Beginning on October 1st, the Maine Health Insurance Exchange Program begins open enrollment under the Affordable Care Act. This new system of shopping for health coverage is seemingly marred in confusion, but will allow consumers to shop for the lowest price, based on their income and family status.
One highlight of the program is that the less income you have annually, the less you will pay for coverage. Maine has two options on the marketplace; Anthem's plan and a new player on the insurance field, Maine Community Health Options (MCHO). Within each of those options, there are three plans: Gold, Platinum and Bronze. Each of those plans come with their own set of price and coverage, and the consumer will have the choice based on their individual or family's anticipated needs.
According to Maine Consumers for Affordable Health Care, 133,000 Mainers are uninsured. This new online-shopping will allow consumers to directly compare options based on price, benefits and quality. They will also be able to determine if a lower premium or a lower out of pocket price is available.
All Marketplace plan categories will cover essential health services, which include: Preventative and wellness services, hospital stays, ambulatory services, rehabilitative and habilitative services, emergency services, prescription drugs, lab services, maternity and newborn care, pediatric oral and vision care, and mental and behavioral health services (including substance abuse disorder services.)
The category that you choose will effect your premium (the amount you pay on a usually monthly basis for coverage) and will also effect your out-of-pocket cost (those expenses not reimbursed by insurance – deductables, coinsurance, copayments and service costs that are above and beyond your chosen plan).
Catastrophic plans are also available for people under 30 years old, and for some who qualify with limited incomes. These policies cover three primary care visits per year at no cost, but the option for lower premium and out-of-pocket costs is not available based on income.
Several federal and state agencies are working to help the public in this transition. Healthcare.gov, a website that allows you to tailor your needs to find the right plan, as well as apply for a plan on the marketplace suggests thinking about your healthcare needs to discover the right option.
Do you expect a lot of doctor visits? If so, it suggests you may want a gold or platinum plan. If not, a Bronze plan may be better, however if a major accident happens, you would be required to pay more of the cost.
The gold plans will result in paying a higher premium, but less when you do visit the doctor or hospital. On the other end of the spectrum, a bronze plan will have a lower monthly premium, but you will pay more when you do use the services.
“What is also important to understand is that the prices you see at the marketplace are the full prices of each insurance option but there are federal subsidies that considerably reduce cost depending upon income levels,” says Doug Jones, Downeast Community Hospital CEO.
Though insurance levels are expensive, some pluses that Jones points out under the program include the fact that pre-existing conditions will not prevent coverage. The essential health services outlined are also more generous than what a private insurance generally offers.
Enrollment in the Marketplace begins on October 1st, and consumers will have 90 days to sign up. Coverage will begin on January 1st, 2014. There will also be Affordable Care Act Navigators through local community agencies that will be available to discuss in more depth and specificity with you to help you explore and choose the right plan. Though navigators are still needed in Washington County, appointments will be available starting on October 1st. DECH plans on having an information/ enrollment table at their October Flu Clinic and will have a registration booth at the hospital with Outreach and Enrollment Coordinators available and accessible.
There are three ways to enroll in the program: online at www.healthcare.gov, apply by phone at 1-800-318-2596, submit a paper application in the mail or you can also apply with the help of a certified navigator or enrollment coordinator. There is additional helpful information about the marketplace at http://www.mainecahc.org/marketplace.htm, including an online calculator that will allow you to get an idea of what options are available to your needs and specifications.