I come from California and still haven’t quite wrapped my head around how few insurance companies are willing/able to do business in Maine. I had a Harvard Pilgrim plan through a previous employer, and was very impressed with them, but they just cancelled their individual product through Dirigo, right? I’ll be looking for coverage for myself (I don’t have an employer offering a plan). Should I look at plans outside of the exchange also? What is the difference between on the exchange and off?
Raisin In The Snow
Dear Raisin In The Snow,
It’s not so much that Harvard Pilgrim cancelled their Dirigo program – the whole Dirigo program is ending on December 31, 2013. Don’t worry though. The same principles and supports are largely still available through health reform rules. For example, you cannot be turned away or be charged a higher rate based upon your health.
The major difference between plans on the exchange and plans off the exchange is the availability of government subsidies. Only plans on the exchange get government subsidies. This is important, naturally, if you qualify for these subsidies. A single person earning less than $45,960 (400% of Federal Poverty) would qualify for some amount of help to buy his/her health plan. In theory, anyone earning more than 400% of Federal Poverty could buy a plan in either “place”. Higher earners may be tempted to go “off exchange.” These plans will have slightly more flexibility to adjust features, since they do not have to fit into the four tiers (bronze, silver, gold, and platinum). Time will tell.
First step, go to healthcare.gov and set up an account. You will get notified when the January 1, 2014 plan information is available. (Target date is October 1, 2013.) I would keep track of the healthcare.gov site, which is hosting the Maine exchange or marketplace. Once you know whether you qualify for a subsidy, then you can decide where to shop. Or the decision may be made for you, if you can get a subsidy by joining an “exchange” plan.
Take these steps before the end of the year, because open enrollment ends March 31, 2014. You can join a new plan during open enrollment, or if you are switching from one to another without a gap between plans. You cannot join a new plan during the year just because you feel like it. This is to protect the health plans from having people join the plan when they are feeling sick, and dropping out when they are feeling better.