A new insurer in Maine’s ACA market to offer hybrid health insurance

Beginning this fall, Cumberland County residents will have the opportunity to purchase a new type of health insurance in the Affordable Care Act marketplace that combines traditional health insurance and primary care.

Taro Health – a new insurance company based in Maine – is offering what would be the first national health insurance plan that consumers will be able to buy starting in November, and starting in 2023.

The insurer is targeting about 5,000 people who choose to pay their doctors directly and forgo traditional insurance, a model called Direct primary care. Under primary care, patients pay out-of-pocket for regular doctor visits and the type of care that can be done at the doctor’s office, such as screening and treatment of minor illnesses, blood tests, blood tests and annual physicals.

By removing insurance paperwork from routine care, primary care advocates say, doctors can focus more time on patients and cut costs by not having to process insurance.

But the founders are examples when patients need special care, such as broken bones, cancer or rare diseases. If they hadn’t purchased insurance in addition to paying the out-of-pocket premiums, they would have been at risk for expensive hospital visits and specialty care. The Taro Health Plan is a general insurance and primary care plan. Members pay monthly for health insurance options and a team of 12 participating physicians as direct assistants.

COMBINATION OF THOUGHTS

“There’s an overlap of ideas,” Jeff Yuan, co-founder of Taro Health, said in an interview Wednesday. “We are insurance. We are not just special care. “

Yuan, of New York City, said his company chose Maine to launch a hybrid insurance model because the state has the highest percentage of direct physician claims in the country. Yuan said he hopes Taro Health will expand into Maine and other markets in the coming years. The MaineHealth network will be in-network with Taro Health.

Taro Health plans are available at CoverME.gov from Nov. 1. Comparison of the purchase of the new plan of Taro Health and the rest of the ACA market plan was not available on the website of the Maine Bureau of Insurance on Wednesday, but is expected to be released soon.

Direct primary care has traditionally attracted people who want to spend more time with their doctors and have the money to pay for monthly membership fees, the cost of regular care and the cost of a regular health plan to cover serious illnesses and injuries.

Dr. Lisa Lucas, a primary care physician in Freeport, said about half of her patients have insurance, and have to pay more for her care than her monthly bill. These customers are buying general insurance plans and paying for primary care, making it more affordable for some families.

“For most of my patients, if they’re paying for insurance, to see me, I’m an additional cost,” Lucas said Wednesday. “But with the Taro system, I am no longer an additional cost. It is integrated into the system.”

Starting in 2023, Taro will have a network of 12 direct physicians in Cumberland County that patients can choose from, and Taro Health’s monthly fee will cover the monthly DPC membership fee, which is usually about $75, Yuan said. Out-of-pocket costs are $9,100, and like other insurance there will be a list of co-pays and co-pays.

Yuan said the emphasis will be on the cost-effectiveness or reduction of all basic services so that patients can stay healthy and therefore do not need expensive specialized care.

“This system is designed for people who want a different kind of care,” Yuan said.

Taro Health will also offer plans in the ACA marketplace, along with Anthem, Community Health Options, United Healthcare, Harvard Pilgrim and Aetna.

COMPETITIVE PRICES

Yuan said the average price of Taro silver is about $600 a month without subsidies. ACA coverage usually provides a higher monthly premium.

“When we priced and purchased our plans, we tried to make sure that we were affordable for Mainers. Our premiums are competitive in price with other insurers, we have several dollars or less than those who are responsible according to the metal sector,” said Yuan.

ACA plans are broken down into copper, silver and gold plans, copper plans with lower premiums but lower benefits, gold with more benefits but higher payouts, and silver the middle of the road plan.

Lucas, a Freeport doctor, said that he used to use medicine outside of the primary care model, and found that he was spending a few minutes with each patient, and not knowing them or their needs. One of them is the tendency to cram as many patients as possible into the system, while primary care serves fewer patients. Another reason they switched to primary care was that insurance records took too long.

“You’re filling out forms for the insurance company to reimburse you instead of thinking about what the patient needs,” Lucas said.

Peter Hayes, CEO of the Healthcare Purchaser Alliance of Maine, which advocates for changes in the health care system in Maine, said that testing different models is welcome as a way to address some weaknesses in the health care system.

“We are happy that there is a new product on the market that consumers can look at. We tend to focus on primary care,” Hayes said. “Time will tell if their new initiative works or not.”

Hayes said one potential problem is that there may not be enough doctors to handle the volume of patients if specialty care becomes popular because each doctor sees fewer patients.


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