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Individual health insurance rates set to drop by up to 60% as a result of Maine health care reform

Governor LePage joins with Republicans to sign the Maine health care reform law (PL 90) into law

There is encouraging news for Mainers coming out of the health care industry. Rates for individual health care plans in Maine are set to drop as much as 60% this July as a result of health reform law PL 90, also known as LD 1333, adopted in March 2011.

PL 90, the free market based health reform law, was passed last March by a Republican majority in Maine’s legislature. Governor Paul LePage signed the bill in a ceremony at the statehouse amid cries from Democrats that it wasn’t right for Maine.

“The law takes Maine in the wrong direction,” said Emily Cain, the house Democrat leader, at the time the bill was passed. But, if you’re a Mainer looking for individual health coverage, you’re probably going to be encouraged by the direction private health care costs are going – down.

“Since the law took effect this past October, we have primarily seen the laws impact to Maine’s small group insurance market with the vast majority seeing lower premiums,” said Joel Allumbaugh, President of the Maine Association of Health Underwriters and Health Care expert at the Maine Heritage Policy Center. “Now we are seeing huge progress in the individual insurance market as well, with rate decreases up to 60%, it’s a huge step forward for Maine.”

The rate filing, submitted this week by Anthem, the primary insurer offering individual plans in Maine, is not yet official. The rates would take effect in July, but first must be approved the state Insurance Superintendent. If the rates do take affect, it will be a relief for those paying for private individual insurance, or those who want to purchase a plan.

PL 90, the health reform law that Republicans guided through the legislature despite passionate opposition from Democrats, expanded the “rate bands” to allow a wider variation in cost between different aged applicants. In the past, insurance companies had to treat a 21-year-old and 55-year-old as basically the same. The new law allows for distinction in age groups.

Democrat Representative Sharon Treat was one of the strongest advocates against PL 90 during the debate about the health reform law. “Unfortunately, in the rush to pass LD 1333 [PL 90], the Republican majority is creating obstacles to better coverage and reduced costs,” she said at the time.

Now, it’s becoming evident that reducing costs to individuals is exactly what the law has done.

Even the “closed book” plans, which are individual plans that are renewing, versus brand new plans, are seeing benefits from the new law. In the past, the policies in the “closed book” category have seen yearly increases well above 10% annually. In the July Anthem filing, the average rate increase is just 1.7%, good news for those already holding individual policies.

Some of the new plans being offered in the individual market by Anthem, called the “HealthChoice Plus Product” include mental health services at no extra cost, when in the past the plans required a “rider” which raised rates by as much as 30%. Not only do the new plans cover mental health, they costs significantly less.

HealthChoice* $2,250 Deductible w/o Mental Health Vs. New Healthchoice Plus $2,000 Deductible w/Mental Health

A current plan, for a 45 to 49-year- old with a $2,250 deductible, without covering mental health, and without the effects of the health care reform law, would cost $601 per month for just one person. The new plan, which covers mental health, would have a $2,000 deductible and cost the individual just $362 per month, a 40% rate decrease according to the Bureau of Insurance.

For the plan holder 60-years-old and over, the current plan would cost $859 per month. As a result of the health reform law, the new plan would cost $645, a 28 percent decrease per month.

This is before new competition enters the fray, a likely scenario that the new law makes possible. Allumbaugh said that he anticipates additional insurers will enter the market, but are not prepared to offer products as early as July.

When new competition does enter the market, it would drive rate even lower, according to Allumbaugh.

Young people are big winners in the rate decreases. A 19 to 24-year-old will be able to purchase a health plan with a $2,000 deductible for about $200 per month, a significantly more affordable option than the current $450 per month for a similar plan. For many, this may be the difference between not being able to afford health care, and holding their own private policy.

A 19 to 24-year-old with a higher deductible of $10,000 could carry a policy for just $100 a month, less than the going rate to pay for a typical monthly iPhone plan. This could be especially important for those in that age bracket who may no longer qualify for MaineCare if cuts are passed in the supplemental budget being voted on this week to close an $80 million budget gap.

