One of my followers recently asked me what I thought her daughter should do about health insurance coverage. She is 27-years-old and has been covered by Dirigo Health for the past two years. She’s been extremely happy with the coverage and is quite upset that the plan is going away the end of this year.
What is Dirigo Health?
For those of you who aren’t familiar with Dirigo, the Maine Legislature created the Dirigo Health Agency (DHA) in 2003 as “an independent executive agency to arrange for the provision of comprehensive, affordable health care coverage to eligible small employers, including the self-employed, their employees and dependents, and individuals on a voluntary basis.”
In December 2013 the following DHA health insurance programs will end:
- Pre-existing Condition Insurance Plan
- Part-time Worker Coverage Voucher Program
“We’re at a loss,” says my follower. “We don’t know what steps to take.”
Maine’s health insurance exchange
The DHA web site advises people to consider enrolling in the new federal health insurance exchange, which is scheduled to begin October 1, 2013. Coverage will take effect January 1, 2014.
Right now two insurance plans will be available through the exchange in Maine:
- Anthem Blue Cross and Blue Shield of Maine
- Maine Community Health Options (MCHO) located in Lewiston, Maine
You can call DHA 24 hours a day toll-free at 1-800-318-2596 for assistance. Hearing impaired callers using TTY/TDD technology can dial 1-855-889-4325.
You can also visit HealthCare.gov for information and to get news and updates.
A recent Bangor Daily News article by health editor Jackie Farwell gives an overview of the exchange in Maine: The basics of Maine’s health insurance exchange.
Back to the question I was asked by a Catching Health follower. I didn’t know how to answer it, so I turned to Linda Riddell, an experienced health policy analyst, for advice. Linda and I both blog for Bangor Daily News. On her blog Health Uninsurance, she answers all sorts of insurance questions. Here’s what she had to say about my question:
My daughter, age 27 and currently unemployed (because of an injury), is on Dirigo.When I first got her on, she had just finished school and started a new job that didn’t include a health insurance benefit. What will happen to her once the Dirigo plan ends at the end of 2013? What will her options look like?
The Dirigo plan benefits will differ from what your daughter will find in the post 1/1/2014 world. Some things may be more generous, others slimmer. For example, the Dirigo plan has a “deductible rollover” which allowed her to count her expenses in the last three months of the year toward her next year’s deductible. I doubt this feature will be available in the plans for next year. On the other hand, the Dirigo plan’s maximum out-of-pocket is probably higher than the new plans. The Affordable Care Act has strict rules about the deductibles and out-of-pocket amounts.
You will be able to get details about the benefit plans after October 1, 2013 for coverage starting January 1, 2014. Since you know she will need the coverage, you might want to get started as soon as you can in October.
The new plans will otherwise treat her the same as the past, except that she may qualify for subsidies to pay her monthly premiums or to pay the deductible and co-pays. By “treat her the same,” I mean that they will have to accept her, cover her current medical condition, and will not be able to charge her extra for her health conditions. She will have choices of deductibles and co-pays. Since she has an ongoing medical condition, she probably won’t want a catastrophic plan. People under age 30 can choose a higher deductible plan than older people can.
When she does find a job with benefits (every parent’s fervent hope!), the employer can make her wait up to 90 days to join their group plan. So, she will need to keep her individual plan until she has an employer-based plan. She can go up to 90 days without coverage, and still not have to pay the penalty/tax. This is probably not a viable option for her, if she has a medical problem; and not advisable for a number of reasons.
Thank you Linda!
Do you have an insurance question?
If you have an insurance-related question, you can send it to me and I’ll pass it on to Linda or you can go directly to her blog Health Unsurance.
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