Community Health Options

What Community Health Options does

Community Health Options is a Lewiston, Maine-based nonprofit Consumer Oriented and Operated Plan (CO-OP) health insurer founded in 2013. It underwrites and administers ACA-compliant health plans for individuals, families, small groups (≤50 employees), and large groups, distributing through CoverME.gov, direct enrollment, licensed broker channels, and a direct employer sales team. The Member-led governance model, with a Board of Directors elected by members, is the company's distinguishing structural feature. Its coverage footprint centers on Maine (99.9% of in-state hospitals in-network) with extension across New Hampshire, Vermont, and Massachusetts via First Health for national coverage and Centers of Excellence partnerships.

The product portfolio spans HMO, PPO, and HMO Tiered plan structures across Bronze, Silver, Gold, and Platinum metal levels, with HSA-qualified high-deductible options. Specialty sub-brands include North Star plans designed for northern and rural Maine counties through a partnership with Northern Light Health. Layered add-on modules include Firefly Health virtual primary care, Amwell 24/7 urgent care and behavioral telehealth, a Chronic Illness Support Program (CISP) covering asthma, CAD, COPD, diabetes, and hypertension, an outpatient infusion Site of Care program through Local Infusion yielding up to 50% savings, Blue Circle Health free Type 1 diabetes virtual care, and pharmacy integration with Express Scripts including the Price Assure generic-price optimization. Administrative services include the CarePartners program for MaineHealth, which serves 20,000+ low-income uninsured adults.

The platform backbone includes a member portal, broker portal, provider portal, HealthSparq-powered provider directory, Availity claims clearinghouse (post Change Healthcare cyberattack restoration), machine-readable files for CMS Transparency in Coverage compliance, and CMS interoperability features letting members share data with third-party health apps via myhealthapplication.com. In 2023 the company processed over 372,000 claims totaling approximately $205.4 million with an average turnaround under four days. Revenue is generated through monthly insurance premiums across all segments, with publicly unstated per-member pricing driven by plan, age, geography, and rating methodology (community rating for individual/small group, experience rating for large group).

Name

Community Health Options

Legal name

Community Health Options

Website

https://healthoptions.org

Company type

Private

Founded year

2013

Operating status

Operating

Headcount range

101–250 employees

Short description

Community Health Options is a Lewiston, Maine-based nonprofit, Member-led health insurer offering ACA-compliant individual, family, small group, and large group plans across Maine and northern New England, with 48,000+ in-network providers and 99.9% of Maine hospitals in-network.

Ownership category

akta.pro rank

Product category

Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)

akta.pro primary industry

CO-OP / Nonprofit Individual Market Plans (HLAEABAH)

akta.pro secondary industries

Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE), Small Group Health Insurance (2–50/100) (FSAIAFAD), Managed Care / Network-Based Group Health Plans (Carrier Network Products) (FSAIAFAO), ACA Marketplace (On-Exchange) Individual Plans (FSAIAEAA)

Keywords

• Health insurance plans
• ACA marketplace coverage
• Group health benefits
• Virtual primary care
• Pharmacy benefits

Headquarters

HQ city

Lewiston

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Health Insurance Premiums: Community Health Options generates revenue primarily through health insurance premiums paid by individuals, families, and employers for comprehensive health plan coverage. Premiums are paid monthly and vary based on plan type, coverage level, and member demographics.

Pricing tiers

Go-to-market motion3 records

Distribution channels5 records

Marketing channels6 records

Core offering

Community Health Options is a Maine-based nonprofit health insurer that sells ACA-compliant health insurance plans to individuals and families (through CoverME.gov and direct channels), to small employers (50 or fewer employees) via community-rated group plans, and to large employers (more than 50 employees) via experience-rated group plans. Coverage is delivered across HMO, PPO, and HMO Tiered plan types and metal levels (Bronze, Silver, Gold, Platinum), with regional North Star plans in northern Maine and supplementary programs including virtual primary care (Firefly Health), 24/7 telehealth (Amwell), Chronic Illness Support Program, Site of Care infusion network, and pharmacy benefits through Express Scripts.

Product overview

Community Health Options is a Maine-based nonprofit health insurer offering a comprehensive portfolio of ACA-compliant health insurance products across individual/family, small group, and large group segments. The portfolio includes plan types across metal levels (Bronze through Platinum) and network structures (HMO, PPO, HMO Tiered), with specialized sub-brands like North Star plans for northern Maine. Core offerings are enhanced by integrated add-on modules including virtual primary care through Firefly Health, 24/7 telehealth via Amwell, pharmacy benefits through Express Scripts with Price Assure price optimization, a Chronic Illness Support Program (CISP) for members with chronic conditions, and a Site of Care program for infusion therapy. The company provides member-facing digital tools including a Member portal, provider directory, and interoperability features for third-party health app connections, alongside administrative services like CarePartners program administration for MaineHealth.

Differentiator

Problem solved

Functional benefit

Products and services

• Individual & Family Health Plans
• Small Group Health Plans
• Large Group Health Plans
• North Star Health Plans
• HSA-Qualified Health Plans

Quantifiable outcome

• Site of Care Program yields savings of up to 50% on infusion therapy compared to non-preferred providers
• +3 more outcomes

Named customers2 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

AI capability2 records

Partnerships

Ten partnerships are on record, tiered core and minor.

