MaineCare misperception comes to light during ACA open enrollment

With open enrollment with the Affordable Care Act (ACA) Health Insurance Marketplace (HIM) under way and the expansion of MaineCare ongoing in the state, all should be smooth sailing with government and state websites and regionally‑based certified application counselors at hand to help people navigate the insurance systems. However, Elaine Abbott, a marketplace navigation specialist with Eastport Health Care Inc., is concerned that a misperception about MaineCare and HIM insurance could land people in a whole heap of trouble.
"All the situations are the same, really," Abbott explains. "The individual is notified that they have been found to be eligible for MaineCare, and a representative at Department of Health and Human Services (DHHS) informs them that they can keep their insurance and MaineCare will act as secondary payer. I only learn about it when these folks call me to re‑enroll for their marketplace insurance. The individuals I have spoken with thus far are confused, so I send them the information" that explains that one can't have both marketplace and MaineCare coverage.
Abbott is extremely concerned because the outcome of being mistakenly enrolled in both could be financially disastrous for someone who is enrolled in MaineCare but keeps their ACA coverage under the misperception that MaineCare would act as a secondary payer for the ACA coverage. "MaineCare is not a secondary payer," Abbott reiterates.
"From what the three individuals have told me, they were certainly given misinformation. Having not been on the call with them, I can't really attest to what they were told, but they all told me the same details," Abbott says. "All I know is: One can't have marketplace insurance in addition to MaineCare." At last count, she notes, about 1,600 people in Washington County were added to MaineCare who had probably been enrolled in the ACA insurance marketplace. "It's a really scary thing. They're being flat out told that they can keep both. And that's not true."
DHHS Communications Director Jackie Farwell says, "Maine DHHS is aware of a concern that some individuals may be under the mistaken impression that they can have coverage through both MaineCare and HealthCare.gov at the same time. This is not correct. While we have not confirmed the source of this concern, we are ensuring that all staff handling these issues provide correct information."
Angela Dubay, who works as a certified application counselor with the Regional Medical Center at Lubec, helps enroll people in the Health Insurance Marketplace. She explains that with a number of Washington County people now eligible for MaineCare with Governor Janet Mills' expansion of the program, "We have to remind people [who are eligible for MaineCare] to go to the ACA marketplace to cancel their insurance and then to call the insurance company to make sure of the cancellation."
Open enrollment for private insurance plans under the ACA started November 1 and runs through December 15, with coverage beginning January 1, 2020. In addition to the <HealthCare.gov> marketplace website, health insurance options and resources may be explored by individuals and small businesses through a new website, <CoverME.gov>. The website is a new statewide outreach campaign launched by DHHS highlighting affordable coverage options through both the federal marketplace and expanded MaineCare.
Maine people are eligible for insurance through MaineCare if their annual income is less than $17,236 for a single person or $29,435 for a family of three. Eligible Maine people may enroll in MaineCare at any time of year. More than 40,000 people are now enrolled through the expansion of MaineCare under Governor Mills.
Maine people with incomes above the MaineCare threshold but less than $49,960 for a single person or less than $85,320 for a family of three may be eligible for lower monthly premiums on the ACA federal marketplace. According to new data provided by the Mills administration, 59% of federal marketplace enrollees in Maine can find a plan for $10 or less per month, while 74% can find a plan for $75 or less. Benchmark premiums in Maine will drop for the second consecutive year, falling by 6% in 2020, following an 8% decrease in 2019.
"No person should have to live in fear of not being able to see a doctor, fill their prescriptions or receive life‑saving care," says Governor Mills. "As governor, my top priority is to ensure that every Maine person can be healthy, join and stay in the workforce to contribute to our economy and care for their families."
Abbott is available to help with ACA questions and enrollment in Calais, Eastport and Machias by calling her at 853‑0189. Angela Dubay, with Regional Medical Center at Lubec, is available by calling 733‑1090 extension 5267.