Earlier this month, superintendent of the Maine Bureau of Insurance Bob Carey warned Mainers to steer clear of "self-funded" health plans, saying that the bureau had intervened in cases where victims had paid monthly premiums, only to have their medical claims denied.

In addition to operating illegally, these bad actors left consumers on the hook to pay tens of thousands of dollars for routine medical expenses.

ABOUT THE AUTHORS

Jeff Yuan and Frank Wu are founders of Taro Health, which offers health insurance plans through the ACA Marketplace at CoverME.gov, and small group plans for Maine employers.

Predatory practices, unfortunately, are a reality of many industries. But the fact that more than a half-dozen operators were able to take advantage of people with the promise of low-cost plans speaks volumes about the broken nature of our current health insurance system - and the deep hunger for more affordable health insurance coverage.

Some 43% of people with insurance coverage - and 57% with marketplace or individual market plans - have reported difficulty affording their care, according to a poll by the independent nonprofit Commonwealth Fund. Nearly two in five working-age adults - 38% - delay or skip needed medical care because they can't afford it.

The medical and financial consequences of delaying needed care and skipping routine screenings are well established. Chronic health conditions can quickly spiral out of control; people die of treatable diseases; emergency rooms swell with crowds; and medical costs and debts mount.

Both doctors and patients are now clamoring for a better way - a way to make comprehensive care accessible and affordable and to truly allow people to lead healthier lives.

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Taro Health's plans, which are one of the four Bureau-endorsed options offered through CoverME.gov, provide more access to care from day one, including unlimited free visits with primary care doctors and mental health care, as well as a myriad of other routine health care services for no additional cost. We designed our plans to give people more access to better care at a lower cost. We know that better access to high quality primary care early means fewer hospital visits and expensive prescription drugs, reducing health care costs in the long run for everyone.

Since we entered the market in 2022, more than 50,000 providers throughout New England have joined our network, including specialists and hospitals in the state's biggest health systems - MaineHealth and Northern Light - and the region's destination systems like Mass General Brigham in Boston. We've also partnered with doctors who don't participate in other insurance networks, including 40 local physician pioneers who practice Direct Primary Care, a model where physicians see fewer patients to focus on building a stronger relationship with their patients - offering longer visits; increased appointment availability; same-or-next day sick visit access; and opportunities to get care in-person and over phone, email or text.

We believe that we can rebuild this broken system together. We listen to story after story about Mainers who are getting routine medical care for the first time in years and seeing radical health improvements as a result. People who let chronic health issues like diabetes, heart disease and high blood pressure go unmanaged for years - and just learned to live with the symptoms and the looming threat of trips to the ER - are now getting the prescriptions they need and are monitoring their conditions and actively managing their health. They're leading happier, healthier lives as a result.

We hope that as open enrollment season begins Nov. 1, more people will follow their lead - and realize that accessing affordable comprehensive primary care isn't just a pipe dream. We hope that will leave less room for the folks offering unlicensed self-funded plans to get traction in Maine.

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