not usually required to file (see www.irs.gov/Affordable-Care-Act/Individuals-and-Families).

• To compare plans, individuals should talk with their broker, agent or Marketplace navigator; visit www.healthcare.gov; visit the Bureau of Insurance website www.maine.gov/insurance, or call or email the Bureau at 1-800-300-5000 ( TTY use Maine Relay 711), Insurance.PFR@maine.gov.

-- Important Points for Those Newly Enrolling or Renewing: Whether purchasing a new plan or re-enrolling in existing coverage, it is a very good idea to:

• Review the provider network to ensure that the health care providers and hospital one intends to use are part of the network. Individuals who want to purchase certain brand name prescriptions versus generic versions should also check the insurance company’s formulary to see if those particular medications are covered. Individuals having questions about these issues should contact the insurance company.

• Use the rate calculator on the Bureau of Insurance website to find out the premium estimate for all plans in an individual’s geographic area, based on age and smoking status. NOTE: the rate calculator does not factor in tax credits that individuals may receive when purchasing a plan through the Marketplace.

• Seek assistance when needed – from an insurance company, an insurance broker or agent, a Marketplace Navigator (see www.enroll207.com), or the Bureau of Insurance.

-- Important Points for Small Businesses:

While small businesses can purchase insurance any time throughout the year, the Open Enrollment period from November 15 to December 15 allows them to do so without meeting minimum participation requirements. The rest of the year, small businesses are required to include at least 70% of eligible employees when purchasing a Small Business Health Options (SHOP) marketplace plan and 75% of eligible employees when purchasing a non-SHOP plan.

Aetna, Anthem, Harvard Pilgrim Health Care/HPHC, Community Health Options (previously known as Maine Community Health Options), and United Health Care Insurance are offering small group plans off the SHOP marketplace. Anthem, Harvard Pilgrim Health Care, and Community Health Options are also offering plans through SHOP.

For more information about these plans, employers can call the Bureau to request the Guide to Small Business Insurance in Maine, or find it on the brochure page of the Bureau’s website. Start of coverage for small businesses which are just beginning to offer employee plans will depend on when the plans on purchased.

Cioppa encouraged small businesses to consult a broker and consider their options each year, and noted that those with 25 or fewer employees may benefit from a tax credit if they purchase employee coverage through the SHOP marketplace. The federal government has defined small businesses as those with 50 or fewer full time equivalent (FTE) employees

Small Businesses are invited to contact the Bureau with questions, using the same contact information provided above.

Last Updated: October 14, 2015 4:59 PM