“Getting more young people into the market is a major plus for all Mainers and was a primary goal of the law,” Allumbaugh notes. “As this happens, the claims experience tends to improve and it can lower the rates even further for all age groups,” Allumbaugh said.

“This is precisely the impact the health reform law aimed for, lowering rates generally, but in a way that helps our insurance markets reverse the death spiral and begin to grow.”

Please add your thoughtful comment . . .
Matthew Lorono says:

And yet, Insurers often try to find
ways to get out covering catastrophic claims when they are made. Funny how that
works. Any altruistic view of any industry is pure foolishness.

Levanger Hallowell says:

MOTHER JONES seems to be breeding morons and idiots. 

Levanger Hallowell says:

Tell us about your pimp and his regard for your ‘silly ass’.  

Name calling gets you NADA.

Insurance provides the behavioral controls sadly lacking in a high risk society…the more risks you take, the more you pay in premiums. 

Sooner or later you decide to get off your couch and working off that ‘silly ass’ of your’s, and moderate your drinking, etc.

Socialized health covers your basic costs, and adds in a few thousand regulations… what happens when OBAMACARE won’t even insure you? 

Levanger Hallowell says:

So why do I always find one?

Rick says:

Whatever happened to being allowed, with limitations, to buy insurance out of state?

Dlbrt says:

Ronald Reagan created an UNFUNDED mandate that Hostpitals had to treat everyone!

Thats how the Costs Skyrocketed!

whawell says:

That was when health care costs and quality were much lower. Today the quality of health care has improved dramatically for most people, but not without higher costs.

whawell says:

Sorry, but if you are looking for an insurance company that operates at a loss you’ll have to search very hard. Operating at a loss long term is a road to extinction for any company. If you want expanded care like what you listed you had better be prepared to pay higher premiums because insurance companies can only remain in existence by making a profit. The best one can expect from insurance is protection against major medical expenses. Okay, I grant you might come out ahead in a given year or two, but over the long term – unless you have had major medical expenses -  you’ll end up each year paying out more out-of-pocket than what you got back.

whawell says:

Usually one gets no more than what he or she  pays for. That principle hold true for most things one buys, not just an insurance policy. If you’re single, I’d certainly suggest you shop around for a better plan while keeping in mind that insurance is meant for protection against unaffordable health care expenses. I say this because it appears some people, including at least one poster in this venue, have the false impression insurance is an investment like a stock or a bond where one stands to make money. Nothing could be further from the truth.

whawell says:

 You showed no evidence for your assertion that deductibles are a scam. Before you buy any insurance policy with a deductible, make sure you read it carefully. If the insurance company does not honor its commitment, then you might have a case for impropriety to announce to the entire world. I am now past retirement age and have checked all my statements for errors or omissions. In all my years I found one mistake, which the insurer promptly corrected when notified. My advice to you is this: don’t bite the hand that feeds you. Insurance policies are almost always work in your favor to protect your hard earned assets. This message comes from someone who has no connection to the insurance industry. Also, if you haven’t learned how to smile, start doing so now. It helps alleviate the pressures of life. :)

Dlbrt says:

Deductables are a scam!

Do they give Premium Deductables?


Dlbrt says:

What a load of bull!

It did 30 years ago when Insurance actually “”Insured””!

Dlbrt says:

What a Crock!

