Maine Community Health Options has asked the state to let it submit eleventh-hour modifications to its Affordable Care Act insurance offerings for 2018.

In a hearing Monday at the state Bureau of Insurance office in Gardiner, CHO said a series of new, lower-cost ACA insurance “silver” plans proposed by competitor Anthem Blue Cross and Blue Shield for 2018 threaten to lure away its members unless the nonprofit co-op is allowed to offer a comparable product line.

Both CHO and Anthem are requesting average individual plan rate increases of roughly 20 percent for 2018. CHO’s hearing before a six-member panel led by Superintendent of Insurance Eric Cioppa to discuss its request for a 19.7 percent increase occurred Monday, while Anthem’s hearing on its request for a 21.2 percent increase took place Friday. The hearing on Harvard Pilgrim Health Care’s 39.7 percent rate increase request is scheduled for Tuesday.

ACA insurance plans are ranked bronze, silver, gold or platinum based on the quality of coverage. In addition, there are “catastrophic” plans that provide the lowest level of coverage and are designed for young, healthy people.

At CHO’s hearing, CEO Kevin Lewis said the revelation at Anthem’s hearing that it might be able to push through silver plans that are comparable in price and coverage to lower-tier, “bronze” plans prompted CHO’s last-minute request to tweak its offerings for 2018. Representatives of CHO, Maine’s largest ACA insurer with about 40 percent of the market, said they were not expecting Anthem’s stripped-down silver plans to be accepted by regulators, but that they wanted a chance to make changes to their own offerings just in case.

“While we have no intention to create a silver metal plan with a lower premium than our bronze plans, we do need to make plan revisions to compete with this product structure should it withstand regulatory scrutiny,” CHO spokesman Michael Gendreau said. “For us, it’s about a level playing field and ensuring a competitive landscape.”


There are more than 40 ACA individual plans offered in Maine, all with differing deductibles, co-insurance rates and out-of-pocket caps, which makes comparisons and generalizations difficult.


If Anthem receives approval for its group of low-cost silver plans, known as Silver X 5800, it would be significant for multiple reasons.

In order to fully take advantage of federal subsidies under the ACA, eligible residents must purchase silver plans. The full range of subsidies is not available for bronze, gold or platinum plans. At a price comparable to bronze plans, the Silver X 5800 plan would likely garner a great deal of interest among Maine residents who are eligible for the subsidies.

However, the actual coverage offered by the plan is more akin to a typical bronze plan. In general, a bronze plan is expected to cover 60 percent of medical costs, while the coverage is generally 70 percent for a silver plan, 80 percent for a gold plan, and 90 percent for a platinum plan. A Silver X 5800 plan would cover just under 66 percent of medical costs.

Bureau of Insurance spokeswoman Judith Watters noted that each tier has an accepted range of actuarial values, which determine what percentage of medical costs are covered. She said the variation from the target level can range from four points under to two points over, which means an actuarial value of 0.66 (66 percent of medical costs covered) is considered acceptable for a silver plan. The Anthem Silver X 5800 plan is slightly less at 0.6584. No other silver plan offered by Anthem in Maine has an actuarial value of less than 0.698.


Watters said the federal Centers for Medicare & Medicaid Services, or CMS, generally handles regulating the classification of ACA insurance plans into their respective tiers. However, she said the bureau has received some indication that CMS might be taking a less active role this year.

Gendreau, the CHO spokesman, said approval of a plan like the Silver X 5800, which costs less but offers weaker coverage, would impact all Mainers who receive the tax credit subsidy.

“As a result, individuals who qualify for (a subsidy) will have lower amounts of support to offset premiums,” he said. “This will also tend to drive consumers to skinnier plans with greater cost sharing.”

Still, Watters said eliminating the Silver X 5800 plan would not greatly affect subsidies, because while it would become the cheapest silver plan if approved, the subsidy is based on the second-cheapest silver plan, and currently there is not much difference in price between the second-cheapest silver plan and the third-cheapest, which would become the second-cheapest if the Silver X 5800 isn’t approved.

It’s not certain that Cioppa will allow CHO to make the requested changes. Some members of the panel questioned why CHO waited until the hearing to request them. Watters said she did not know when Cioppa would make his decision. State-approved ACA insurance rates are due to be submitted to the federal government by Aug. 16.

“We know that it is late in the game, but we feel that this is crucial to our 2018 success,” said Nancy Johnson, an assistant vice president at CHO.


Also at the hearing, several CHO policyholders urged Cioppa not to approve the co-op’s request for a 19.7 percent hike.

Castine resident Jane Irving said she and her husband spend more than one-quarter of their $82,000 combined annual income on premium payments to CHO. Irving said she recently received a letter from the co-op saying that their premium will likely increase in 2018 by 15 percent to 26 percent.

“I would beg you not to raise premiums, because this is just insanity,” she said.

Correction: This story was updated at 1:08 p.m. on July 25, 2017 to clarify that the full range of subsidies is not available for bronze, gold or platinum plans.

J. Craig Anderson can be contacted at 791-6390 or at:

Twitter: jcraiganderson

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