AUGUSTA, Maine (AP) — Maine residents buying health care coverage on the exchange this winter are getting their first look into how the rates compare for the various proposed plans.
The state recently released side-by-side comparisons of the plans offered by Maine Community Health Options, a new health cooperative, and Anthem Blue Cross Blue Shield, the two companies offering coverage for individuals on Maine’s federally run exchange. The plans, which were approved by the state last week, must now be approved by the federal government before enrollment begins Oct. 1.
Deductibles and monthly premium costs for plans with similar benefits are largely comparable between the two companies, often differing by no more than $100. But Mainers will pay more or less depending on the level of coverage sought, where he or she lives and other factors, like age and whether he or she is a smoker.
Both companies are offering gold, silver and bronze plans. Gold plans generally have higher premiums, but cost less for each doctor visit. Bronze plans have lower premiums, but cost more every time a person seeks care.
Rural residents can generally expect to pay more for coverage than city dwellers no matter what level of coverage he or she chooses. A 60-year-old living in Washington County buying silver coverage under MCHO would likely pay a monthly premium of about $800, or about $200 more a month than if they lived in Cumberland County. Meanwhile, that same Washington County resident would pay about $950 a month if she or she chooses an Anthem plan.
If that person smokes, they could pay a monthly premium as much as $1,200 for a silver Anthem insurance plan. MCHO’s plans do not raise costs for smokers because the company believes that a better approach to long-term wellness is encouraging people into treatment, rather than penalizing those with certain behaviors, said Kevin Lewis, CEO at MCHO. Anthem officials did not return calls on Monday.
The state estimates that as many as 250,000 people in Maine may use the new exchange, including about 130,000 people currently uninsured. However, the number of people who will actually buy insurance on the exchange is likely to be lower as many keep their plans off the exchange or remain uninsured.
Mitchell Stein, policy director for Consumers for Affordable Health Care, said the changes under federal health care law make comparing the new costs on the exchange to what individuals currently pay nearly impossible.
‘‘It’s very different than what came before so there is no apples-to-apples basis for comparison,’’ he said.
Stein cited the fact that people between 100 percent and 400 percent of the federal poverty level — or up to $80,000 a year for a family of four — will be eligible for federal subsidies on the exchange, making their out-of-pocket costs significantly lower. There is also a cap on out-of-pocket costs at more than $6,000 under the federal health care law, meaning that many Mainers who currently pay deductibles as $15,000 will see those costs come way down, he said.
But Joel Allumbaugh, director of the Center for Health Reform Initiatives at the Maine Heritage Policy Center, said the requirement that companies bring down deductibles is likely to make the rates skyrocket. Individuals could see their rates increases by as much as 100 percent, he said.
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