An Act To Expand The Right To Shop For Health Care Services

LD 1152 requires Maine health insurance carriers offering small group plans to create plan designs that directly incentivize enrollees to choose lower-cost, high-quality providers for specific outpatient services. It mandates incentives (like reduced premiums or gift cards) equal to at least 25% of the price difference between a provider’s charge and the statewide average for services like physical therapy, imaging, lab work, infusion therapy, and now surgical procedures. The bill expands out-of-network coverage by requiring insurers to apply payments made to out-of-network providers toward deductibles if prices are at or below the statewide average, removing previous limitations on health maintenance organization plans and geographic restrictions. This affects small business employees and their families covered under these plans by increasing transparency and financial incentives for cost-conscious healthcare choices.