State announces 13.1% average decrease in 2021 individual health insurance rates

Thu, 08/27/2020 - 6:30pm

    AUGUSTA — The Maine Bureau of Insurance announced Wednesday its review and approval of the rates submitted by the state's three individual market health insurance carriers for the 2021 plan year.

    The overall, or weighted average, reflects a decrease of 13.1 percent in monthly premiums in the Market, per a news release. 

    "The coronavirus pandemic has reinforced how important it is that every person has access to affordable health insurance and the ability to see a doctor," said Governor Janet Mills. "These insurance rates are most welcome news and will make health care more accessible for more people. Our Administration will continue to fight for health care for Maine people."

    The health insurance rates submitted by Anthem Health plans of Maine, Harvard Pilgrim Health Care, and Maine Community Health Options, range from a decrease of 26.5 percent to a decrease of 4.3 percent, depending on the plan.

    Other factors used to determine an individuals premiums are age, county of residence, and whether or not the individual uses tobacco.

    The cost to most consumers who buy insurance on the Individual Market is lowered further by financial assistance available through the marketplace. In Maine, 85 percent of consumers qualified for this assistance to lower their premiums in the 2020 plan year.

    "The average decrease in the individual rates in 2020, and now for 2021, reflect the stabilizing of what was once a fairly unstable marketplace," Insurance Superintendent Eric Cioppa stated.

    The trend reflects the effect of the Maine Guaranteed Access Reinsurance Association (MGARA) which was relaunched in 2019.

    MGARA helps insurers, per a news release, keep premiums low by ceding coverage of members with high-cost conditions to the reinsurance program.

    “As noted above, the majority of those purchasing their own insurance do not pay full price,” the release stated. “Those who are at 400 percent or more of the federal poverty level do pay full price and directly benefit from any lowering of premiums on the Individual Market.”

    "The MGARA program, which works behind the scenes, has given Maine more control over its Individual Market and has made a significant difference in the premiums that insurers need to charge," Cioppa said.

    Governor Mills announced plans late last year to give Maine yet more control over its Individual Market, and potentially over the Small Group Market, as well.

    The Administration, together with BOI and the Department of Health and Human Services (DHHS), is transitioning to become a State Based Marketplace on the Federal Platform (SBM-FP), which will allow the State to take a more active role in promoting health insurance coverage and supporting local consumer assistance programs, while still making use of the federal enrollment platform,

    This gives Maine more flexibility to improve the shopping experience for the more than 65,000 Mainers who currently purchase health insurance for themselves and enables Maine to invest and target resources otherwise going to the federal government to enroll uninsured Mainers in affordable coverage, a news release stated.

    The transition is one component of the Made for Maine Health Coverage Act, which Governor Mills signed into law on March 18, 2020 after it was passed unanimously by the Legislature.

    Maine has submitted its application or Blueprint to become a State-Based Marketplace and with federal approval will begin operating as a State-Based Marketplace on the Federal Platform effective for the Marketplaces Open Enrollment period starting on November 1.

    DHHS also recently issued a Request for Proposals for Navigators for the Marketplace, who will help to ensure Maine people are aware of their coverage options and have the assistance they need to apply and enroll.

    DHHS will continue to promote coverage through the website, and will launch another public awareness campaign to coincide with the open enrollment period this fall.

    Individuals are encouraged to visit for more information about their coverage options, including MaineCare, prior to open enrollment this fall or if they are currently without health coverage.

    The Administration is also assessing the option of becoming a full State Based Marketplace (SBM).

    In the SBM model, Maine would oversee all aspects of the Individual and Small Group markets, including offering a state-specific enrollment platform to replace

    Additionally, under a provision of the Made for Maine Coverage Act, BOI has contracted with Gorman Actuarial, Inc. to review the impact of merging the Individual and Small Group markets using different scenarios.

    The Bureau released the Gorman report this week and will hold a public virtual meeting on September 3rd at 1 p.m. to review the modeling and impacts of the scenarios, which include extending the MGARA reinsurance program to Small Group plans. If a merged market or expanded reinsurance program are pursued, the Bureau will need to submit another Federal 1332 Innovation Waiver. The BOI-approved Small Group Market rates for 2021 reflect a relatively modest weighted average increase of 5.3 percent.

    The 2021 Individual and Small Group rates have been submitted to the federal Centers for Medicare & Medicaid Services (CMS) for final approval and to be uploaded to for open enrollment, which runs November 1 to December 15. The BOI has posted a 2021 Individual Rate Calculator to its own website, to help individuals prepare for Open Enrollment. A 2021 Small Group Rate Calculator has also been posted.

    Consumers with questions about insurance matters can contact the Bureaus consumer divisions by calling 800-300-5000 (TTY call Maine Relay 711), e-mailing, or visiting