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Facts and Figures

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Insurance Carriers

State Government Insurance Programs Offered

Pre-Existing Condition Insurance Plan (PCIP)

Run by the Dirigo Health Agency - Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs.

MaineCare - Services include Adult family care services, Ambulatory care and surgery, Ambulance services, Dialysis, Case management, Nursing services,Chiropractic, Community support, Benefits for the elderly and for members with mental and physical disabilities, Dental, Family planning, Hearing aids, Home health, Hospice, Inpatient and outpatient Hospital services, Laboratory and x-ray services, Medical supplies and durable medical equipment, Behavioral health, nursing, Therapy (occupational, physical), Vision, Physician services, Preventive health services, Podiatry, medical imaging services, Rehabilitation services, Rural health clinics, Speech and hearing services, Transportation services, STD screening, and more.

Dirigo Choice

(State-Sponsored Plan) - Coverage for qualified individuals, sole proprietors, and small businesses. Voucher program that pays for insurance on of part-time/seasonal workers.Some services include Preventive care, Inpatient/outpatient, Prescription drugs, Maternity and well-child care, Childhood Immunizations, Emergency care, Mental health, Smoking cessation and education programs, Domestic partner coverage, Extensive provider network and out-of-network coverage, and No referral required to see a specialist. Small employers: Must be Maine residents, have 2–50 employees, contribute 60% of the cost of employees’ coverage. Employees’ dependents not covered. Sole proprietors: Must be Maine residents, pay 60% of cost for single coverage before discount is applied, are not required to give minimum contribution. Individuals and sole proprietors: Must complete a Certification Statement. Part-Time Worker Coverage Voucher: Must be Maine residents, work 10–35 hours a week, be uninsured for the last 90 days, living up to 300% FPL with asset of $60K (for singles) or $120K (for 2+ household members).

Maine Children with Special Needs Program As of March 1, 2008, CSHN has capped program enrollment and will no longer be accepting applications for payment of services.

CubCare (Search: CubCare) - CubCare covers: Doctors visits, Hospital care, Immunizations, Prescriptions, Surgery, Lab and x-ray, Dental, Medical equipment and supplies, Chiropractic services, Therapies (speech, physical, occupational), Vision, Hearing, Ambulance, Case management, Mental health and substance abuse treatment, Family planning services, Prenatal care, and Transportation. Low-income children ages 0–18. No citizenship requirements for pregnant women and children. Maine residents. Income must be equal to or less than 180% FPL.

Women-Infant- Children (WIC) (Search: WIC) - Pregnant or postpartum women and children up to the age of 5 years with a family income at or below 185% FPL. Must be a state resident; and be at nutritional or medical risk, as determined by a health professional

Maine Breast and Cervical Health Program (Search: MBCHP) - covers Breast exams, Pap tests, pelvic exams, mammograms, limited diagnostic or follow-up services. Uninsured women undergoing treatment for breast or cervical cancer may qualify for MaineCare. Pre-Existing Health Conditions Covered

Medicare - Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

Heath Care Reform

Small business tax credits.  25,800 small businesses in Maine could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1  Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years.  This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.

Closing the Medicare Part D donut hole. Last year, roughly 21,500 Medicare beneficiaries in Maine hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Maine who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020. 

Support for health coverage for early retirees. An estimated 20,200 people from Maine retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3  Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.

New consumer protections in the insurance market beginning on or after September 23, 2010.

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 729,000 Maine residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 69,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Maine peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 660,000 residents of Maine with health insurance from their employer, along with anyone who signs up with a new insurance plan in Maine.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 3,330 individuals in Maine who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $17.2 million federal dollars are available to Maine starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 132 Community Health Centers in Maine but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 6% of Maine’s population who live in an underserved area.

New Medicaid options for states. For the first time, Maine has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

"Vista Health Solutions" Tel (888)215-4045 Email [email protected]