What is Maine Community Health Options?
A New Health Insurance Option for Residents of the State of Maine: Maine Community Health Options Starting in mid-2013 there will be a new health insurance option in Maine: Maine Community Health Options (MCHO). The federal Affordable Care Act (ACA) includes an important provision that facilitates the development of nonprofit, member-directed health insurance companies, called Consumer Operated and Oriented Plans (CO-OP). MCHO is one of 24 CO-OPS in the country.
MCHO was organized in 2011 as a result of a $62.1 million in federal loans from the Centers for Medicare and Medicaid Services (CMS) to support the developmental needs ($7.1m) and reserve requirements ($55m) to create the reserve requirements to create the CO-OP. It will be the only Maine-based health plan that is also governed by the same people who are covered by its policies. The CO-OP will offer health plans for individuals and small businesses (< 50 employees), and also provide health insurance options for the large group market.
The ACA charges CO-OPs with being innovators in health care delivery and insurance benefits, and to be leaders in reform efforts. The federal law also requires that any surplus revenue the CO-OP generates must be returned to its members in the form of lower premiums or cost-sharing, improved quality, expanded benefits or financial stabilization. CO-OPs are self-governed by an elected board, but are subject to the same state rules and regulations regarding minimum benefits, actuarially equivalent packages, and reserve funds as traditional health insurance companies.
What distinguishes a CO-OP from other non-profit insurers is that the CO-OP is member-governed, and organized solely to keep members healthy, health care costs low, quality high and provide consumers and businesses with a new choice for health insurance.
What is a Health Insurance Marketplace (HIM)?
The Health Insurance Marketplace (formerly known as "Exchange") is a new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, members will be getting their health care insurance through the Marketplace and you will be able buy your insurance through the Marketplace too.
What will differentiate Maine Community Health Options from other insurers?
Anyone who is covered by a CO-OP health plan is a CO-OP member, and the CO-OP operates solely for the benefit of its members. A CO-OP can never be sold or acquired.
Because net revenues must be returned to the members in reduced premiums and/or increased benefits, all CO-OP members have a stake in the success of the plan. When members are active in managing their own health and use the health care system wisely, members ultimately benefit from reduced total costs.
CO-OP members have a voice in the values, direction, goals and governance of the CO-OP.
The CO-OP is dedicated to reducing costs and improving health care.
MCHO is designated by the U.S. Department of Health and Human Services (HHS) as the only Consumer-Operated and Oriented Plan in Maine.
The Health CO-OP will fill an important niche in the community of cooperative enterprises in Maine.
Who can buy insurance plans from MCHO?
MCHO will offer health insurance plans to Maine residents: individuals, families, and businesses both on and off the Health Insurance Marketplace (HIM) beginning January 1, 2014.
When will the CO-OP insurance plans be available?
Enrollment will begin in October of 2013 for coverage beginning January 1, 2014.
What are some of biggest tasks ahead for MCHO?
The enrollment period for our health insurance is October 2013 for a start date of January 1, 2014. In the meantime, we are reaching out to the people of Maine share our goals and plans. Additionally, we are developing our health insurance plans and benefits, creating provider networks and hiring and building a top-notch staff.
How much will the CO-OP’s health insurance plans cost?
It’s too early to know what the premiums will be for 2014, but our goal is to offer plans that beat our competition. Additionally, subsidies will be available to people at 133 – 400% of poverty level to ensure everyone has access to coverage. We will offer creative plan designs that give consumers positive incentives to get healthy and use health care wisely. The beauty of the CO-OP’s structure is that when our members are healthier and better health care consumers, they will enjoy lower premiums and better benefits.
Is the CO-OP financially secure?
Yes. MCHO is backed by $55 million in solvency reserve loans that were awarded by the US Department of Health and Human Services / Centers for Medicare & Medicaid Services (CMS).
Is MCHO run by the federal or state government?
No. MCHO is a Maine-based, private, not for profit entity.
Who will be included in the provider network?
A statewide network of physicians, hospitals, and other providers is in development with a focus on supporting the work in Maine on patient centered health homes, integrated behavioral health, and oral health.
What role will physicians and providers have in this plan?
We have already had discussions with providers who are interested in providing services to match their community needs. We believe providers and patients know how best to improve health and well-being. We will be flexible in our approach and responsive to ideas that providers have – including patient centered medical homes, telemedicine and other innovations that will improve health and save costs.
What features will MCHO offer that will help improve healthcare in Maine?
Improving the cost, quality, and outcomes of healthcare in Maine means improving value for the people of Maine. Improving value is an important goal of MCHO. We want our members to get the highest quality health care locally and to have the best experience possible. Together with our patients and providers, MCHO will focus on the following goals:
Increasing appropriate use of preventive care services
Better disease management
Promoting community resources
Improving health outcomes
Using technology to share information
Integrating primary care and mental health care
Improving communication between patients and providers
How will a CO-OP health plan help Maine's economy?
Individuals and small businesses in Maine currently do not have many options for health insurance. This is a big problem in a state like Maine, where our economy is driven by small businesses who have very little say in the health insurance market. Many people do not have health insurance now or are at risk of being without health insurance. Also, many who are insured have limited coverage (underinsured). MCHO will provide affordable options to small businesses, individuals, and families. MCHO also has many other goals to help the people of Maine, including:
Helping patients get more involved in their care
Lowering insurance costs or making costs more stable for Maine’s business, individuals, and families
Supporting doctors and providers who use practices that most often lead to better patient outcomes
Lowering administrative costs
My insurance advisor says this is risky. Why should I become a member of MCHO?
Unfortunately, all health insurance is risky. Right now, your risk includes high-premium increases, decreased benefits and the loss of coverage. With MCHO, you are part of a member-governed cooperative where your interests are also the primary interests of the cooperative, since you and the other members are the cooperative.
Will brokers in our communities be knowledgeable about MCHO’s products?
Maine Community Health Options will partner with select brokers to ensure they have the tools and materials to assist small businesses in making the right decisions. Feel free to contact MCHO for the names of brokers that we work directly with or to speak to anyone of our member relations resources to assist you.
How will MCHO help patients be more involved in their care?
As a member-led plan, patients will be given a larger voice and more opportunities for involvement in their health. Health insurance plan design will support shared decision-making and member-focused decision support tools.
How will MCHO support the patient-physician relationship?
MCHO will utilize a variety of methods to foster both provider and patient engagement. Support for local practices, electronic medical record (EMR) connectivity and improved integration of care are among the approaches that MCHO will support.
How will MCHO support small businesses?
MCHO will offer more health insurance options for small businesses. Additionally, as a member-led plan, business customers will have a broader opportunity to be involved with the ongoing development of the health plan. We will also provide tools and support to small businesses that will help educate employees and motivate them to become more involved with their health and healthcare. Successfully engaging employ¬ees in their healthcare will help lower premiums.
Where can I get more information?