DirigoChoice and ME

Beatrice Blake
Self-employed Enrollee
East Blue Hill

“I want to tell you that DirigoChoice saved my life…”

My family of four, like many people in Maine, is self-employed. Until 2001, we were paying $225 per month for health insurance with a  $2,500 deductible. Then our insurance company left the state. We ended up with the cheapest policy we could find: $519 per month with a $5,000 deductible, which offered my family and me almost nothing in terms of health care. It is really depressing to be paying that much per month, and still have to pay medical bills for diagnostic services (except mammograms and pap smears).

When you are scraping together $519 a month to pay the premium, you hesitate to get routine health care because it all costs extra. I was afraid to go to the doctor because of out-of-pocket expenses, which our family couldn’t afford.

That is why I am so thankful for DirigoChoice. I'm glad that the Governor's office knows what it is like for working families. Finally we have insurance that has good coverage and is affordable. We are paying $553 per month, but doctor's office visits only cost us $20. Our deductible is down to a more manageable $1,450.

I want to tell you that DirigoChoice saved my life. Under DirigoChoice diagnostic screening services are covered in full (meaning no co-pays and deductibles for these services), so I could receive a screening colonoscopy (which everyone should have after age 50). Because of this important test, my doctor discovered that I had colon cancer, which could be treated before it was too late. If it had not been for Dirigo, I would not have received the care I needed to find this problem in time. Now my prognosis is good, and I am very, very grateful.

I think DirigoChoice is a great program and I applaud our state government for courageously addressing the needs of its hard-working citizens.

Shirley Bull
Small Business Enrollee (Owner)
Brooksville

“When we moved here we did not realize how difficult it would be to obtain reasonably priced health insurance…”

My husband and I moved to Maine five years ago and built Sunrise Cottages and the Breakfast Shed in Brooksville, Maine. Our dream was to build a business in order that we could be self-employed and live in such a beautiful and safe environment. We've done that—built our cottages and restaurant and after 4 years we think we are doing pretty well! 

When we moved here we did not realize how difficult it would be to obtain reasonably priced health insurance for ourselves. Before Dirigo, the only choice we had, other than no insurance at all, was to acquire catastrophic coverage with a deductible of $5,000 and no coverage for doctor visits or prescriptions. 

The Dirigo coverage has made it possible for us to have better coverage (co-pays and prescriptions) with a lesser deductible, at the same price.

Jim Bergin and Judy Garvey
Blue Hill

“For the first time in ten years, we have health care that is affordable through DirigoChoice…” 

For the first time in ten years, we have health care that is affordable through DirigoChoice. During the short time we have been Dirigo members, we have learned that one of us has a correctable serious health issue that had gone untreated due to our former lack of affordable health care. This condition can now be corrected and the quality and longevity of life improved incredibly.

If we lose Dirigo, we would need to return to our $15,000 deductible catastrophic insurance policy—and even that was becoming unaffordable. Under that policy, we did not visit doctors, as it was all out of pocket, and we could not afford to go. The only purpose for that policy was to protect our assets in case of serious illness. If that policy had gone up in price, we would have become completely uninsured, putting our home equity, as well as our health, at great risk.

Josephine Jacob
Small Business Enrollee (Employee)
Deer Isle

“[My husband’s] company was one of the few that offered health insurance… [but] the level of coverage deteriorated over the years as the costs of heath insurance increased…”

I am currently enrolled in DirigoChoice through the boat building company my husband works for. He had worked for a relatively small construction firm for 20 years. That company was one of the few that offered health insurance as a benefit for its employees. However, the level of coverage provided deteriorated over the years as the costs of heath insurance increased. The employer bent over backwards to find plans that the company and employees could afford and would come as close as possible to meeting their health insurance needs.
 
The feature I found most lacking in the several health plans we were enrolled in over the years was coverage for preventative measures an insured person might undertake to ensure continuing good health over a lifetime. I hear, time and time again, about the most insurance money being used in a person's last several months of life, often due to conditions that could have been ameliorated long ago with attention paid to lifestyle changes. 

My understanding is that DirigoChoice aspires to including coverage for treatments that fall under the category of "prevention". There isn't as much money to be made by providers for prevention of disease. Therefore I think it makes good sense for DirigoChoice to break away from established models of providing health care and look to moving toward a self-administered model that has been working well for several businesses in our state.

Maine has excellent infrastructure that has been built up over the last five years by the Healthy Maine Partnerships. I look forward to much more collaboration between HMP and Dirigo Health in promoting active lifestyles that include access to nutritious foods for all, opportunities to enjoy the benefits of physical exercise at whatever level an individual is capable, and compassionate, realistic support for cessation of tobacco use. I believe these goals have a better chance of being met with the support of a health plan that has more control over its use of its funds.   

Patricia Estabrook
Small Business Enrollee (Owner)
Belfast

“Dirigo is a lifesaver and a vacation saver…”

I am the owner of All About Games in Belfast.  One of the most challenging aspects of running a small business in Maine is being able to provide health insurance for my workers. 

