Existing-illness insurance scours Maine for clients | The Portland Press Herald / Maine Sunday Telegram

Existing-illness insurance scours Maine for clients | The Portland Press Herald / Maine Sunday Telegram.
By John Richardsonjrichardson@mainetoday.com
Staff Writer

With only 14 subscribers so far, officials believe many people don’t know about the federally subsidized health program.

Mainers who can’t afford health insurance and have a history of serious illness may qualify for federally subsidized coverage.

But they probably don’t know it, say federal and state officials and consumer advocates.

The Pre-Existing Condition Insurance Plan has been available in Maine for nearly a year. It was created by the national Affordable Care Act and is administered in Maine by the Dirigo Health Agency.

But it has only 14 subscribers.

The plan has certain restrictions. Subscribers must have gone without insurance for at least six months and been diagnosed at some point with one of 37 conditions, such as cancer or diabetes. Nevertheless, experts say, there are tens of thousands of Mainers who could qualify.

“That’s why we’re hoping to get the word out,” said Jaye Weisman, regional administrator of the federal Centers for Medicare and Medicaid Services, which oversees the program.

Weisman, who is based in Boston, traveled through Maine this month to help draw attention to the program, which also has fallen short of expectations in the rest of the country. The federal government expected hundreds of thousands of Americans to sign up in the first six months, but only about 22,000 have enrolled in the program’s first year.

The coverage plan is intended to last only until 2014, when other provisions of the Affordable Care Act are expected to provide more permanent options.

Critics have said the program is too expensive and restrictive. The federal government is trying to boost enrollment by lowering premiums in some states where it administers the insurance plan. That does not affect Maine and other states that chose to take the federal funding and implement their own programs with their own premiums.

Maine’s premiums are relatively low, at least given the cost of private health insurance, said Joe Ditre, executive director of Maine Consumers for Affordable Health Care, a nonprofit advocacy group.

Standard premiums for an individual range from $438 to $658 a month, depending on age and other factors. Deductibles vary from $1,750 to $2,500 a year.

Mainers who earn less than 300 percent of the federal poverty limit — $32,490 a year for a single person — qualify for subsidized premiums, which can be as little as $111 a month for an individual.

By comparison, someone who buys private insurance in Maine’s individual market could pay more than $600 a month and have a deductible of $5,000 to $15,000 a year.

“A number of people are holding on by their fingertips to these very expensive coverage plans,” said Ditre.

Many other people have dropped the expensive private coverage and are going without insurance unnecessarily, he said. “They don’t know about this program,” Ditre said.

While Maine law forbids private insurance carriers from turning down people who are already sick, the insurers can in some cases make subscribers wait a year or two before the insurance covers the pre-existing condition. Under the Pre-Existing Condition Insurance Plan, and other Dirigo plans, pre-existing conditions are covered from the start.

“I don’t know what’s holding people back,” said Sandy Maddocks of Brunswick, one of the 14 subscribers in Maine.

Maddocks, who is 62, said she has had cancer and heart disease, conditions that made health insurance impossible for her to afford years ago. “They said, ‘If we accept you, you just won’t be able to afford us,’ and they were right,” she said.

Maddocks went without health insurance for five years, trying to avoid doctors and hospitals and feeling like an outcast when she went to the emergency room and had to turn down expensive tests. After she had a mild stroke, Maddocks called Dirigo Health in September and learned about the pre-existing coverage plan.

Maddocks pays $650 a month because she does not qualify for subsidies, she said. But she is grateful to have comprehensive coverage for the first time in years.

“At least I know I’ll probably get the care I should,” Maddocks said.

The federal government spent $120,000 in the last six months of 2010 to cover claims from the small number of Mainers in the program. The federal funding helps extend the reach of the Dirigo Health Agency, which used to offer coverage for people with pre-existing conditions as part of its standard pool of subscribers, said Karynlee Harrington, Dirigo’s executive director.

Harrington said the state has not had money to market the federal program, but many more Mainers could benefit if they knew about the coverage or called to ask.

“People think they don’t qualify for these programs,” she said. “We have 130,000 uninsured people in the state. I’ve got to believe a number of those people have one of these conditions.” 


For more about the Pre-Existing Condition Insurance Plan, call (877) 892-8391 or go to: http://www.dirigohealth.maine.gov/Pages/pre_exist.html

Maine Consumers for Affordable Health Care also offers assistance, at (800) 965-7476.

Staff Writer John Richardson can be contacted at 791-6324 or at:



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