Frequently Asked Questions (FAQ)

What is Maine Community Health Options? 

New Health Insurance Option for Residents of the State of Maine: Maine Community Health Options

There is 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 is the only Maine-based health plan that is also governed by the same people who are covered by its policies. The CO-OP offers health plans for individuals and small businesses (< 50 employees), and also provides 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 nonprofit 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 differentiates 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 offers health insurance plans to Maine residents: individuals, families, and businesses both on and off the Health Insurance Marketplace (HIM) beginning January 1, 2014.

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 is 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. Click here to search our Provider Directory.

What role do physicians and providers have in this plan? 

We believe providers and patients know how best to improve health and well-being. We are 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 does 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 focuses 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 does 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 does MCHO support the patient-physician relationship? 

MCHO utilizes 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 supports.

Where can I get more information?  

You can visit our website at www.maineoptions.org for new information. You may also email your questions to Bill Schulz, Director, Provider Network Operations (wschulz@maineoptions.org) or Karen Getchell, Manager, Provider Contracting (kgetchell@maineoptions.org)