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New in 2022: A Look at Changes in Individual/Family Health Insurance Plans

Oct 15, 2021

Fall is a time for back to school, state fairs, “leaf-peepers,” and thinking about your healthcare insurance. Open Enrollment season, as we call it in the business, begins November 1 and lasts through January 15, 2022. This season brings some positive changes in health insurance including changes in Health Options’ plans.

First, all health insurance carriers in the individual/family marketplace will offer Clear Choice plans to bring more transparency to the buying process. These plans are designed to make it easier for Maine people to compare options across health insurance carriers. Clear Choice plans have a standard cost-sharing design, meaning they have the same deductible, co-pays, and co-insurance for medical services across all health insurance carriers in the state. All Health Options’ Clear Choice plans are designated with “CC” in the plan name.  It is important to note there may be some differences between carriers in clear choice plans, so you will want to look beyond the cost-sharing. For example, Health Options offers a chronic illness support plan to reduce the cost of care for Members with asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, and hypertension in many clear choice plans, and other carriers do not have this exact benefit. 

Also, for 2022, Health Options is pleased to add a tiered provider network to some of our individual/family HMO plans. In our tiered plans, primary care providers, imaging, labs, and out-patient hospital services are categorized by a preferred or standard tier.  The preferred tier offers high quality, lower cost-share providers and service options. Plan Members are easily directed to preferred tier providers and locations when completing a provider search. Tiered plan Members can continue receiving services from a standard tier provider with a standard co-pay. 

In another change to our provider network selections, we offer several plans that include national in-network coverage through First Health®. These plans are ideal for individuals and families who spend time outside the New England region and need reliable coverage both at home and on the road. Other plan enhancements include $0 cost for urgent care telehealth on non-HSA plans through our partnership with Amwell®. Health Options will also be offering Maine’s only Platinum health plan in the individual/family marketplace, which has the lowest deductible and cost-share across plans and offers co-pays with no deductible for in-network primary care, specialists, behavioral health visits, and urgent care facilities.

Finally, there are some legislative changes affecting health insurance in Maine. If you’ve used Healthcare.gov to learn about tax credits and other cost reductions, you will now be using CoverME.gov, Maine’s new online Health Insurance Marketplace. CoverME.gov is operated by the Maine Department of Health and Human Services. With the American Rescue Plan enacted earlier this year by the Biden Administration, more Mainers than ever are now eligible for advance premium tax credits (APTC) to help pay for coverage. Be sure to visit our storefront (healthoptions.org) to check your eligibility for tax credits and go to CoverME.gov after November 1, 2021, to January 15, 2022, to apply for the APTC and/or for cost-sharing reduction credits.

While these changes are all good news, we know how hard it can be to navigate health insurance decisions. As always, we are here for you. Our Member Services team can address any questions you have regarding your 2022 healthcare coverage. If you need help selecting a plan, go to healthoptions.org or call Member Services at (855) 624-6463, Monday through Friday, 8:00 a.m. to 6:00 p.m.  You can also reach out to your trusted broker.

SEE ALSO

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 have a chronic condition like asthma, diabetes, coronary artery disease or cancer
  • You have a planned surgery coming up
  • You frequently visit specialists or your primary care physician
  • You are planning to have a baby or have small children
  • You take expensive brand or specialty medications

You might consider a Bronze plan if:

  • You are healthy and take few medications
  • You rarely see a doctor

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.