Bureau of Insurance Encourages Mainers to Compare Health Insurance Plans as Open Enrollment Period Nears--Agency’s Guidance Applies to the Individual Market

October 25, 2016


Contact: Doug Dunbar


Augusta -

With the national Open Enrollment period to purchase, renew, or change individual health insurance plans for 2017 approaching, Insurance Superintendent Eric Cioppa is encouraging Maine residents to compare their options. Open Enrollment on the Individual Market runs November 1, 2016 through January 31, 2017.

“Individuals who purchase their insurance directly would be wise to comparison shop,” Superintendent Cioppa said. “Mainers should not assume that the plan they currently have is the best option for them next year. It’s important to compare the price of premiums and also of cost-sharing amounts; that includes deductibles, copays and co-insurance. Also, consumers should determine whether a 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.”

A rate calculator at www.maine.gov/insurance/ACA/Pricecompare/IndividualHealth_Index.html created by the Bureau makes it easy for users to find out which companies and which plans they can purchase (based on where they live) and an estimate of their rates (based on their age and whether or not they smoke). The calculator does NOT apply potential tax credits (also known as subsidies). Individuals who purchase plans through the Marketplace will be able to calculate their estimated tax credit at www.healthcare.gov.

The companies selling 2017 Individual plans in Maine are Aetna, Anthem, Harvard Pilgrim Health Care and Community Health Options (CHO). All plans will be sold on and off the Healthcare.gov Marketplace, except Aetna’s, which will only be available off the Marketplace. Those individuals who qualify for a tax credit need to purchase their plan through the Marketplace to have the credit applied.

Individuals who purchased a 2016 Individual (or Family) plan will receive a letter from their insurance company about any changes to benefits or premium. If an individual does not select a new plan and continues to make payments, insurance companies will automatically re-enroll them 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.

Those who purchased a 2016 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.

Anthem policyholders with grandfathered and transitional plans will receive a notice from the company informing them that their plan has been discontinued. The letter from Anthem will also provide information about other options with the company. These individuals may also purchase any plan offered by any of the other companies.

Community Health Options has made changes to its out-of-state coverage. Members should check with CHO about the status of its out-of-state providers.

Out-of-pocket expenses for out-of-network services through both CHO plans and Anthem’s POS plans are applied to a separate deductible from in-network services, which can significantly increase costs for individuals.

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. Information about many insurance topics can be found on the Bureau’s website at www.maine.gov/insurance.

The Maine Bureau of Insurance is part of the Department of Professional and Financial Regulation (www.maine.gov/pfr), which encourages sound business practices through high quality, impartial and efficient oversight of insurers, financial institutions, creditors, investment providers, and numerous professions and occupations.


Facts and Tips About Open Enrollment on the Individual Market

Enrolling for the First Time?

• The earliest your new coverage will start is January 1, 2017.

• Purchase a plan by December 15 to have coverage in place on January 1.

• To have a tax credit applied to your premium, be sure to purchase your plan through the federally facilitated Marketplace at www.healthcare.gov.

• You may be able to get coverage sooner if you have lost insurance because you lost your job, got a divorce, aged-off your parent’s plan, moved outside of your health plan service area, or had a change in immigration status. For a full list of qualifying events go to www.healthcare.gov.

Renewing Your Coverage?

• Did you have a Marketplace plan in 2016? If so, you may see an adjustment to your tax credit due to a change in the second lowest silver plan (which is the basis for all subsidy calculations).

• Was your plan discontinued? If so, you may be re-enrolled into a slightly different plan by your insurance company. You can accept the new plan or purchase a different plan of your choice from any of the companies that are selling.

• Have you had changes to your income and/or to your household size since you bought a Marketplace plan for 2016? If so, it is very important to report those changes at www.healthcare.gov as soon as possible, to have the correct premium tax credit applied for 2017 and avoid owing money at tax time.

Important Points for All Consumers, Whether Newly Enrolling or Renewing:

• Make sure your health care providers, hospital, and prescriptions are covered by your plan. Contact the insurance company if you have questions about what is covered.

• Estimate your rates; use the rate calculator on the Bureau’s website to see estimated premiums for all plans in your geographic area. Estimates are based on your age and smoking status.

o NOTE: the rate calculator does not factor in tax credits that you may receive when purchasing a plan through the Marketplace. Visit www.healthcare.gov when Open Enrollment starts on November 1 to get premium estimates that include tax credits.

• 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.   Facts and Tips About Open Enrollment on the Small Group Market • For the purposes of purchasing health insurance in Maine, Small Businesses are those with 50 or fewer full time equivalent (FTE) employees.

• Businesses with 25 or fewer employees may benefit from a federal tax credit if they purchase employee coverage through the federally facilitated Small Business Health Options (SHOP).

• Small businesses can purchase insurance any time throughout the year if they meet minimum participation requirements.

• Minimum participation requirements require business to include at least 70% of eligible employees when purchasing a SHOP plan and 75% of eligible employees when buying a non-SHOP plan.

• If you are a small business owner, you have a special opportunity each year from November 15 to December 15 to buy a plan without meeting minimum participation requirements.

• Small businesses in Maine should consult a broker and consider their options each year.

• SHOP plans are offered by Anthem, Harvard Pilgrim Health Care, and Community Health Options.

• Off-SHOP plans are offered by Aetna, Anthem, Harvard Pilgrim Health Care, HPHC, Community Health Options, and United Health Care Insurance.

For more information about these plans, call the Bureau at 1-800-300-5000 to request the Guide to Small Business Insurance in Maine, or find it on the brochure page of the Bureau’s website at www.maine.gov/insurance. A comparison of small group plan rates is also posted on the Bureau’s website. Small Businesses are invited to contact the Bureau with questions.

Last Updated: October 25, 2016 9:45 PM