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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

Once upon a time, anyone who needed immediate medical attention would head to the emergency room (ER). Today it’s important to know all the options available so that when a time of need comes, you're better prepared to get the care you need at a cost that won’t break the bank.

First, it’s important to say that, in cases of a medical emergency, dialing 9-1-1 or/and heading to your nearest emergency room is still the way to go. But, for less urgent needs, like a bad sprain or high fever, we recommend using an Urgent Care Center, which is available without an appointment and is typically less expensive than the emergency room. Review this list of Urgent Care Centers in New England or have it handy to familiarize you with the Urgent Care Centers nearest to you.

For even less urgent needs – like a chest cold that won't go away, or those times when a child needs a sign-off for a minor injury to play sports – you also have a telehealth option. Health Options offers Amwell® Urgent Care telehealth at $0 cost-share on all non-HSA plans and $64 and $0 after the deductible for HSA plans.

The Amwell telehealth platform makes it easy to talk to healthcare professionals trained in internal medicine, family medicine, emergency medicine, and pediatrics about non-emergency needs whenever you need. For even more ease, if your telehealth provider recommends a prescription, you can get refills or be prescribed new medication. Note: Some prescriptions, including controlled substances, cannot be prescribed online. 

To get started with telehealth services, log into your Member portal, and click on the Health & Wellness tab. Once you've registered, your information will be stored for future visits. Telehealth makes access to care easy and affordable – no waiting room required.