An Act To Lower Health Insurance Costs, Reduce Barriers To Health Care And Ensure Fair Prices For Health Care

Maine's LD 2196 aims to lower health care costs by capping hospital price increases at the federal Medicare market basket rate and limiting maximum charges for inpatient and outpatient services to no more than 200% of the Medicare rate, effective January 1, 2028. The bill also requires insurance carriers to maintain prior authorizations for chronic condition treatments for at least one year and prohibits them from restricting coverage for previously approved services or prescriptions within 90 days of a patient switching plans. To ensure fair pricing for providers, the legislation mandates that insurers pay in-network primary care and behavioral health specialists at least 110% of the Medicare rate. Additionally, hospitals must comply with these price caps to avoid civil fines, while insurance companies are required to submit detailed data on utilization trends and per-unit payments to state regulators starting in 2028.