Dwj4357 says:

Are you saying John Baldacci’s cover up of “raping” the DHHS budget and Maine Retirement System that Marden’s CEO uncovered isn’t legit?? Get the facts before putting words in other people’s mouth’s. Gov. Lepage has done more for this State in his short time in office than Baldacci did in 8 years…Actually, we went backwards about 10years with Baldacci in office.   

whawell says:

You stated “If I get a $5,000 deductible policy, the coinsurance would have to run beyond $30,000 to be a break even proposition”. I think there’s a misunderstanding on your part as to how deductibles work. Deductibles are usually met when most or all covered costs of services amount to the deductible limit, not just the part of the costs the ensured person is responsible for paying, such as coinsurance. For young people who are healthy, I recommend a policy with a high deductible to protect themselves from having to pay out unexpected costly services that could cause them financial ruin, like expensive cancer treatments or open heart surgery. Keep in mind, the reason for any insurance plan is not to save on the cost of services. Insurance should never be viewed as a financial investment. Rather, it should be viewed as protection from financial ruin.

In all instance, health insurance should not be viewed any differently than any other type of insurance, such as, fire protection for your home.

I think he’s saying that Joel Allumbaum’s carved himself a nice little (lucrative?) niche in this health insurance debacle being foisted on the citizens…. 

Joel Allenbaum, a well paid lackey, blah, blah, blah.

As the experts on “cherrypicking”, you should know !

Why is it always the “liberal” media when they fail to trumpet all of the garbage generated out of this administration ? Some folks think we’ve heard more than enough from the Marden’s CEO…

The whole healthcare model needs to change because the ONLY role insurance companies play is to minimize access so as to maintain profits…they are the PIMPS in the present system of healthcare delivery. Why don’t you silly asses understand this ? Are the campaign contributions more important than the responsible expenditure of healthcare dollars ???

blue__sun says:

The point is you’re paying less because you’re getting less. You’re hunt for the socialist boogie man is comical.

ArtHenry says:

Someone is missing something here, I don’t know if it’s me, or others.
In the 90′s and before, our family had insurance from Mutual of Omaha, it was great and low cost, we could buy from anyone we wished, out of state or in, then in around ’96 the Democrats changed the law, drove all the health insurance co’s out of state, Omaha salesman called me, said they were leaving the state because of the new laws, and would not be serving new customers in Maine any more, so the populace ended up with two companies to choose from, nice deal..
It looks to me like the Governor is taking us back to free choice, Thanks Gov..

Dlibby8784 says:

READ the article… starts July 1

phinious says:

These plans are enough to make you go mental. Just wait till the Acme home health insurance sales man from east overshoe comes knocking on your door, or visits you in the hospital, and imagine the billing nightmare for the providers. 

phinious says:

I had an hsa. That money grows tax free and contributions are tax deductible. Why would I spend that money? The hsa is basically another IRA.

phinious says:

Me Too. I also carry the 500 dollar accident rider that adds $25 or so…I am about to go for the republican get sick and die plan.

phinious says:

I have been paying $275 for an anthem 15000/30000 deductible. I was just notified that my new premium would be going up to going up to $325. 
I am a 63 year old self employed ( employer) carpenter. I am looking at close to a 20% increase. ??????  The differential is only to get worse as the ratios move towards 5 to 1. Do you know any young people willing to trade their cell phone plan for a ten thousand dollar deductible  health insurance?

Watcher says:

 Maine is in this health insurance mess because of the Democrats who screwed it up for all of us. Over the last 30-40 years they made sure there was no high-risk pool, they made sure that people could get insurance anytime they wanted even if they were sick, they made sure they the citizen could not go out of state to get a better cheaper policy, they eliminated community rating. Then the bozo’s started a government run insurance program which did nothing but give people who didn’t need it subsidized insurance.  They Democrats ran all competition out of Maine.

Now that the Republicans are trying to correct the Liberal dimwits’ mistakes the Liberal are calling foul.    Typical of them to bitch and complain but offer no help or solutions.

Watcher says:

 Your link takes us to a blog by the Maine Center for Economic Policy which organization is a Liberal one antagonistic to Conservative ideas. It cherry picks data that support its view as NancyEH says below about the Maine Wire. It is not to be believed.

Levanger Hallowell says:

Are you saying he’s not an expert and you are?   

Levanger Hallowell says:

When Health insurance companies shunned the Maine market it was the hostile regulatory imposition by the Liberal Democrats who created a nightmare marketplace driving up costs by imposing mandate after mandate. 

