For plan year 2022, most individual health insurance plans in Maine will use one of several “Clear Choice” plan designs. Each Clear Choice plan design will have a standard cost-sharing design, meaning they have the same deductible, copays, and co-insurance for medical services, no matter which health insurance company offers the plan.
When comparing each Clear Choice plan among health insurance companies, you can focus on the provider network available and the premium cost, knowing that the level of coverage provided is the same. All plans using these structures will include “Clear Choice” or “CC” in the plan name.
The Clear Choice plan designs being offered on CoverME.gov in 2022 are:
- Bronze - $7,500 deductible
- Bronze - $8,700 deductible
- Bronze - $7,000 deductible, HSA compatible
- Bronze - $5,900 deductible, HSA compatible
- Silver - $3,500 deductible
- Silver - $5,500 deductible
- Gold - $1,500 deductible
- Gold - $2,500 deductible
- Platinum
For a detailed view of Clear Choice Plan Designs for 2022, see the table below:
This table is also available in PDF form.
| Benefits | Catastrophic | Bronze $7,500 | Bronze $8,700 | Bronze $7,000 HSA | Bronze $5,900 HSA | Silver $3,500 | Silver $5,500 | Silver $3,500 HSA | Silver $4,500 HSA | Gold $1,500 | Gold $2,500 | Platinum |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Estimated AV Value | N/A | 64.19% | 64.56% | 64.60% | 64.70% | 70.53% | 70.52% | 70.51% | 66.38% | 80.14% | 77.48% | 88.54% |
| Deductible | $8,700 | $7,500 | $8,700 | $7,000 | $5,900 | $3,500 | $5,500 | $3,500 | $4,500 | $1,500 | $2,500 | $500 |
| Maximum OOP | $8,700 | $8,700 | $8,700 | $7,000 | $7,050 | $8,700 | $7,500 | $7,000 | $7,000 | $5,000 | $6,000 | $3,000 |
| Coinsurance | 0% | 50% | 0% | 0% | 50% Coins. After Ded. | 40% | 30% | 10% Coins. After Ded. | 20% Coins. After Ded. | 30% | 30% | 20% |
| PCP and Behavioral Health Office Visits* | $50 for 2nd & 3rd visits then deductible | $40 | $50 | $30 | $30 | $25 | $25 | $20 | ||||
| Specialist Visit | 0% Coins. After Ded. | 50% Coins. After Ded. | $100 | $60 | $60 | $50 | $50 | $40 | ||||
| Free Standing Urgent Care | $60 | 0% Coins. After Ded. | $40 | $40 | $40 | $40 | $25 | |||||
| Outpatient Facility Fee (e.g. Ambulatory Surgery Center) | 50% Coins. After Ded. | 40% After Deductible | 30% After Deductible | 30% Coins. After Ded. | 30% Coins. After Ded. | 20% Coins. After Ded. | ||||||
| Outpatient Surgery and Physician/Surgical Services | ||||||||||||
| Inpatient Hospital Services and ER | ||||||||||||
| Inpatient Physician, Rehabilitation, and Surgical Services | ||||||||||||
| Ambulance | ||||||||||||
| All Other Benefits | ||||||||||||
| RX- Tier 1 Generic | $25 | $25 | $25 | $25 | $25 | $5/$25 | $0 | |||||
| RX- Tier 2 Preferred Brand | $50 | 0% After Deductible | $50 | $50 | $50 | $50 | $15 | |||||
| RX- Tier 3 NonPreferred | $100 | $100 | 30% | $100 | 30% up to $300 | $100 | ||||||
| RX- Tier 4 Specialty | $250 | $250 | 50% | $250 | 50% up to $600 | $250 | ||||||
| Preventive Medical Benefits | 0% | |||||||||||
| Pediatric Dental- Preventive & Diagnostic | 0% | |||||||||||
| Pediatric Dental- Restorative & Basic Services | 20% Coinsurance after Deductible | |||||||||||
| Pediatric Dental- Major Services & Medically Necessary Orthodontics | 50% Coinsurance after Deductible | |||||||||||
*1st PCP and Behavioral Health Office Visit Have $0 copay; subsequent visits have copay before deductible except HSA plans
Yellow cells indicate services covered before the deductible is met.