Health Insurance Coverage through
the Dirigo Health Agency
Dirigo is Open and Accepting New Enrollees
DirigoChoice provides health coverage to small businesses, self-employed, and certain groups
of people buying coverage outside of a workplace. The plan is offered through the Dirigo
Health Agency and Harvard Pilgrim Health Care (HPHC).
DirigoChoice – what does it cover?
- Routine preventive care
- Inpatient/outpatient services
- Prescription drug coverage
- Maternity care
- Well-child care
- Childhood immunizations
- Emergency care
- Mental health services
- Smoking cessation education programs
There is no deductible for preventive services or prescription drugs. You don’t need a
referral to see a specialist. DirigoChoice has an extensive provider network throughout Maine.
DirigoChoice – how much does it cost?
Eligible enrollees receive discounts on the monthly cost, deductibles and annual out-of-pocket
expenses based on income, household size, and assets. Discount levels range from 10% to 80%
off the monthly premium, depending on income and family size.
To view available discounts on monthly costs, deductibles, and out-of-pocket expenses,
go to the
DirigoChoice Discount Estimator.
Please note that the level of subsidy is changing
in October of 2011.
DirigoChoice – who can apply?
DirigoChoice is available to residents of the State of Maine in the following categories:
- Small Employers (2-50 employees)
- Sole Proprietors (Self-employed of 1)
- Individuals
There are no pre-existing condition restrictions. Domestic partners can be covered as well.
There are three plan options. The benefits are the same for all options but the deductible
levels and out-of-pocket maximums are different.
- Plan 1: Not Available (N/A) for Individuals and Sole Props
- Plan 2: $1,750 deductible
- Plan 3: $2,500 deductible
Discounts are applied to monthly premium payments. Those discounts then result in
reductions in deductible and annual out-of-pocket expenses.
For instance, if an individual was eligible for a Group B discount (80%) the
deductible and out-of-pocket costs for the plans available to individuals, effective October 2011,
would be:
| Group B - 80% Discount |
|
Deductible |
Out-of-Pocket |
| Plan 1 |
N/A for Individuals |
N/A for Individuals |
N/A for Individuals |
| Plan 2 |
Single |
$750 |
$1,850 |
|
Family |
$1,250 |
$3,450 |
| Plan 2 |
Single |
$750 |
$950 |
|
Family |
$750 |
$1,650 |
To be eligible for Group B an individual would have to have income less than
$16,245 and assets less than $15,000 OR a family of 3 would have to have income less
than $27,465 and assets less than $30,000.
This sliding scale of monthly payments, deductibles, and out of pocket maximums helps make
DirigoChoice more affordable to enrollees.
DirigoChoice Contact Information
For more information or to request an application
visit the DirigoChoice website
or call the DirigoChoice office:
Toll Free #: 1-877-892-8391 / TTY: 1-207-287-4344
Fax #: 1-207-287-9922
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