Maine health plans comparison sketches out options and cost

A side-by-side comparison of what insurance plans on Maine’s new health care exchange will cost gives consumers their first look at what they will be able to buy from Anthem Blue Cross Blue Shield or Maine Community Health Options.

The plans will offer different benefits and costs, but will be similar in many ways, officials said Monday. Most of the premiums – not including federal subsidies that many people will qualify for – will be about $200 to $600 per month, depending on factors such as age, geography, smoking and the type of plan.

Anthem and Maine Community Health are the only two insurance providers on the exchange, where individuals who otherwise don’t have health insurance will buy it. People can start purchasing plans Oct. 1 for benefits that will begin Jan. 1, as a key part of the federal Affordable Care Act.

Less than 10 percent of consumers are expected to purchase plans on the exchange, according to the Maine Bureau of Insurance.

The two providers filed rates with the bureau last week. The filings satisfied a federal requirement but did not immediately include the side-by-side comparison.

The Bureau of Insurance released a more user-friendly rate comparison this weekend for “bronze” and “silver” plans on the exchange. It released a rate comparison for “gold” plans on Monday.

Competition for customers between Anthem and Maine Community Health helped keep prices in line, said Mitchell Stein, policy director for Consumers for Affordable Health Care.

“In the grand scheme of things, these numbers are pretty close to each other,” he said.

Although there are only two providers, consumers will choose from a wide array of health care plans.

The “bronze” plans will offer lower premiums but higher deductibles than “silver” and “gold” plans, which will have more generous benefits but higher monthly premiums.

In the comparison, the two providers’ rates are similar across a spectrum of age groups and geographic regions in the state.

The providers were also permitted to adjust rates based on tobacco use. Anthem did so, but Maine Community Health did not adjust for tobacco use.

Maine Community Health did not set higher rates for smokers in part because the administrative cost of tracking whether people smoke is burdensome, said CEO Kevin Lewis. Focusing on smoking prevention and helping people quit smoking are better uses of time and resources, he said.

In one example, a monthly premium for a “bronze” plan for a 40-year-old nonsmoker in Cumberland County would be $234 with Anthem and $243 with Maine Community Health.

Customers of Maine Community Health would have a $5,000 annual deductible while Anthem customers would have a $5,750 or $6,000 deductible.

Other differences in the benefit packages include varying rates for co-insurance — the amount the customer pays after the deductible is met — and emergency room and office visits.

The rates do not reflect federal subsidies for which many people who buy on the exchange will qualify. The subsidies, for people with annual earnings at 100 to 400 percent of the federal poverty level, will substantially lower the cost of insurance and limit out-of-pocket costs.

Currently for an individual, the federal poverty level is $11,490 at 100 percent and $45,960 at 400 percent. For a family of four, the numbers are $23,550 and $94,200.

Lewis said Maine Community Health tried to provide the best benefits to customers at the lowest costs.

Anthem spokesman Chris Dugan said consumers should be careful to examine the benefits they receive relative to the cost, since some plans may match their needs more closely than others.

For instance, someone who needs a specific prescription may choose a plan that more generously covers prescription costs.

Dugan said many preventive measures are now free under the Affordable Care Act, including annual physicals, cholesterol tests, vaccines and flu shots.

“There’s an extensive amount of education to come for consumers,” Dugan said.

The state Bureau of Insurance will host a series of public meetings this month to educate customers on the Affordable Care Act.

Lewiston Mayor Robert Macdonald issued a news release Monday criticizing the “narrow network” plan that Anthem is offering on the exchange. The network excludes central Maine hospitals, including Central Maine Medical Center in Lewiston, although Anthem is also offering a broad plan that covers health care providers statewide.

On balance, the “narrow network” plan is less expensive, said Stein with Consumers for Affordable Health Care.

“This proposal is bad for patients, bad for (Central Maine Medical Center), and bad for the entire Lewiston/Auburn region,” Macdonald said in his statement. “It is clearly intended to advance the financial interests of Maine Medical Center and the Portland region to our detriment.”

All Maine Community Health Options plans have networks that cover the entire state.

Dugan said residents of central Maine will have many choices for health insurance, including plans offered by Anthem and Maine Community Health.

The narrow network “doesn’t impact the vast majority of consumers,” he said.

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