Maine Insurance Superintendent Clarifies Issues Related to Open Enrollment Period of ACA Individual Market

October 24, 2017

 

Contact: Judith Watters, Consumer Outreach Specialist
Phone:

 

Augusta -

AUGUSTA – “Most Maine residents who purchase insurance through the ACA Marketplace will have several plan options and, for those who qualify for federal subsidies, may find that they don’t have to pay much more for coverage in 2018,” Maine Insurance Superintendent Eric Cioppa stated. He shared these key points:

Those who qualify for premium subsidies will still receive them in 2018, and those who qualify for cost-sharing reductions will still receive them.

• Even though premium rates are increasing, individuals and families with premium subsidies will likely see them off-set by increases in premium subsidies.

• Even though insurance companies will not receive reimbursements from the federal government for providing cost-sharing reductions (CSRs), the insurance companies must still provide the cost-sharing reductions to low-income individuals and families who qualify, and who purchase a Silver plan through healthcare.gov.

Those without subsidies are advised to avoid inadvertently purchasing a higher priced Silver plan.

• To cover the loss of CSR payments, insurance companies priced Marketplace Silver plans higher than they otherwise would have. Because any plan offered on the Marketplace must also be offered off the Marketplace, these higher priced Silver plans could potentially be sold to individuals without subsidies.

• Some less expensive Silver plans will be offered off the Marketplace, only; these, along with Bronze and Gold plans, will be a better value to those without subsidies.

• Individuals without subsidies who currently have a Silver plan will want to guard against being automatically re-enrolled into a high priced Silver plan, by actively shopping.

Those with subsidies may find that Bronze and Gold plans are more affordable than in the past.

• Those who qualify for cost-sharing reductions will still only qualify for them by purchasing a Marketplace Silver plan.

• However, because the cost of Silver plans on the Marketplace has increased disproportionately compared to Bronze and Gold plans, a premium subsidy applied to a Bronze plan will stretch further (though cost-sharing will be higher); and a subsidized Gold plan may not cost much more than a subsidized Silver (and cost-sharing will be lower).

Compare all costs, not just the premiums, as well as networks, providers and drug formularies.

• Look at deductibles, co-insurance, copays and maximum out of pocket amounts to determine the total cost of a plan, based on your health and anticipated use of services.

• The Bureau’s rate calculator at maine.gov/insurance makes it easy to find out which plans are available and their estimated rates. The calculator does NOT apply subsidies. Individuals who purchase plans through the Marketplace will be able to calculate their estimated subsidies at healthcare.gov.

• Make sure your preferred providers and medications are covered by the specific plan you are considering. Bureau staff, ACA Navigators and Assistors, as well as Agents and Brokers can help with this.

Don’t wait until the last minute – start now. Open Enrollment is just six weeks – Nov 1 – Dec 15.

• New plans must be purchased by December 15 to have coverage for 2018 and to avoid a tax penalty. Look at your options, ask questions, choose a plan, complete an application and (if applicable) update financial and household information on healthcare.gov soon, to avoid encountering a bottleneck as enrollment comes to a close.

Letters from Insurers to Current Members

Individuals who are either 1) currently enrolled in a plan with Community Health Options or Harvard Pilgrim on or off the Marketplace, or 2) are currently enrolled in an off-Marketplace Anthem plan, and who continue to pay their premium, will be auto-enrolled in their current plan for 2018 (or one like it, if their current plan is terminating), unless they shop and sign up for a different plan.

Anthem, Community Health Options and Harvard Pilgrim will send letters to their members informing them of their right to purchase a new plan, or to simply auto-re-enroll by continuing their payments. The letters will explain any changes to members’ current plans.

Anthem members who currently have a Marketplace plan can actively choose to stay with Anthem by selecting a new Anthem off-Marketplace plan without subsidies, or they can actively shop for a new Marketplace plan with another company. Otherwise, they will be assigned to another Marketplace plan with another company by healthcare.gov, based on their geographical location (they will receive a letter from healthcare.gov explaining the new plan they’ve been assigned).

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 at enroll207.com. Consumers can also contact the insurers directly to ask questions about covered services, providers, medications, and cost-sharing or to purchase unsubsidized plans.

Last Updated: October 25, 2017 12:34 PM