At one time, you could shop on the internet for insurance from up to 100 providers; EXCEPT IN MAINE. The maps for providing quotes had every State except Maine.

The cost of getting a policy in Maine as astronomical; people sought out 0f state residency and got better coverage for half the cost. 

Levanger Hallowell says:

High risk pools have proven to be a very effective way to gather together high cost patients to plan and allocate resources for the specialized facilities that care for them.

Unless you’re a socialist, like Weinand,  seeking to sink the current insurance plan by bankrupting it with the most expensive patients. Fortunately, wiser and more rational people are using common sense to design a better way to deal with high risk patients. 

Levanger Hallowell says:

Joel Allenbaum, a real expert, provided the background based on testimony. 

Levanger Hallowell says:

People who pose the least risk should have the lowest rates.

I bet you’d be the first to complain if your premium for car insurance was the same as that for a driver with a bad driving record?

Levanger Hallowell says:

If profit is bad; what is loss? 

Levanger Hallowell says:

Routine health care is not what insurance is intended to cover, as much as your fellow socialists would like it to become.

The best vehicle—in terms of flexibility, and ease of use, is health saving account accessed with a debit card. It can cover nutritional supplements, fitness group membership, dental/eye glasses; and other expenses not covered under Obamacare.

My wife reluctantly got one, and loved to use it for routine maintenance.  

HSA…all the way! 

John says:

But I thought the government solved all problems…

Allows more people to afford a catastrophic policy. You really are an idiot McKane – people need affordable insurance for basic health care – like pap smears, and physicals, and wart removal, and stitches to close a cut, and tetanus shots, etc.

Catastrophic insurance doesn’t cover any of that. I never have understood why you are so in the pocket of for-profit health insurance companies. It’s actually beyond ideology.

But hey – at least you’ll not be troubled on having to vote to increase the monthly tax to fund MGARA. No – that will be someone else’s problem.

JeezumCrowe says:

Who wrote this piece? Why don’t they have the gumption to affix their name to it? Perhaps because if it’s sounds to good to be true … Truth is, it’s disgraceful, deceptive, agitprop.

Alright – this is really the last point:

Forgot to mention that Joel Allumbaugh, who works for MHPC, is also on the Board of Directors of MGARA, the State-run high-risk pool.

Matt Sparrow says:

Of course–the Maine Wire, like Fox news on “reports” on the parts of a story that support their world view.  Here is a more “Fair and Balanced” Report:

When will the Maine Wire begin presenting the truth?

NancyEH says:

MHPC/Maine Wire is known for cherry-picking data; in this case, highlighting one small group of health insurance consumers that had its rates lowered by 60%.  However, they admit the overall rate – for ALL consumers who can afford health insurance or have it paid for by an employer – went up by 1.5%.  Therefore, there must have been many, many consumers whose rates went UP by a lot. How about some facts? Check out’s-the-real-story-with-health-insurance-rates-in-maine/

One last point:

As this study from 2009 makes plain, it is common for one insurance company to dominate a market (in Maine, for example, WellPoint had 78% of the market).

This is by design. There are no laws or regulations that keep competition out of Maine or other states or metropolitan areas. Insurance companies have agreed to allow each other this dominance, as then they have no reason to lower premium rates. Winning!

Nor does the author mention that PL90 allows insurers to force very sick persons off their policies and into the State-run high-risk pool, known as the Maine Guaranteed Access Reinsurance Association (MGARA).

MGARA is paid for in part by a $4 a month tax on every person that has private health coverage. By shedding themselves of having to pay costly claims, insurers can lower premium costs for their customers. Of course, when the MGARA actually starts to provide coverage, and runs out of money, look for that monthly tax to increase.

Put more simply, socialize the risk, privatize the profits.

Hollyb says:

Nancy Pelosie, “Just wait and read the details later.”

