Open enrollment for the Affordable Care Act marketplace begins Friday, and Maine’s Medicaid expansion will likely contribute to a decline in 2020 signups for ACA coverage, experts say.
But with more people having either an ACA marketplace plan or Medicaid, the state’s uninsured rate should plummet.
Mainers who apply for ACA coverage through HealthCare.gov and appear to be eligible for Medicaid would be notified and have their application transferred to the Maine Department of Health and Human Services for an eligibility determination. People who are interested in renewing or obtaining individual health insurance for 2020 can find out more information at CoverME.gov and at enroll207.com.
Those earning up to 400 percent of the federal poverty level, or $83,120 for a family of three, are eligible for subsidized ACA insurance. Seventy-four percent of Maine residents eligible for ACA insurance will be able to select a plan with a $75 or lower monthly premium, according to federal data.
Maine voters approved Medicaid expansion in 2017, but former Republican Gov. Paul LePage refused to implement it. Democratic Gov. Janet Mills implemented the expansion on her first day in office, and since then about 40,000 people have signed up for Medicaid, according to state data. Thousands more are expected to enroll in Medicaid in the coming months, including those who are switched from ACA plans to Medicaid.
Mitchell Stein, a Maine-based independent health policy analyst, said that while he doesn’t have a signup projection, he does expect fewer Mainers to sign up for ACA insurance.
“I expect ACA enrollment to go down, but for a good reason,” Stein said. Maine had roughly 70,000 people sign up for ACA coverage last year, down from a peak of 84,059 in 2016.
Although repeal efforts have so far failed, the Trump administration has taken numerous steps to weaken the ACA, including eliminating the individual mandate that required adults to sign up for insurance or pay a penalty, and slashing outreach and advertising budgets.
Nationally, since President Trump took office, ACA enrollment has declined from 12.7 million to 11.4 million. Still, despite predictions it would collapse, “the ACA is alive and well,” said Ann Woloson, executive director of Maine-based Consumers for Affordable Health Care.
Stein said Medicaid expansion means fewer people in Maine will be uninsured.
States that have refused to expand Medicaid have about double the uninsured rate of expansion states, according to the Kaiser Family Foundation. Maine’s uninsured rate before it expanded Medicaid was about 8 to 10 percent, based on estimates by three separate groups, including the U.S. Census, the Kaiser Family Foundation and Gallup.
Before Maine expanded Medicaid, those who were unable to obtain insurance through an employer – and who earned between 100 and 138 percent of the federal poverty limit, between $20,780 to $28,676 for a family of three – could purchase ACA marketplace insurance. Those enrollees were permitted to keep their ACA plans in 2019, but will be migrated to Medicaid for 2020.
Exactly how many people will be switched from an ACA plan to Medicaid is unclear, but a rough estimate from Kaiser Family Foundation state-by-state statistics shows that it probably will be about 5,000 to 9,000 people in Maine.
Stein pointed out that, especially for low-income residents, Medicaid is likely to be superior insurance.
Medicaid has zero or nominal out-of-pocket costs for patients, while ACA insurance can have co-pays, deductibles and monthly premiums. ACA premiums for low-income enrollees are low, usually about $10 to $20 per month. Some plans have zero premiums.
Rates for 2020 declined or increased slightly depending on the insurer, according to the Maine Bureau of Insurance, ranging from a decrease of 7 percent to a 0.9 percent increase. Maine has stabilized ACA rates through a reinsurance program. People who get subsidies to purchase insurance – about 85 percent of enrollees – are shielded from rate increases.
Those with ACA insurance in Maine are more likely to be older and live in rural areas, with 51 percent between the ages of 45-64, and 56 percent living in rural parts of the state, according to the federal Center for Medicare and Medicaid Services.
Meanwhile, Maine is ramping up efforts to publicize ACA open enrollment, even as the Trump administration cuts outreach efforts. Called the CoverME campaign, the effort includes the new www.CoverME.gov website, digital and television ads promoting Medicaid and the ACA, and beefed-up in-person assistance. A $750,000 grant from the Robert Wood Johnson Foundation is helping to publicize the CoverME campaign.
“For the first time in Maine, open enrollment is an opportunity for Maine people and small businesses to understand their options for affordable, high-quality coverage through both (Medicaid) and HealthCare.gov, with no coverage gaps. We look forward to launching the statewide CoverME campaign to help people in every corner of Maine get the insurance they need to live healthy lives,” Jeanne Lambrew, Maine’s health and human services commissioner, said in a statement.
Also, Maine is proposing to switch from a federally run marketplace to a state-run ACA marketplace in 2021, which would unlock an additional $2 million in federal funding for outreach efforts.
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