LEWISTON — Maine Community Health Options has won the state's approval to post individual and small-group plans to the upcoming Affordable Care Act health insurance exchange. It is now up to the federal government to give its OK.
MCHO, based in Lewiston, is the state's first health insurance co-op — a nonprofit governed for and by members. It will be one of two Maine insurance companies with plans on the exchange, or marketplace. The other is Anthem Blue Cross and Blue Shield.
An interstate company could offer additional plans in Maine, but none has filed a proposal with the Maine Bureau of Insurance.
The Bureau gave the OK to MCHO's seven individual and five small-group plans for the exchange. The federal government still must review the plans. It is expected to announce its decision in September.
Individuals and small groups will be able to buy insurance off the exchange starting Oct. 1. The insurance will take effect Jan. 1, 2014.
Those who buy individual plans from the exchange may be eligible for a federal subsidy in the form of a tax credit. The subsidy amount is calculated on a sliding scale for people earning between 100 percent and 400 percent of the federal poverty level.
About 124,500 Mainers now have individual or small-group health insurance plans, and another 133,000 have no insurance. Those 257,500 people are most likely to be affected by the exchange, by choosing it for themselves or working for an employer who chooses it. However, Maine Bureau of Insurance officials believe far fewer people will go through the exchange.
MCHO also received state approval for seven individual and five small-group plans available for purchase away from the exchange. It projects providing insurance for about 15,000 customers, the majority of them through the exchange.
MCHO plans will:
* Offer a broad network of hospitals and doctors.
* Pay for the first three appointments for behavioral health care each year.
* Pay for doctor visits, medication and other needs for patients with asthma, diabetes, hypertension or chronic obstructive pulmonary disease (COPD) in an effort to keep chronic conditions well-managed and to keep patients healthy and out of more expensive emergency situations.
* Encourage people to get or stay healthy by providing plan incentives — including money — for having a primary care doctor, getting active, eating well or engaging in other healthy behaviors.
Plan prices will be based on a person's age and location, but not on tobacco use.
"We have a generous tobacco cessation benefit and we want to encourage people to use it and to be able to move off of tobacco because of the long-term impact," CEO Kevin Lewis said. "And if we're asking people if they smoke or not and there's a big price differential, well, people that do (smoke) may then not 'fess up and wind up not availing themselves of the treatment that's there."
MCHO's plans are in bronze, silver and gold tiers.
MCHO also will offer catastrophic coverage with higher deductibles but the same free preventive care and behavioral health visits as its other plans. The first three visits to a primary care doctor each year are also free in that plan.
It is unclear how MCHO's plans and prices compare to Anthem's, the other company with plans on the exchange. Although the Bureau of Insurance released the plans' filings Wednesday, the hundreds of pages of documents did not provide the detail or clarity necessary for comparison.
"What was released today was absolutely confounding for the average consumer," said Joe Ditre, executive director for the Augusta-based advocacy group Consumers for Affordable Health Care.
Bureau officials say they are working on summarizing cost/benefit information for consumers. They hope to have it by late next week but say it could take longer.
MCHO offered some rate examples Wednesday. It expects to post detailed plan and rate information on its website next week.
The bureau will hold informational sessions on the Affordable Care Act in August. The central Maine session will be held at 6 p.m. Thursday, Aug. 29, at Central Maine Community College in Auburn.
This story was edited at 1:56 p.m. Thursday, Aug. 1.