The unknown author of this piece expects us to believe that the Health Choice and HealthChoice Plus plans are more or less the same – except that no information about the new HC Plus is available.

Further, there are three different HealthChoice plans currently marketed by Anthem:

joeatk says:

Jonathan, thanks 
I can obtain the information and run a spreadsheet.  But it is difficult to image a policy with a lower deductible and having coinsurance being less expensive than a policy  that has no coinsurance and no benefit payments until I reach a $15,000 deductible. If I get a $5,000 deductible policy, the coinsurance would have to run beyond $30,000 to be a break even proposition… run perhaps to $50,000 to get any savings. I already have a great deal of “skin in the game.”… $15,000. How many of Maine’s insured population has any more skin in the game?
But, I will call Anthem to get the numbers.

blue__sun says:

I’m not familiar with the plan but it appears mental health costs are not borne by this new alternative plan.  Who knows, there may be other exclusions.  Yes, Anthem is still going to look for the same level of profit so either you or someone else is getting less.

Lise from Maine says:


My husband has Anthem medical insurance at his work as a benefit package but he pays out of pocket for my medical insurance and guess what?

His out of pocket expense for my health insurance keeps going up and up and up, etc. every July. He and I both expect another hike this coming July.

We rarely use this medical insurance, but yet my husband continues to pay higher premiums every year.

What is wrong with this picture?

This article is deceptive in my opinion.

It favors young people who rarely get sick and who rarely use their medical coverage.

What about other people who are not in this age bracket?

60% rates drop?

We won’t count on it.

Thank you!

The Deductible amounts are not changed, in fact, you will be able to get a much lower deductible policy. Some of the changes are to the coinsurance after the deductible amount is met. This is a great idea – Allows more people to afford a catostrophic policy but also puts more consumer skin in the game.

joeatk says:

 I have not explored a “new plan”, but how much more “out of pocket” can you get than to have no coverage, no benefits, no co-pay,  nothing -  up to the $15,000 deductible?

CrisEdwardJohnson says:

I’m having a problem understanding this article in light of the notification that my friend (a small business owner living on the Mid-coast) just received from Anthem letting her know that her rates were going up.

What exactly does “up to” mean? Whose rates are going down? Whose
rates are going up?

How does a private insurer forgo 60% of it’s premiums and make a profit?

And what are you up to telling stories like this?

mainenowandthen says:

And just what is the “right direction”, Rep. Cain?  As usual, the Democrats are content to sit on the sidelines and carp, rather than make the effort to effectively lower health insurance costs.  It is no accident that for over a decade Anthem (a for-profit organization) has had free rein to inflate health insurance costs at will, rather than have to compete in an open market.  

PoliticallyRight says:

If you have an idividual policy, you will have to change to the new plan which, by the way, will have more out-of-pocket but ultimately is a huge savings and is what Maine people want.

tomuchbs says:

Good news for working mainers and young folks entering the labor market.  Thanks to the Governor and legislators that are fixing this mess.

As to hearing the news in the lib-think media papers, dont hold your breath.  The censorship and bias of the sussman news gorup should alarm all mainers that will be impacted by the lack of balanced news coverage. 

Maryjo02 says:

Our premium with Anthem is going up by 22% for a 59 year old and child. With a $2,500.00 deductible. The premium is 1,400.00 per month

Rbald says:

Great news! Wonder if the Portland Press Herald will report this? Today’s headline is about the cuts to Mainecare made by the evil, heartless Republicans led by Gov LePage. The challenge now before us is getting this news out to the public because the liberal news media certainly won’t do it.

joeatk says:

I just received my notification from Anthem of the change in my premium for a $15,000 deductible, individual policy.  I am between 60-65. The increase in cost is 18%;  $239/month to $281.64.
Where is the cost savings?

Glenhutch says:

This cannot be true since the progressives told us so. Great job and keep up the good work.

Hollyb says:

Good job! Every state in our country should us this as a Health Insurance model.