In January 2014, Maine Community Health Options (MCHO) became the first Maine nonprofit Consumer-Operated and Oriented Health Plan (CO-OP). Maine residents are offered high-quality, affordable health insurance that focuses on promoting health and well-being. It provides insurance plans to employers, families, and individuals.
What Did Maine Community Health Options Name Change to?
MCHO changed its name to Community Health Options to indicate its expansion into New Hampshire in June 2015. This also supports its mission of “partnering locally with individuals, businesses, and providers”. Community Health Options now has more than 72,000 members.
What Is a Health CO-OP?
A CO-OP is a program of the U.S. Centers for Medicare and Medicaid Services (CMS). CO-OPs were created as a consequence of the Affordable Care Act of 2010. The ACA authorized the establishment of consumer-directed CO-OPs. This was designed to increase competition among health insurers.
As a private, nonprofit entity guided by a customer-based Board of Directors, enrolled members have a strong say in the development and management of the plan. Being governed by their customers, CO-OPs are designed to offer small businesses and individuals consumer-friendly, high-quality options. Similar to other cooperative examples, the idea is to use profits to help members. This can be accomplished by:
- lowering premiums
- improving benefits
- increasing the stability of coverage
CMS monitors CO-OPs closely to make sure that they are meeting their goals.
Why Does Maine Need a CO-OP?
Currently, small businesses and individuals in Maine don’t have many choices about health insurance. This is a big problem in Maine where the economy is driven by small businesses who don’t have much say in the health insurance market. The result is an increasing amount of people going without health coverage, or who are at risk of going without coverage. The CO-OP program loan allows Maine Community Health Options to provide health insurance for these two important groups.
According to a 2021 report from NAMI Maine (part of the National Alliance on Mental Illness), more than 37% of adults in Maine revealed that they had experienced symptoms of anxiety or depression. In addition, the Maine Integrated Youth Health Study, published in 2022, showed that almost 43% of students in Maine said that during the pandemic, their mental health wasn’t good “most of the time” or “always.”
Maine Arts Commission Support
The Maine Arts Commission is a State agency. The Commission supports artists, educators, arts organizations, policymakers, and creative workers across the state. They also award grants to nonprofit organizations such as the Community Health Options CO-OP.
Plan Options
Family and individual health insurance plan options include the following plans:
Platinum
The insurance company pays about 90% in a Platinum plan and the member pays 10% of the cost. The Platinum plan has the highest monthly premium but provides the most coverage when you need care. Good for members who don’t mind the premiums and expect to make use of their benefits often.
Gold
With a Gold plan, the insurance company pays about 80% of the cost and the member pays 20% for health services. Gold plans have lower deductibles but higher monthly premiums compared to other levels.
Silver
In a Silver plan, the insurance company will pay about 70% and the member will pay 30% of the cost of the service. The Silver plan offers moderate monthly premiums, deductibles, and out-of-pocket costs compared to the other plans.
Bronze
In Bronze plans, the company pays about 60% and the member pays 40% of the cost for services. This plan has low premiums but requires members to pay a higher deductible and typically higher out-of-pocket costs.
Catastrophic
Catastrophic plans are meant for people under 30 or others with specific exemptions. This is an affordable way to protect from worst-case scenarios.
HSAs
Some of the options may include HSAs (Health Savings Account). An HSA is a type of personal savings account you can use to pay certain health care expenses. It allows you to put money away and withdraw it tax-free as long as it’s used for qualified medical expenses.
Several of the Community Health Options plans include a Chronic Illness Support Program which lowers cost-sharing for in-network treatment of:
- Diabetes
- Asthma
- Chronic obstruction pulmonary disease (COPD)
- Coronary artery disease
- Hypertension
Health Insurance Terms
Here is a crash course in translating health insurance terms into language that’s easy to understand.
Premium
Just like car insurance, your premium is what you pay upfront for your health insurance coverage.
Deductible
The deductible is the amount you have to spend for your own covered healthcare services before the insurance plan begins to pay. Bear in mind that there are some low or no-cost provider visits, services, and medications available before you pay the deductible.
Co-payments
These are definite amounts you pay at the time of the covered healthcare service such as a lab test, prescription, or urgent care visit.
Co-insurance
After you reach your deductible, you and the insurance company will share any remaining covered costs.
Maximum out-of-pocket (MOOP)
The MOOP is the highest amount that you pay in any given plan year for all covered services before your benefits will pay 100% of covered expenses that year.
In-network
This refers to the group of care providers who have negotiated discounts with your health insurance company. Using in-network providers will help you pay less for services.
Out-of-network
These providers have not negotiated lower prices with your insurance company.
Casco Bay Recovery is In-Network with Maine Community Health Options
Casco Bay Recovery in Portland, Maine is part of the MCHO network. This means that if you or someone you care about has MCHO for your insurance provider, you can get comprehensive coverage for substance use disorder treatment in Portland, Maine, and mental health treatment.
At Casco Bay, we offer intensive outpatient treatments including a partial hospitalization program in Portland, Maine, and a specialized program for individuals struggling with a dual diagnosis in Portland, Maine of substance abuse with a co-occurring mental disorder. Contact us today. We can help you sort through your coverage and get you back to achieving your goals.