Maine’s two leading providers of Affordable Care Act-compliant individual health insurance are requesting average rate increases of just over 9 percent in 2019, and smaller increases if a state-run reinsurance program is revived.

Massachusetts-based Harvard Pilgrim Health Care asked for an average premium increase of 9.5 percent for its individual plans on Maine’s ACA marketplace in 2019, according to documents filed Monday with the state Bureau of Insurance. Lewiston-based Community Health Options requested an average premium increase of 9.2 percent for its individual plans, according to its filings. For an estimated 85 percent of individual ACA policyholders in Maine, those rate increases would be offset by higher federal premium subsidies.

Both of the requested rate increases are lower than the 16 percent hike that health care analysts predicted for 2019, and they are far lower than what Harvard Pilgrim and Community Health requested in previous years.

Reasons provided by the insurers for their proposed rate increases include the elimination of the individual mandate penalty and the resulting, anticipated decrease in younger, healthier Mainers purchasing individual ACA insurance in 2019. The individual mandate was repealed as part of the federal tax reform bill approved by congressional Republicans in December.

Insurers had assumed in 2017 that the mandate would be going away and had largely adjusted their rates accordingly. Ed Kane, Harvard Pilgrim’s vice president for Maine, said the current ACA market is relatively stable compared with previous years.


“Unlike last year, there have been no policy developments that necessitated unexpected increases beyond adjustments for medical costs,” he said.

Although lower than expected, some affordable health care advocates in Maine said a 9 percent rate increase is still too much.

“As we saw in the filings from both Community Health Options and Harvard Pilgrim, the vote last winter by Sen. (Susan) Collins and Washington Republicans to repeal the ACA individual mandate, coupled with short-term (health) plan proposals, means health insurance rates are going up for Mainers,” said Rebecca London, Maine director of the Protect Our Care Campaign, a pro-ACA policy group. “While she seems to be reticent to try to repeal the ACA again, the damage is done and now thousands of Maine citizens will be forced to pay nearly 10 percent more for their health insurance.”


One factor that could help offset premium increases next year is a state-run reinsurance program that was put on hold when the ACA was implemented but is expected to be relaunched and take effect in 2019.

The state’s reinsurance plan – called the Maine Guaranteed Access Reinsurance Association – redistributes insurance money by charging a fee of $4 per person per month on individual and small- and large-group plans, and funneling the revenue only to individual plans. The reinsurance plan also would tap into federal money to help pay for what is estimated to be a $90 million program in 2019. That would help keep individual premiums lower than they would be otherwise.


For that reason, the Bureau of Insurance asked insurers submitting rate requests for ACA-compliant individual insurance in 2019 to submit two proposals – one for if the reinsurance plan is reinstated, and one for if it isn’t.

The requested increases of 9.5 percent and 9.2 percent assume that the reinsurance plan is not reinstated. If the program is revived, both insurance providers said it would result in smaller rate increases.

Harvard Pilgrim’s revised rate request calls for an average rate increase of 4.6 percent for individual insurance if the reinsurance plan is reinstated, and Community Health’s revised rate request calls for a 6.9 percent average increase.


Only Community Health and Harvard Pilgrim continue to offer ACA-compliant, federally subsidized individual health insurance in Maine. Anthem also provides ACA-compliant individual coverage in Maine, but it is not sold on the ACA exchange and does not qualify for federal subsidies.

Anthem is requesting an average rate increase of 13.8 percent for individual plans without the reinsurance program, and a rate decrease of 8.7 percent if the reinsurance plan is reinstated.


Anthem also notified the Bureau of Insurance that it would resume offering on-exchange plans in 2019 if the reinsurance program comes back, which would give Mainers a third option for subsidized ACA individual insurance. The company offered subsidized, on-exchange ACA insurance in 2017, but opted to stop doing so in 2018.

Community Health Options, Anthem, Harvard Pilgrim, Aetna, United Health Care and others also offer a variety of ACA-compliant small-group insurance plans in Maine. The requested average 2019 rate increases for small-group plans in the state range from about 3 percent to 15 percent, depending on the provider and whether the reinsurance program is revived. In the case of small-group plans, a revival of the reinsurance program would result in slightly higher rates, because the program adds cost to small-group plans with no corresponding benefits.

Nearly 76,700 Mainers had individual ACA coverage in the first quarter of 2018, down 10 percent from the 85,300 who had it a year earlier, according to the bureau. Another 60,000 Mainers had ACA-compliant small-group coverage through their employers.


Mainers who purchase individual insurance through the ACA marketplace have seen their premiums soar by as much as 110 percent since 2014. While those cost increases have been largely offset by increased federal subsidies for the majority of policyholders, an estimated 10,000 Maine policyholders who earn more than 400 percent of the federal poverty limit are not eligible for subsidies and must bear the entire brunt of the increases.

The surging costs already have priced some Mainers out of the market, and that trend is expected to continue in 2019.


ACA individual policies are categorized by bronze, silver, gold or platinum based on the quality of coverage. Mainers earning up to about $27,000 can qualify for zero-premium bronze plans through the ACA, while typical premiums for people who earn $40,000 to $45,000 are roughly $200 to $300 per month, depending on the policyholder’s age and place of residence. Insurers can charge up to three times more based on age, and can also charge more based on address. The average monthly out-of-pocket premium for ACA individual coverage in 2018 is $94 for Mainers who receive subsidies.

The Bureau of Insurance had set a deadline of 4 p.m. Monday for Maine’s ACA marketplace insurers to submit their rate increase requests for 2019, but it did not release the documents until Tuesday.

All rate requests must be approved by the bureau and the U.S. Centers for Medicare and Medicaid Services. The approval process is streamlined at the state level if the average rate increase being requested is less than 15 percent because the bureau is not required to conduct rate hearings.

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

Twitter: @jcraiganderson

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