Buying health insurance probably isn’t among the more exciting purchases you’ll ever make. But like it or not, it’s one of the most important each year. So, we want to help you get it right.
When you start shopping for health insurance, likely the first thing you’ll check is the price, or monthly premium. This makes sense, but just like buying a car or a house, price doesn’t tell the whole story.
You might think of the premium—the monthly charge for coverage—as a “sticker price.” But that’s only the beginning of what you’ll pay because most plans include co-pays, co-insurance and deductibles, which all add up to how much you pay out-of-pocket annually. You can learn more about those costs here.
It’s important to understand the benefits you’ll use because they directly impact how much you might pay to reach an annual maximum out-of-pocket limit, when insurance takes over and pays all your costs. Generally, the less you pay for insurance, the higher your deductible—and the more you’ll pay out-of-pocket as you use more services. So, knowing what you might need will help you limit out-of-pocket costs and maximize your benefits.
You’ll also want to understand types of coverage and be sure your carrier offers a comprehensive network. For example, an “HMO” which stands for health maintenance organization; gives you access to preferred providers; but you’ll need to stay in-network to get coverage. A second popular option, a “PPO,” or preferred provider organization, costs more but affords the freedom to use out-of-network providers at a slightly higher price.
Within each type of plan, deductible costs are designated by Bronze levels, which cost the least, and Silver, Gold and Platinum levels which cost more, but have lower deductibles. You can learn more about those levels here.
As you compare plans, you’ll get information about costs and coverages, but you’ll also see which plans offer services like wellness programs, dental or eye exams, or chronic care programs to support you along the way. Unique to Health Options, for example, is a care management program that partners with community services to support wellbeing, such as providing transportation to appointments or even meals for someone who is recovering at home.
You might consider a Silver, Gold or Platinum plan if:
You might consider a Bronze plan if:
While costs can weigh heavily when selecting a plan, it’s most important to choose coverage that fits your needs. And you might find help paying for insurance thanks to the recent passage of the 2022 Inflation Reduction Act, which extended Affordable Care Act premium tax credits. To find out if you’re eligible, visit CoverME.gov, Maine’s online Health Insurance Marketplace. For information or to get help choosing a plan, you can also call Member Services at (855) 624-6463.
The Merger of Maine’s Small Group and Individual Health Insurance Markets Reduces Premiums Near-Term While Standardizing Plan Design for Employers
The CMS announcement on Friday, July 15th of its official approval of the Mills Administration's request to extend the state’s reinsurance program over the combined Individual and Small Group markets provided the final statutory requirement for the establishment of the merging of these markets beginning 2023. This piece explores some of the opportunities and challenges for Small Group health insurance decision-makers and the brokers that support them.