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2020 Individual Insurance Market – Hot Topics

Explore the latest trends in Maine's health insurance market as we analyze individual and small group insurance plans for 2020. Learn about rate filings, coverage options, and legislative changes impacting the insurance landscape. Key topics include the Maine Guaranteed Access Reinsurance Association (MGARA), the impact of the Affordable Care Act's Section 1332 waiver, and updated requirements for coverage such as hearing aids and telehealth services. This report is essential for consumers, insurers, and stakeholders navigating Maine's evolving health insurance environment.

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2020 Individual Insurance Market – Hot Topics

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  1. 2020 Individual Insurance Market – Hot Topics HC4ME October 3, 2019

  2. Consumer Health Care Division/BOI Health, life, disability, LTC, Medicare supplement, annuities Ensures that forms from insurers to consumers comply with statutes and regulations Assists Mainers having problems with their fully-insured plans Provides information/answers questions about insurance, rights, and responsibilities

  3. Maine’s Health Insurance Market Looking at trends Looking at 2020

  4. Health Insurance Coverage

  5. Maine’s Health Insurance Enrollment Enrollment reported as of 3/31 except for 2013 & 2014 is year end.

  6. Average Health Rate Increases

  7. Maine Guaranteed Access Reinsurance Association (MGARA) • Purpose: stabilize and reduce premiums in individual market; encourage participation (or continued participation) of carriers • ACA Section 1332 “State Innovation Waiver” application • Restart: 1/1/2019 • “Invisible high risk pool”

  8. MGARA 2019 YTD 1332 grant transfer to MGARA completed 6/26/19 $23,910,080 drawn from MGARA's account with the Feds as of 8/15/2019. As of 6/30/2019: Ceded lives: 3227 Ceded premium: $15,963,061 Assessment revenue: $5,452,869 Claims incurred: $34,542,973

  9. 2020 Individual and Small Group Approved Health Insurance Rate Filings Individual HealthcarePlans Small Group HealthcarePlans

  10. 2020 Plans By Network Type, Metal Level & Carrier

  11. BOI 2020 Individual Market Rate Calculator

  12. Catastrophic Plans • High deductibles, plus 3 PCP visits & preventive care • Eligibles: • People under age 30 • Hardship/affordability exemption (for households whose premiums are more than 8.24% of their income) • No premium subsidies • Cannot combine with an HSA • Won’t necessarily show up on lists of plan options for people aged 30+ • Exemption process goes through healthcare.gov - can be lengthy

  13. Hot Topics Maine’s Legislative Session Washington, DC

  14. Health Benefits For health plans issued or renewed on/after 1/1/2020 Hearing aids: all individual & group plans must cover up to $3,000 for those over 18 with documented hearing loss. Colorectal cancer screenings: removes age. Now, most recent cancer guidelines (age 45). Abortion: a carrier covering maternity services also provides coverage for abortion. Telehealth/telemonitoring: coverage for any medically necessary service delivered through telehealth, including telemonitoring.

  15. Pharmacy Benefit Manager (PBM) Licensure Effective 1/1/20, but PBMs with current registration – 4/1/20 • Licensure: application and checklist went live 10/1/19 • Carrier responsible for activities of PBM; PBM has fiduciary duty to carrier • Allows payment of cash price for meds and not filing a claim if cash price is less than cost-share • Prohibits spread pricing • Requires that all rebates must be remitted by PBM to carrier and used to lower premiums • Rulemaking starts soon

  16. Short-Term Limited-Duration Policies Bulletin in the works: • Nonrenewable • Issued for period ending 12/31 of issue year • All prior policies can’t exceed 24 months (combined, regardless of same or different carriers) • 12 months between policies • Subject to State mandated benefits, preventive coverage • Forms & rates are pre-approved • MLR minimum: 50% • In-person broker sales only • No marketing of 1/1 policies during open enrollment • Written disclosure required by carrier or producer

  17. Association Health Plans Maine’s position has not changed: • Non-fully insured AHPs: MEWA licensing law, solvency requirements, actuarial review of rates (and community rated small groups), network adequacy requirements, mandates for small groups, joint & several liability • Fully-insured AHPs: 24-A M.R.S. § 2805-A (association groups); § 2806 (trustee groups); § 2808 (other groups) • Rate review if they include small groups • Form filing • Bona fide sponsoring organization approved by the Bureau as meeting the requirements of Maine law for either an association, trust, or “other” group

  18. Maine Bureau of Insurance Maine.gov/pfr/insurance 1-800-300-5000 (TTY: Relay 711) Insurance.pfr@maine.gov

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