• Aetna
• Anthem Blue Cross and Blue Shield
• Harvard Pilgrim Health Care

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• MEGA Life & Health

• Supplemental Medigap Insurance
• Medicare Advantage Insurance

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• SecureHorizons by UnitedHealthcare
• Sterling Insurance
• Universal American

Introduction to How Maine Health Insurance Works & Looking to the Future

How Health Insurance Works in Maine and Looking to the Future

This issue brief reviews current health insurance coverage in Maine, how insurance is supposed to work (and why it oftentimes does not) and how can/should Maine position itself in light of expected health care reform at the national level.

Health care in Maine (and elsewhere) is very expensive. Insurance costs reflect the underlying costs of medical care (plus administration and proit or surplus, which are usually modest compared to the cost of care). Advanced technology; provider and consumer driven demand for services, i.e., utilization; malpractice expenses; the aging of the population; unhealthy lifestyles and other factors are major contributing factors that would still drive the high cost of health care even if Maine established a perfectly eficient and effective insurance program.

Who has Health Insurance Coverage?

When it comes to paying medical bills, nearly all Mainers fall into one of ive categories:

• Employee-sponsored. For more than half of us (704,000), health insurance is provided through a place of work. This coverage varies widely from employer to employer and often depends on the size of the company, whether it is unionized, pressures on the company's bottom line and competitive pressures to retain a workforce.
• Individual. About 5% of Maine's population (63,000) purchases a private health insurance plan directly. These individuals often pay the entire premium cost directly. In order to reduce these premium costs, individual policies are often characterized by a very signiicant front end deductible. Such plans are increasingly purchased through a Health Savings Account ("HSA") which permits individuals to deposit, invest and withdraw funds to pay cost sharing expenses under favorable, federal tax treatment.
• Medicare. A federal insurance system for people over age 65 or disabled, coverage is provided to about 18% of Maine's population (243,000). Medicare premiums are collected through payroll taxes and payments by individuals covered by the program.
• Medicaid. More than one out of ive Mainers (305,000) is covered by Medicaid, known as "MaineCare" in Maine. This program is generally available to low and lower income individuals and families. Medicaid is jointly funded by both the state and the federal governments; for every dollar that Maine pays for health care services, the federal government "matches" approximately two dollars.
• A subset of the Medicaid population (about 66,000) is also covered by Medicare. An example of a "dual eligible" would be someone with very low income who is over age 65 (Medicare eligible for hospital and physician services) and resides in a nursing home (covered by Medicaid). Dual eligible individuals are typically the most expensive population covered by the Medicaid program
• No coverage. Less than 9% of the population (119,000) is estimated to be uninsured and pays directly for health services. This population is the greatest source of bad debt and charity care for health care providers. As a consequence of Medicaid expansion activities and the Dirigo Health Plan, this population has diminished by about 13,000 people since our 2007 Issues Brief.