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Residents of Maine searching for health insurance have several options. Your employer may offer private health insurance, you may purchase insurance on your own, or you may be eligible for Medicare or Medicaid. Learn about your health care coverage options in Maine.
If you want to enroll in a health care plan via Maine’s marketplace, you’ll need to do it on the Healthcare.gov site.
You’ll need to create an account where you’ll be asked for some information to register, including your name, place of work, Social Security number, area of residence, family income, and other relevant information. You’ll need some of this information for every member of your family you are registering.
Once your account is created, you’ll be able to examine as many as three plans at a time to compare features like premiums, coinsurance, copays, and deductibles. This will help you pick the plan that works best for your family.
Three insurance companies are available:
Although the process of signing up for health care remains the same whether doing it for yourself or for your family, the questions that you need to consider can be quite different. When making decisions about an individual or a family plan you’ll need to consider things like your overall health, your family’s health, how much you want to pay for a premium, and how much you want to pay out-of-pocket.
When you’re selecting a health plan for yourself, you have a bit more flexibility than when you’re selecting one for your family. The only person whose health you need to consider is your own. Are your health care needs minimal? You can likely choose a health care plan with a low monthly premium and a high deductible. If you have a chronic condition and frequently visit your primary care physician or specialists, you may be better off selecting a plan with a higher monthly premium and a lower deductible.
The kind of plan that you choose can also make a difference in terms of your healthcare.
Regardless of what plan you select, you can earn premium tax credits that lower your monthly premiums if your income is between 100% to 400% of the FPL. You may also be eligible for cost-sharing reductions (CSRs) if you select a silver plan.
Health care questions become a little more complex when you’re considering individuals other than yourself and how they fit into a health care plan. You and your spouse may be healthy but perhaps you have children with health issues like asthma or a child who needs mental health care.
Healthy families can probably go with an HMO. This is a good plan if you and your family don’t make many visits to the doctor. However, if a member of your family has a chronic health issue and needs medical treatment on a regular basis, including the potential for many costly prescriptions, a PPO or a POS plan might be a better option.
Ultimately, it boils down to how much you can afford for the monthly payment versus how much you can afford for out-of-pocket expenses like copays, deductibles, and coinsurance.
Prices on the Maine health insurance marketplace in 2021 have declined by as much as 13% in some cases. The Maine marketplace uses the Healthcare.gov metal categories: bronze, silver, gold, and platinum. There is also a catastrophic level in Maine. The levels signal a difference in how much you’ll pay for premiums and deductibles.
|Average premium in Maine||2018||2019||2020||2021|
|Most affordable bronze plan||$379||$374||$384||$348|
|Most affordable silver plan||$566||$525||$506||$435|
|Most affordable gold plan||$641||$646||$609||$494|
In Maine, Medicaid is known as MaineCare, and it also operates the Child Health Insurance Program under the title of SCHIP. These health benefits can be free or very low cost depending upon several factors. MaineCare includes doctor’s visits, emergencies, substance abuse treatment, and prescription drugs.
Maine expanded Medicaid in February 2019. As of May 2021 more than 77,000 Maine residents had enrolled in this broader version of Medicaid. Overall, Maine has enrolled more than 312,000 individuals in MaineCare and SCHIP.
If you apply for MaineCare, you need to be a U.S. citizen, a permanent resident, or a legal alien. You need to show that you need health insurance assistance, and that your financial situation can be categorized as low-income or very low-income. You are also eligible if you fit in one of the following categories:
Under the expanded 2019 guidelines, any adult age 19 to 64 is eligible for MaineCare with a household income that is less than or equal to 133% of the FPL. An individual can earn no more than $17,131 a year, while a family of three is limited to $29,207 a year. Note that for households with more than eight people you can add as much as $6,038 per person to that income limit.
If you are blind or disabled, the limit is 100% of the FPL and if you are working but disabled it is 250%.
There are asset limits as well: $2,000 for an individual, $3,000 for a couple. The limit is based on income and property but does not include one home, furnishings, appliances, and one vehicle.
This program provides free or low-cost health insurance to families with children or pregnant women.
Eligibility depends on several factors:
Medicare is the federal government’s healthcare program for people aged 65 and older or those who are disabled. In Maine you have several options on how to receive Medicare.
Medicare Supplement Insurance plans cover some costs that occur with Original Medicare, such as deductibles, copays, and coinsurance. A Medicare Supplement Insurance plan will not cover dental, hearing, or long-term care. Many of these plans will provide you with health coverage if you travel outside the United States. A Medicare Supplement Insurance plan will not work with a Medicare Advantage Plan.
If you need help understanding your Medicare options, you can contact a counselor from the Maine State Health Insurance Assistance Plan (SHIP). SHIP’s trained, volunteer counselors will provide you or your caregiver with free, unbiased, and confidential guidance to better help you understand your Medicaid options. The counselors will also help you understand other health care options and if you are eligible to receive any assistance on prescription drug costs or other out-of-pocket expenses. The counselors do not sell or recommend insurance policies.
Currently, there are no short-term health care policies available in Maine.
Although the ACA mandates health coverage, the tax penalty for not doing so was eliminated by the Supreme Court in 2019. Currently, Maine does not have its own health insurance requirement.
Currently the most popular form of cost-sharing plans in Maine are religious-based health care plans. You do not have to be a member of any denomination, or even religious, to sign up for a plan. While these plans are relatively inexpensive, they are not considered to be health care plans by the federal government or the state of Maine. As a result, they remain unregulated. Unlike ACA-compliant plans, cost-sharing plans do not have to provide coverage for certain health care needs. If you are considering purchasing such a plan, make sure you confirm it provides coverage for your health concerns.
In most cases yes. It is unlikely that you will be able to save enough money using an FSA or an HSA to pay for all your health care costs. An HSA or FSA can help you with prescription drug costs, copays, and coinsurance, but do not provide coverage for serious health problems.
It depends upon your job. Short-term disability coverage is not meant to cover health care costs. Instead it is meant to help you with household expenses like your mortgage, groceries, or car payments. If you have a job that makes injury a likelihood, then short-term disability coverage is a good idea.
Again, it depends upon your job. Any form of disability coverage is not meant to cover long-term healthcare costs. If there is a risk of serious injury on your job, then long-term disability coverage is a good idea.
MaineCare SCHIP covers dental treatment, well-child exams, lead screenings, all necessary immunizations, and treatment for chronic health conditions or emergencies.