Designing Maine's DirigoChoice Benefit Plan

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Executive Summary

Maine's Governor Baldacci signed The Dirigo Health Reform Act, Public Law 469, into law on June 18, 2003. The purpose of the Reform Act is to make quality, affordable health care available to every Maine citizen within five years and to initiate new processes for containing costs and improving health care quality. The Dirigo Health Reform Act seeks to address health care costs, quality, and access.

In order to address access, the Act authorizes the creation of the Dirigo Health Agency to design and administer a voluntary market-based health plan to help small businesses, the self-employed, and individuals afford health coverage. The Act envisioned that the health plan would be offered by a private insurance company or be self-administered and that workers and individuals who meet income guidelines would receive financial assistance to participate in the program.

This report addresses benefit design of the health plan, DirigoChoice™. A June 2004 issue brief provides a more comprehensive overview of the Dirigo Health Reform Act.

DirigoChoice™ is designed to provide Maine businesses that have 50 or fewer eligible employees, the self-employed, and individuals with an affordable, high-quality option for health coverage. It will look like many health insurance products currently on the market and will be offered by a private insurance company. The plan will compete with private insurers in the small group and individual markets. It must comply with all insurance regulations and attract voluntary participation. However, because DirigoChoice™ is part of a broader initiative to lower health care costs, increase access to health care, and ensure high quality health care, it has some unique features:

  • DirigoChoice™ is a public-private collaboration between Maine's Dirigo Health Agency and Anthem Blue Cross and Blue Shield (Anthem) and is coordinated with MaineCare (Maine's Medicaid program, administered by Maine's Department of Health and Human Services), to create a seamless program of health care coverage.
  • In addition to emphasizing primary care, DirigoChoice™ includes additional wellness and prevention benefits to improve health and prevent disease and illness.
  • State dollars are used to reduce costs for low income enrollees and to cover public administrative and oversight functions.
  • Qualified employers and employees share the costs of insurance coverage with the state through monthly payments, annual deductibles, and financial discounts.

Downloads

Publication Details

Publication Date: December 1, 2004
Authors: Cynthia Pernice, Jill Rosenthal
Citation:

Designing Maine's DirigoChoice Benefit Plan, Jill Rosenthal, M.P.H., and Cynthia Pernice, B.A., The Commonwealth Fund, December 2004

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