• Northern Light HealthcoreStrategic or Co-development Partner · 20 August 2025Strategic partnership to lower costs and improve access for Community Health Options Members using Northern Light Health facilities across Maine. Includes improved rates, preferred provider copays on HMO Tiered New England plans, easier-to-understand billing, and streamlined Prior Approval processes. New North Star plans proposed for northern Maine counties (Penobscot, Piscataquis, Somerset, Hancock, Aroostook, Washington). Agreement covers 1,000 Northern Light Health providers at 9 hospitals and 127+ locations.
• Blue Circle HealthcoreTechnology or Integration · 7 April 2025Free virtual Type 1 diabetes care partnership for Members over 18 with Type 1 diabetes. Blue Circle Health offers diabetes counseling, nutrition help, and care coordination working with Community Health Options' Care Management team and Members' current care teams.
• MaineHealth (CarePartners)coreImplementation/ SI/ Consulting Partner · 3 September 2024Administration partnership for MaineHealth's CarePartners program providing free or low-cost healthcare for low-income, uninsured adults who cannot afford private insurance and don't qualify for public programs. Community Health Options provides enrollment cards, processes claims, and tracks service data. Program has enrolled 20,000+ members from 10 counties.
• AvailitycoreTechnology or Integration · 28 March 2024Claims clearinghouse partnership implemented following Change Healthcare cyberattack to restore provider claims processing capabilities. Fully operational for all providers to submit electronic claims.
• Firefly HealthcoreTechnology or Integration · 28 November 2023Virtual primary care partnership offering Members 18+ access to virtual-first primary care teams including a primary care doctor, nurse practitioner, health guide, and behavioral health specialist. Firefly model provides personalized care plans, chronic condition management, and coordination with in-person specialists. Members can schedule first appointment within 3 business days.
• Local InfusioncoreStrategic or Co-development Partner · 18 May 2023Preferred provider partnership for outpatient infusion Site of Care Program. Local Infusion offers private suites, nurse practitioners for all care, flexible hours including nights and weekends, and dedicated infusion guides for scheduling and financial guidance. Program yields savings of up to 50% compared to non-preferred providers, with Members eligible for incentives up to $1,000-$3,700 per year.
• AmwellcoreTechnology or IntegrationTelehealth partnership for 24/7 urgent care telehealth and behavioral health services (therapy and psychiatry). Available to all Members at $0 out-of-pocket on 2026 plans.
• First HealthcoreTechnology or IntegrationNational network partnership providing coverage for Members outside Maine, including those who travel, have children away at college, or live part-time outside the state.
• Maine Community FoundationminorStrategic or Co-development PartnerPartnership to administer Community Health Options' Community Benefit Expenditure wellness grants program. The foundation has helped distribute $419,850 in grants to 65+ Maine nonprofits since 2020.
• National Fitness CampaignminorStrategic or Co-development PartnerPartnership to install free outdoor Fitness Courts across Maine. Three courts installed in Lewiston, Hampden, and University of Maine Farmington as part of the world's largest free outdoor gym network.

Scale indicators7 records

Recent moves8 records

Expansion highlights6 records

Direct peers

• Martin's Point Health Care: Maine-based, nonprofit health plan and care delivery organization offering individual, Medicare Advantage, and group plans. Directly comparable as a regional nonprofit insurer competing for the same Maine individual and employer market with a similar member-led mission orientation.
• Anthem Blue Cross Blue Shield of Maine: Major competitor on the CoverME.gov marketplace and in the small/large group employer segment in Maine. Directly comparable in product mix (individual ACA, small group, large group) but vastly larger in scale and backed by Elevance Health's national infrastructure.
• Harvard Pilgrim Health Care: New England nonprofit health plan now operating under Elevance Health, offering individual, Medicare, and employer plans across Maine, New Hampshire, Massachusetts, and Connecticut. Directly comparable regional nonprofit peer with overlapping geography and similar product portfolio.
• Blue Cross Blue Shield of Vermont: Vermont's only nonprofit BCBS plan and the state's largest health insurer, serving individuals, small groups, and large employers. Directly comparable as a regional nonprofit carrier in northern New England with similar community-oriented governance and product structure.
• Tufts Health Plan: New England-based nonprofit health plan (now part of Point32Health) offering commercial, Medicare, and Medicaid plans in MA, RI, CT, and NH. Comparable as a regional nonprofit carrier with overlapping provider networks and similar employer-focused distribution model.

Emerging players

• Taro Health: Tech-forward health insurer that has entered the Maine individual ACA marketplace. Comparable as a newer entrant pursuing the same ACA individual segment in Maine with a differentiated technology-led member experience approach.

Broad incumbents

• Elevance Health (formerly Anthem): National managed care company that owns Anthem Blue Cross Blue Shield of Maine and Harvard Pilgrim Health Care. Comparable as the dominant multi-state carrier competing in the same Maine and New England markets with far broader scale and product breadth.
• UnitedHealth Group: Largest U.S. health insurer offering ACA Marketplace, employer, and Medicare plans nationwide including in Maine. Comparable as a broad incumbent that competes for individual and group accounts across every geography Community Health Options serves.
• Aetna (CVS Health): National health benefits carrier offering ACA Marketplace and employer plans in Maine and across New England. Comparable as a large multi-state incumbent competing on small group and large group employer benefits with deep pharmacy and clinical integration.
• Cigna Group: Global health services company offering employer-sponsored health plans and ACA Marketplace coverage in select markets including parts of New England. Comparable as a broad incumbent pursuing the same mid-market and large group employer segment with strong stop-loss and specialty capabilities.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights6 records

Customer concentration

• Facebookfacebook.com/CommunityHealthOptions
• LinkedInlinkedin.com/company/communityhealthoptions
• Instagraminstagram.com/communityhealthoptions
• TikToktiktok.com/@communityhealthoptions
• Xx.com/CmtyHlthOptns

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles5 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Community Health Options