New insurance model debuts

 Cooperative Care
By DEIRDRE FULTON  |  June 7, 2013
Among many other things, the Affordable Care Act created a new model of health insurers, called Consumer Operated and Oriented Plans (CO-OPs), governed by the same people who are covered by their policies. The first such non-profit health insurance organization in the state, Maine Community Health Options (MCHO), opened its office space in the Bates Mill complex in Lewiston last week.
According to the federal government’s healthcare.gov website, “In a CO-OP, your health insurance needs and concerns are a top priority because you and your fellow CO-OP customer/members elect the board of directors. A majority of these directors must themselves be CO-OP customers. CO-OPs must use profits to lower premiums, improve benefits, or improve the quality of members’ health care.”
That’s exactly how MCHO, which will open enrollment starting this October, will operate, says CEO Kevin Lewis. MCHO will offer plans for individuals, families, and small businesses (less than 50 people), and has partnered with several local health-care organizations (such as MaineGeneral and Maine Coast Memorial Hospital) with a mutual focus on preventative care, disease management, integration of physical and mental health, and oral care. CO-OP plans were created to increase access, lower costs, and improve health-care quality, and Lewis believes MCHO will operate at “the nexus of those three,” benefitting many Mainers but especially those who are currently under- or uninsured.
MCHO, which expects to attract 15,000 subscribers in its first year, received a five-year, $7 million loan from the federal government to help fund start-up costs, as well as a second $55 million, 15-year loan to adequately capitalize the CO-OP when benefit plans become available. While it is too early to predict the exact cost of MCHO plans, Lewis says the organization hopes to offer “premium pricing as low as possible,” with subsidies available to people between 133 and 400 percent of the federal poverty level and incentives for positive health outcomes. Learn more at maineoptions.org.
Related: Health-care's big moneyman in New England, Avoiding the problem, Letters to the Portland Editor: July 10, 2009, More more >
  Topics: This Just In , health care, ACA
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