September 28, 2017

Cioppa issues 'urgent message' for Maine's ACA marketplace customers

Maine Insurance Superintendent Eric Cioppa took the unusual step Wednesday of issuing what his office characterized as an "urgent message" for Mainers purchasing health insurance coverage on the state's individual health insurance exchange for 2018.

Responding to Anthem Blue Cross and Blue Shield's announcement that it was pulling out of Maine's Affordable Care Act Marketplace for individual coverage in 2018, Cioppa issued this advisory to those seeking individual coverage: "Take the time to compare your options, and do it before open enrollment ends on Dec. 15. As most people are well aware, there has been quite a bit of turmoil in the insurance market this year. This has resulted in higher rates, and also in fewer choices."

Anthem's departure leaves about 28,000 Mainers in need of finding a different plan, Maine Public reported.

A news release from Maine's Bureau of Insurance reported that Community Health Options and Harvard Pilgrim will continue to offer plans both on and off the ACA marketplace. Anthem will continue to sell plans off the marketplace, but those plans can't be purchased with premium subsidies available under the ACA and would not provide "cost-sharing reductions," or CSRs, to eligible low-income consumers, according to the bureau.

Uncertainty over 'silver plans'

But Cioppa's news release also noted "it remains uncertain" whether the federal government will continue to fund the CSR subsidies, which automatically lower the deductibles and other cost-sharing for "silver plans" purchased on the ACA marketplace by individuals with incomes between 100% and 250% of the federal poverty level.

"If federal funding is discontinued, these extra benefits will have to be funded by increasing the premiums for those 'silver plans' that are sold through the marketplace," Cioppa wrote.

"The important thing for consumers to know is that because the CSR program has not been funded, 'silver plans' might no longer be the best choice for many consumers, particularly those who are not eligible for CSRs."

Given the volatility and complexities involved, Cioppa encouraged consumers to contact the bureau if they need help in evaluating their options by calling 1-800-300-5000 Monday through Friday from 8 a.m. to 5 p.m. or emailing questions to

Cioppa said that the bottom line is that the complicated pricing structure makes it more important than ever for consumers to look carefully at all costs involved in the plan they choose, including:

  • the premium payment (including any premium subsidy they may receive to help cover the cost);

  • the deductible amount that will have to be paid before the insurance company begins to pay;

  • the co-insurance amount that they will need to pay after the deductible is met; and

  • any co-payments to see primary care providers or specialist, as well as for medications.

Anthem voiced misgivings during rate filings

Anthem's departure from Maine's individual ACA marketplace is not entirely a surprise, since the insurer had testified in 2018 rate filing documents that the "individual ACA market is becoming increasingly unstable."

It also expressed concern that the potential "absence of funding of CSRs" would make the risk of the ACA individual market "materially worse in future periods."

Community Health Options and Harvard Pilgrim cited similar misgivings in their rate filings about political volatility creating challenges for insurers in the ACA exchanges.

In late August, Cioppa approved average rate rate increases ranging from 18% to 27% for plans offered by Community Health Options, Harvard Pilgrim and Anthem for 2018.

CHO issues statement

In a news release sent to Mainebiz this morning, Lewiston-based Community Health Options announced today that it is committed to the Maine individual on-exchange market for plan year 2018.

"We at Community Health Options remain committed to the Maine market, to Maine businesses and consumers," CEO Kevin Lewis said. "We continue to focus our efforts to provide greater efficiencies, provide excellent member service in all aspects of our company, and fulfill our mission of better health outcomes at lower total costs of care. While the landscape of health reform has been murky of late, our ongoing efforts to do well for Maine people has never been clearer."

Lewis underscored Cioppa's advisory about the coming open enrollment period for 2018, which begins Nov. 1 and runs through Dec. 15.

"This is a change from previous years, when open enrollment lasted three months," Lewis stated. "Consumers are encouraged not to delay and enroll by Dec. 15, 2017, to ensure coverage starting Jan. 1, 2018."

Lewis said CHO will be offering a new suite of HMO products for the individual market in addition to our traditional PPO plans and expected that Anthem's departure will increase its membership for individual ACA coverage.

"We have demonstrated sufficiency of capital to bring on more members and encourage Maine consumers to review our plan designs and broad network access that we support for our membership," he wrote. "Political turbulence has been a mainstay of health reform for the past decade. We continue to focus on working with the available framework and bring the greatest value and service excellence to our membership."

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