Maine Bureau of Insurance warns of ACA scams, substandard plans
by Joe Lawlor - Portland Press Herald - November 28, 2023
To find an Affordable Care Act plan, visit www.CoverME.gov.
As open enrollment for Affordable Care Act plans continues, the Maine Bureau of Insurance is warning consumers to be cautious of scams, limited-benefit plans and misleading information when searching for a health care plan.
The website to find ACA plans in Maine is www.CoverME.gov. Open enrollment for 2024 plans started on Nov. 1 and continues through Jan. 16. About 63,000 Maine people have individual plans through the ACA.
The insurance companies licensed to sell individual ACA plans in Maine include Community Health Options, Anthem, Harvard Pilgrim/Point32, United Healthcare and Taro Health. Other products resembling major medical health insurance are sold, but are either not insurance or offer limited benefits.
“If you purchase a non-regulated plan, the Bureau of Insurance may not be able to assist you if the company later does not pay claims as promised,” said Timothy Schott, the bureau’s acting superintendent. “It is worthwhile to spend a little time and make sure that you are purchasing an authorized insurance plan from a Maine licensed company.”
Aside from the official website and working directly with the five ACA insurers in Maine, purchasing plans from other entities may result in getting a substandard health insurance plan, or a plan that is not actually health insurance.
For instance, consumers who use “lead generating websites” are “often sold limited-benefit insurance plans instead of major medical health insurance plans,” the bureau said. The websites often show up when putting in a simple online search for Maine ACA health plans.
“There are crucial differences between these types of plans – major medical plans are traditional health insurance that covers preventive services, office visits, inpatient and outpatient services, and emergencies, while limited-benefit plans only cover specific medial issues (such as cancer) up to a certain dollar amount,” the bureau said.
Another common problem is that there are products that look like health insurance, but are not insurance, such as “health care sharing ministries.”
“Health care sharing ministries are not insurance plans and do not guarantee that all your claims for medical services will be covered. If your medical claim does not meet the sharing criteria for any reason, you will be responsible for the entire medical bill. If the ministry has spent what they collected, they may not be able to pay your claims,” the bureau said.
In addition to plans that offer few benefits, there are also numerous scams, where consumers will think they are purchasing insurance, but instead pay money for a plan that doesn’t exist.
ACA rates for Maine’s health insurers increased by 14.6% for 2024, although about 80% of consumers are shielded from rate increases because they are low- or middle-income and qualify for subsidies.
The Maine Bureau of Insurance listed the following “red flags” to help determine if you are being sold a scam or a substandard plan:
• The person on the phone won’t identify the name of their company.
• The person on the phone won’t provide you with their Maine license number.
• You are not given the chance to review documents prior to purchasing the plan.
• The person on the phone insists that you must make your purchase “right away” or you’ll lose the deal.
• You are told you need to pay a fee in order to purchase the plan.
• You are told you must join an association in order to purchase the plan.
Penobscot voters pass referendumon on Publicly Funded Health Care /
by Chris McKinnon
The question of which Maine town would be the first to pass a referendum supporting publicly funded universal health care was decided on November 7th, when voters in Penobscot went to the polls to decide the question: “Shall the citizens of Penobscot call on the Maine Legislature to create a publicly funded health-care plan that provides every Maine resident with comprehensive medical care?” And by an impressive 2-1 margin the people of Penobscot, in Hancock County, gave their approval.
Penobscot voters delivered a resounding victory, raising expectations for future victories. More voters will address the same question in 2024 in town meetings across the state. Penobscot went first, in no small measure, because of the diligent and effective advocacy of Hancock County resident, David Jolly, who serves on the Board of Maine ALLCare, the group behind the referendum question.
It might also be noted that Maine people have passed comparable resolutions through representative meetings, boards, and councils in municipalities across the state. “[C]hange is possible at the state level,” David Jolly, Maine ALLCare Board Member, believes. And “Maine AllCare wants our state legislators to make that happen here.” That’s “why we ask all Maine residents to work with us for high-quality, affordable health care for all,” he adds.
The referendum was promoted by Maine ALLCare, an organization singularly devoted to securing universal health care for all Maine residents. Founded in 2010, with an all volunteer staff, the organization was quick to advance the cause of publicly funded health care for all Mainers. A central premise of Maine ALLCare’s project is “that health care, a basic necessity, be treated as a public good, since it is fundamental to our well-being as individuals and as a democratic nation.”
By 2014, with an increasing base of support, Maine ALLCare successfully championed a universal, single-payer health care bill, LD-1345, through the Maine Legislature. The bill passed both House and Senate by a sizable margin, 91-52 and 20-14, in turn. Regrettably, the bill was vetoed by the extreme right-wing Republican governor, Paul LePage. An attempt to override the unpopular veto fell short by four votes and the bill died.
But today, the cause has a renewed impetus thanks to the ongoing leadership of Maine ALLCare, its staff and volunteers, and to Maine people who once again demonstrated their support for publicly funded universal health care. As the fight continues, the challenges of confronting the existing for profit system will intensify.
Health care is central to the life of everyone. But capitalism is averse to ensuring health care as a human right. Taking private profit out of the health industry will provoke stiff resistance from the capitalist class. It will take a broad and inclusive working-class movement to prevail and to win for all Maine residents what the voters of Penobscot, Maine demanded of our state legislators on Election Day 2023.
Chris McKinnon is a grassroots activist and retired librarian living in central Maine.