Harvard Pilgrim Health Care will likely insure Mainers in the federal health insurance marketplace next year, according to company officials.

The nonprofit insurance carrier would join Maine Community Health Options and Anthem Blue Cross/Blue Shield in the marketplace, a key element of the Affordable Care Act that reduces the ranks of the uninsured.

“We believe in the ACA’s goal of providing affordable health care coverage for everyone,” said Edward Kane, vice president for Harvard Pilgrim Health Care’s Maine division, when asked why the company, which already operates in Maine, will likely enter the marketplace.

Barring unforeseen circumstances, Kane said, Harvard Pilgrim will offer plans to Mainers for 2015, with sign-ups to begin this fall.

Companies have until May 31 to file paperwork to enter the marketplace for next year. Harvard Pilgrim has not yet done so.

Aetna, which sells small-group plans in Maine but is not participating in the Affordable Care Act’s Maine marketplace, has not yet decided whether it will join, said an Aetna spokeswoman.


The six-month enrollment period for individuals to buy insurance in the marketplace for 2014 ended Monday. About 7.1 million Americans enrolled. More than 25,000 Mainers had signed up through February, the latest month for which statewide numbers are available.

The marketplace offers subsidized insurance for individuals whose earnings are 100 percent to 400 percent of the federal poverty level, with subsidies for single adults earning up to about $50,000.

Harvard Pilgrim was the sole insurance carrier for Maine’s Dirigo Health, a state program to provide affordable insurance that was phased out at the end of 2013.

Mitchell Stein, a Cumberland-based health policy analyst, said, “We were a little surprised (Harvard Pilgrim) didn’t participate in the first year” of the ACA marketplace, considering its role in Dirigo Health and its base in New England.

Kane said his company’s decision to stay out of the marketplace in Maine this year was one of timing, not desire. “We needed a little more time to prepare; that’s it in a nutshell,” he said.

Harvard Pilgrim offers insurance in the marketplace in Massachusetts, which had a comparable health insurance system before the ACA became law. Stein said the company’s experience operating in a highly regulated marketplace, dating back to the mid-2000s in Massachusetts, should help it as it expands to more states.


The Affordable Care Act, signed by President Obama in 2010, was modeled in part on Massachusetts’ health reform program.

Stein said Harvard Pilgrim’s move to join the marketplace in Maine is a sign that the system “is working and almost certain to grow.” With more companies joining the marketplace in Maine, the effects on premiums will be watched closely, he said.

Increasing choices for consumers should push prices down, Stein said, although it’s still unknown how the demographics of the people insured this year could affect next year’s rates. The 2015 rates won’t be known until later this year, according to the Maine Bureau of Insurance, with rates finalized by the fall.

Experts have speculated that younger, healthier consumers waited until the last few weeks to sign up on the marketplace. They say those people help to limit the cost of insurance by offsetting the cost of care for older, sicker people.

Through February, nearly four of every five Mainers who bought plans in the marketplace chose to be insured by Maine Community Health Options, a new health insurance co-op, instead of Anthem.

With more insurance carriers in the marketplace, Maine Community Health Options doesn’t expect to maintain such a dominant market share, said its CEO, Kevin Lewis.


“We’ve been counting on additional carriers entering the marketplace,” he said. “From the consumer’s point of view, there will be a wide array of choices.”

Lewis said that capturing such a commanding market share was a “pleasant surprise,” but it’s not the goal of the co-op.

“Our success is not determined by that percentage,” he said. “It’s by offering consumers good choices at a competitive price.”

In determining what its rates would be, Maine Community Health Options didn’t know how many other insurers would join the marketplace for 2014. “We developed our plans from the ground up,” Lewis said.

Because of the myriad of plans offered, with various deductibles and co-pays, it’s not clear whether Maine Community Health Options and Anthem offered plans that differed much by price, according to Bureau of Insurance filings.

Joe Lawlor can be contacted at 791-6376 or at:


Twitter: @joelawlorph


Comments are no longer available on this story