While on vacation in Washington County this September, an employee of mine woke up one morning to find his face swollen to double its size. He called several doctors in the Calais area and was unable to be seen that day, so he was forced to go to the emergency room at Calais hospital. By the time he was seen, he was running a fever and in great pain. The doctors were able to prescribe an antibiotic to clear up his infection and save his vacation. When Ray returned home, he visited his regular physician and found that the infection was completely cured.

Without Dirigo Health, Ray's vacation would have been ruined, and he would have faced significant debt. Dirigo is a lifesaver and a vacation saver.

Faye Pertuis
Self-Employed Enrollee
Portland

“Now with DirigoChoice… I have preventative care…”

After 30 years in the health care profession and a layoff, I was only able to get a $5,000 deductible catastrophic insurance policy at a cost of over $300 per month.  There was no coverage for physicians, labs and testing, or prescription drug coverage.  I needed to protect my home from foreclosure should I ever need hospitalization or major surgery. 

Now with DirigoChoice, for just $56 per month more ($356), I have preventative care, which includes physician coverage, labs and testing (mammograms and pap smears). That preventative care will reduce long term costs by identifying problems early when costs and treatment are less expensive and invasive. 

Linda Dartt
Self-Employed Enrollee
Montville

“When Dirigo became available to self-employed individuals, I enrolled immediately…”

My name is Linda Dartt. I am currently self-employed as a consultant in the healthcare field. Before I left my last position to pursue consulting on my own, I had medical and dental coverage under the federal COBRA (Consolidated Omnibus Budget Reconciliation Act) extensions for 18 months.  When the extended medical coverage period ended, I enrolled in a plan offered by Anthem, which offered the only real options available for individuals in Maine. I chose a plan with $100 annual preventive care not subject to the deductible, most coverage at 80% after a $2,250 annual deductible and no prescription coverage. This minimal coverage cost me $456 monthly. I was "fortunate" to be able to afford this exorbitant sum, at least for a while. In addition to the premium, I was spending more than $300 monthly on prescription drugs. All of this totaled more than $5,000 a year for coverage of a major catastrophe, another $3,600 for pharmaceuticals and I had almost no coverage for routine or preventive care.

When Dirigo became available to self-employed individuals, I enrolled immediately. Because my income level does not qualify for a subsidy, my monthly premium is now $356. For this amount, I have complete preventive coverage not subject to the deductible, an annual deductible of $1,750, an office visit co-payment of $20 and pharmaceutical coverage at a maximum of $50 per prescription. My prescriptions now cost me about $50 monthly. All of this amounts to less than 60% of my previous insurance cost for far better benefits than I had before.

I think that by emphasizing preventive and primary care, the Dirigo plan will contribute to better future health status for the people of Maine. By allowing us to obtain care at a reasonable cost before we develop chronic and/or debilitating conditions, the citizens of Maine will, in the long term, benefit from both lower health care costs and a healthier populace. The alternative is to force uninsured people into delaying care and arriving at Emergency Departments with serious issues, which is a situation that costs all of us in higher and unnecessary costs. Subsidizing discounts for low-income individuals by using the higher premium payments by those who can afford to pay it allows Maine to maximize the use of State funds and cover more people with better care.

As a taxpayer, I am proud that the Maine Governor’s Office and Legislature have taken a step toward providing all residents with access to good preventive care and protection from the cost of a major medical crisis. Governor Baldacci and his administration deserve praise for trying to do something to improve access to health care for the people of Maine. Providing coverage for those who otherwise wouldn't have it is the right thing to do, but it also makes economic sense.

Jacquie Murphy
Self-Employed Enrollee
Westbrook

“Dirigo Choice has been a life-saving program for me…”

DirigoChoice is not a political football—you’re playing with people’s lives. I am an individual who is enrolled in DirigoChoice. DirigoChoice has been a life-saving program for me.

I was in a physically abusive marriage for over twenty years because I was afraid that I could not survive financially on my own due primarily to the high cost of medical care and my financial inability to get health insurance on my own. I took a leap of faith and left that marriage.

I became clinically depressed and was hospitalized two times in a one-year period because of my fear that I could not make it on my on financially. When DirigoChoice became an option, I was able to overcome my fears and recover from the depression. I was finally able to afford good coverage. DirigoChoice provided me with coverage to support the medical treatments I needed to recover. Not only did the program provide me with peace of mind, it allowed me to survive financially.   

Please make sure that DirigoChoice can continue to succeed by ensuring that there is a sustainable funding mechanism. Thousands more Mainers could benefit from the DirigoChoice program as I have, and they deserve the chance to enroll! 

Maine People’s Alliance—Organizing for a Better Maine!

565 Congress St., Suite 200, Portland, Maine 04101; (207) 797-0967; mpa@mainepeoplesalliance.org
27 State Street, Suite 44, Bangor, Maine 04401; (207) 990-0672; jesse@mainepeoples alliance.org
145 Lisbon Street, Suite 200, Lewiston, Maine 04240; (207) 782-7876; kate@mainepeoplesalliance.org