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Dirigo
Health:
What Does it Mean to Me?
Last updated on
1/4/05
The Problem…
If you live in Maine right now, you have limited choices
for health care coverage. Mainers who don't qualify
for MaineCare or who don't have insurance supplied
by their employer are left with the option of private
insurance plans--or no insurance at all. Private insurance
plans are increasingly costly and generally have very
high deductibles (commonly $5,000 or more). This type
of health insurance has little or no value for many
people, but it is often the only health insurance
option left.
The Solution…
Dirigo Health is a new health care coverage choice
for small businesses, self-employed, and individuals
without access to job-based coverage. Dirigo Health
will offer a valuable health coverage choice to small
businesses and the self-employed and three new health
care coverage options for Mainers (based on their
ability to pay).
Three New Coverage Options…
Should be available for enrollment
no later than
October 4, 2004
for self-employed and small businesses and February
1, 2005 for some individuals.
All three options are more affordable than current
private insurance plans and provide better coverage.
Dirigo Health will be good quality coverage that is
comprehensive, has no lifetime maximum, low deductibles,
low out-of-pocket expenses, and includes preventative
coverage (wellness care, nutrition counseling, smoking
cessation, wellness education, cardiac rehab and routine
vision and prescription drugs).
1) Free or Low-Cost
Coverage - MaineCare free or low-cost coverage
will be expanded to cover:
- Single adults or couples without children or without
children living at home at a higher income level
of $11,637/yr for an individual or $15,624/yr for
a couple;
- Parents (or caretaker relatives) at a higher income
level. For example, the income guidelines will be
about $24,980/yr for a family of two, $31,340/yr
for a family of three, and $37,700/yr for a family
of four.
2) Sliding-Scale
Coverage - Dirigo Health sliding-scale
fee coverage will be available to:
- Eligible individuals with gross incomes under
$26,940/yr;
- Eligible families of 2 with gross incomes under
$36,360/y;
- Eligible families of 3 with gross incomes under
$45,780/y;
- Eligible families of 4 with gross incomes under
$55,200/y.
3) Reasonably Priced
Coverage - Dirigo Health will provide valuable
coverage at "full-cost" price to:
- Eligible individuals with gross incomes above
$27,930/yr;
- Eligible families of 2 with gross incomes above
$37,470/yr;
- Eligible families of 3 with gross incomes above
$47,010/yr;
- Eligible families of 4 with gross incomes above
$56,550/yr.
What's Available for Help Right Now?
Through the Covering
Kids and Families Campaign (funded by the Robert
Wood Johnson Foundation), Consumers for Affordable
Health Care offers a free HelpLine.
The HelpLine Coordinator can assist you with figuring
out if you may qualify for MaineCare right now (and
get you started with the application process) or sign
you up for a mailing list to receive updates on the
progress of Dirigo Health. Please call 1-800-965-7476
to talk with a representative about your options.
For more information on what is available in Maine
right now, check out our Health
Care Guide.
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