Are you looking for affordable health insurance in Maine, but aren’t sure what’s available? Here you’ll find answers that will help you choose the coverage that’s right for you.
Maine has the nation’s oldest population, which it cares for through Medicare, the federal government’s insurance program for people over 65.1
The state has made progress in lowering the number of people with no health insurance, thanks in part to the Affordable Care Act (also known as Obamacare).
The number of uninsured Mainers dropped from 125,000 in 2014 to 69,500 in 2020,2 which represents 5% of the state’s 1.4 million residents.3 The expansion of Medicaid in 2019 is expected to reduce it even more.
Maine offers several health insurance solutions for individuals, families and small business owners. You might even qualify for one of the programs that insure you inexpensively, depending on how much you earn.
Here are answers to some of the questions Mainers ask most often when they’re trying to decide on health insurance.
When Is Maine’s Open Enrollment Period?
Maine’s Open Enrollment Period (OEP) for health insurance under the Affordable Care Act (ACA) takes place from November 1 to January 15.4 You’ll need to re-enroll each year during this period to avoid a break in coverage.
Insurance brokers and agents can help you find a plan that’s right for you, but keep in mind that to qualify for help in paying for your insurance (subsidies, or premium tax credits), you have to buy your ACA policy directly from the Marketplace.5 In 2021, more than 60,000 Mainers enrolled in an ACA policy, down from 62,000 the year before.6
Outside of the OEP, you can use a Special Enrollment Period (SEP) to sign up for health insurance at any time of the year if something happens in your life that qualifies you for a SEP, such as losing your job or having a baby. You have 60 days from the date of the event to apply for a health plan.7
How Do I Enroll in Maine Health Insurance?
You can enroll in ACA health coverage directly through the Maine Health Insurance Marketplace at the federal government’s healthcare.gov website. The state is planning to switch to its own exchange in fall 2021.
The Marketplace offers ”metal” plans in bronze, silver and gold (the more valuable the metal, the more coverage you get and the higher the cost of the plan), as well as catastrophic health insurance. All Maine metal plans include essential health benefits, as required by the ACA. Catastrophic plans are only available for people up to age 30 and those with hardship exemptions.8
Maine’s Consumer Assistance Program Helpline is available to help you Monday to Friday, from 8:30 am to 4:30 pm at (800) 965-7476. The CoverME.gov site includes an overview of all options for individual coverage, too.
How Much Does Maine Individual Health Insurance Cost?
On average. a Marketplace silver “benchmark” plan in Maine will cost you $440 a month for 2021, down from $513 in 2020 and $544 in 2019.9
The average monthly premiums for 2021 Maine health insurance plans are:10
- $348 for the lowest-cost bronze plan
- $435 for the lowest-cost silver plan
- $494 for the lowest-cost gold plan
Remember that these are the costs before any savings you might be eligible for based on your family size and household income.
If you qualify for ACA subsidies, your monthly premium could be much less. How much you pay also depends on the type of plan you choose. Among metal plans, bronze-level coverage typically has the cheapest health insurance premiums in Maine but the highest out-of-pocket costs.
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Which Companies Offer Individual Health Insurance Plans in Maine?
You can choose from three health insurance companies for 2022 individual and family plans:11
What Are My Coverage Options?
Marketplace Plans (Obamacare)
Before 2021, you qualified for premium tax credits or subsidies to pay for health insurance if you made between one to four times of the federal poverty level.
In 2021, the formula changed. Subsidies were expanded and the income cap was removed. You are expected to pay no more than 8.5% of your annual household income on health insurance based on the price of the benchmark plan. The federal government would cover the balance through subsidies.
In 2021, nearly 60,000 Mainers enrolled in an individual plan through the Marketplace, and almost nine out of 10 enrollees received this assistance.14
Another way you can save money on premiums is through cost-sharing reductions (CSRs). CSRs go to pay for copays, prescription drugs and other out-of-pocket expenses, but they only apply to silver plans you buy through the ACA Marketplace. Generally, you must earn between 100% and 250% of the FPL to qualify.15
Check a 2022 subsidy chart and calculator to see the savings you might qualify for.
More than 300,000 Mainers have Medicaid as of April 2021.16 The program is called MaineCare and it provides free and low-cost health insurance to residents who need it. You can enroll in Medicaid at any time of year.
Maine is one of the states that have expanded their Medicaid program to include low-income residents who earn under 138% of the FPL. Since its implementation in January 2019, the expansion added nearly 82,000 more people to the MaineCare rolls.17
You qualify for MaineCare if you meet household income requirements and you are either a child under 19, the parent or caretaker of a child, pregnant, age 65 or older, or are blind or have a disability. Full details are explained in these MaineCare Eligibility Guidelines.
If you have questions, visit MaineCare Services to find the right person to help you.
Children’s Health Insurance Program (CHIP)
If your household makes too much to qualify for Medicaid and you have children under age 18 who are uninsured, they may qualify for low-cost insurance through the Children’s Health Insurance Program (CHIP).18 In Maine, the program is called CubCare and the monthly fee is $8 to $64 for each enrolled child.19
In March 202`, over 14,000 residents were covered under CHIP.20 You can enroll in CubCare at any time.
How Do I Apply for Help Paying for My Insurance?
Your eligibility for financial assistance for a Marketplace plan will be determined as you go through the application process at healthcare.gov. This includes your eligibility for Medicaid and CHIP, too.
To apply for MaineCare (Maine’s Medicaid), follow the instructions at My Maine Connection and take these steps:
- Go through the Prescreen to confirm that you are eligible.
- Create an account with My Maine Connection.
- Download the MaineCare Application.
- Follow the instructions to complete your application for health insurance.
What About Medicare for Maine Seniors and People With Disabilities?
Medicare is a federal health insurance program that covers most seniors over the age of 65 and younger adults with disabilities. As of 2020, over 345,000 Mainers (or one-quarter of the population) had enrolled in Original Medicare or Medicare Advantage
About six out of 10 Medicare enrollees get Part A and Part B coverage through the federal government’s Original Medicare program. The rest get these benefits through private Medicare Advantage (Part C) plans.22 Part C plans cover additional benefits, including Part D prescription drug coverage.
You can also buy individual Part D prescription drug plans from private insurers, especially if you choose to get Part A and Part B coverage through Original Medicare. As of 2018, more than 145,000 Maine residents have a standalone Part D plan.23
Original Medicare typically covers only about 80% of approved costs. If you choose coverage through Original Medicare, you can also add a Medicare Supplement Insurance plan (called a Medigap policy).
Maine (and most states) offers 10 standardized Medigap plans that help pay some to all of your uncovered, out-of-pocket costs. These include copayments, coinsurance and deductibles.
The benefits for each standardized Medigap plan are set by the federal government, so the basic benefit structure for each plan is the same no matter where you buy it. But the insurance company is free to charge what it wants for its policies, so your cost can vary depending on the insurer you buy it from.
If you have questions about any aspect of Medicare insurance, Maine State Health Insurance Assistance Program (SHIP) provides free counseling by calling (800) 262-2232 or visiting their website.
Can I Buy Short-Term Insurance in Maine?
Yes, the state does allow short-term plans with an initial plan duration up to 12 months. However, a new law took effect in 2020 to provide more consumer protections and so far no insurers have stepped forward to offer policies, including the three insurers who provided coverage in 2019.24 So currently no short-term coverage plans are available to buy if you live in Maine.