Maine Health Insurance

Health insurance in Maine

● Maine uses the federally run health insurance marketplace in HealthCare.gov, although the state is planning to switch to its exchange platform in the fall of 2021.

● The open enrollment period for 2021 medical coverage in Maine will run out from November 1 to December 15, 2020. A qualifying event is required to register outside of that window.

● Unlike the LePage administration's obstructive approach, the Mills administration has been actively working to increase enrollment in private health insurance and MaineCare.

● Short-term health insurance plans can be sold in Maine with initial plan terms of up to 12 months, but strict new rules are in place in 2020 and as a result there are no more insurers offering short-term plans in Maine.

● Anthem has rejoined Maine's exchange for 2019; interest rate changes have been very modest, thanks in part to the new reinsurance program. For 2020, average premiums have fallen slightly and are falling by about 13% by 2021.

● Governor Janet Mills implemented the expansion of Medicaid coverage in Maine as soon as it became a crisis in 2019 and her administration is promoting enrollment in health insurance.

● The uninsured rate fell from 11.2% in 2013 to 8% in 2018 and 2019.

● Maine's CO-OP is one of four still operating in the United States.

● More than 25% of Maine's population is enrolled in Medicare plans.

This page includes summaries and details of different types of health insurance available to Maine residents. We've included an overview of Maine's health insurance marketplace and the open enrollment period that applies to individual marketplace plans, a summary of how the Medicaid expansion was eventually implemented in Maine, and details about Medicare coverage and the annual Medicare open enrollment period. You'll also find information about Short-Term Health Plans and New Maine Rules that have tightened the restrictions that apply to those plans.

Maine Health Insurance marketplace

As a result of the Affordable Care Act (Obamacare), each state has a health insurance exchange/marketplace. Individuals and households use the marketplace to buy health insurance, and the marketplace can provide financial assistance (premium subsidies and cost-sharing reductions) based on household income.

Maine uses the federally managed health insurance marketplace, so residents of the state sign up through HealthCare.gov. But Maine plans to have a state-run exchange that uses the HealthCare.gov registration platform starting in autumn 2020 and a fully state-run exchange, with its own registration platform, starting in autumn 2021.

Anthem exited Maine's health insurance marketplace in late 2017, leaving only two insurers that offered plans for 2018. But Anthem is back in the trade for 2019, so Maine is back to having three insurers offering stock marketplace plans:

● Community health options

● OS Pellegrini di Harvard

● Anthem

All three insurance companies have state-level service areas, so Maine exchange enrollees can choose from plans offered by three insurers.

Average premiums in Maine's individual health insurance marketplace increased by about 1% in 2019, decreased by about 1.6% in 2020, and will decrease quite significantly in 2021, with an overall average decrease of 13%. This stabilization of rates (following strong rate increases in 2017 and 2018) is largely due to the reinsurance program that the state implemented in December 2019.

[But on the other hand, rates would likely have fallen in 2019 if not for destabilizing actions by the federal government, including eliminating the individual mandate sanction after the end of 2018 and expanding short-term and associative health plans.]

In a move away from the LePage administration's hands-off approach to health insurance awareness, the Mills administration actively worked to increase enrollment in Maine's health insurance marketplace during the open enrollment period for 2020 coverage. The state has launched a new website (coverME.gov) and public outreach campaign designed to spread awareness of the state's broad Medicaid coverage and private health insurance options available to individuals and small businesses.

Maine open enrollment period and dates

The open enrollment period for 2021 health plans will run out from November 1 to December 15, 2020. Open enrollment is an opportunity for individuals and families to sign up for self-purchased health coverage. These plans are used by people who are self-employed, people employed in a small business that does not offer health benefits to workers, and people who have retired (and therefore lost their employer-sponsored health benefits) before Medicare eligibility.

During the open enrollment period, people can recently sign up for health coverage for 2021 or renew or change existing coverage. It is also an opportunity to update the financial information on file with the exchange, to ensure that the subsidies for 2021 are accurate.

The open enrollment period applies to all individual major medical plans, including those purchased in the exchange and those purchased directly from an insurance company. But grants help reduce monthly premium costs, and subsidies to reduce out-of-pocket medical costs are both only available to people who buy their coverage through exchange. Then it is advisable to start with the exchange when shopping for hedging, in order to determine eligibility for financial assistance.

Outside of the open enrollment period, Maine residents need a qualifying event to enroll in important individual medical coverage, both on the stock exchange and outside of the exchange.

Medicaid expansion in Maine

For the first five years that expansion of the ACA's Medicaid coverage was available, Maine was the only state in the Northeast to refuse federal funding for Medicaid expansion. But that changed in 2019, when Governor Janet Mills took over.

Maine voters approved the expansion of Medicaid coverage with an election initiative in 2017, but then-Governor Paul LePage blocked the expansion throughout 2018. Mills, who served as Maine's attorney general, had promised to make Medicaid expansion one of his top priorities when he took office, and signed an executive order expanding Medicaid coverage on his first day in office.

As of September 2020, there were more than 61,000 people enrolled in expanded Medicaid plans in Maine. Maine's total Medicaid/Chip enrollment was 230,389 people as of May 2020.

Short-term health insurance in Maine

Maine tightened the regulations of the short-term health insurance plan as of January 2020, under a new law that was enacted in 2019. As of December 2020, there were no insurers selling short-term health insurance plans in Maine, due to strict state regulations.

Short-term plans in Maine can no longer extend beyond December 31 of the year in which they are issued, so the maximum duration (which was already limited to 12 months) will vary depending on the date of purchase of a plan. The new law includes additional restrictions, such as a ban on the sale of short-term health insurance plans during the open enrollment period for ACA-compliant plans (November 1 - December 15) if they are scheduled to apply in the New Year and a ban on selling short-term plans online or by phone (an in-person meeting would be required to purchase a policy).

Maine and the Affordable Care Act

When Congress passed the Affordable Care Act in 2010, Maine senators voted against the measures, while its two representatives voted in favor. Senator Olympia Snowe retired in 2013 and Sen. Bernie Sanders (I-Vt.) and Sen. Bernie Sanders (I-Vt.) King is generally in favor of the Affordable Care Act.

Susan Collins and Representative Chellie Pingree remain in office. Michael Michaud, a Democrat, left office and was replaced by Representative Bruce Poliquin, a Republican, in 2015. Poliquin was Maine's representative until 2019, when Democrat Jared Golden took his seat after defeating him in the 2018 election. Golden wants to strengthen and build on the ACA, while Poliquin wanted to repeal the ACA and replace it with a "free marketplace" solution.

In both 2011 and 2012, Maine's legislature considered laws to establish a state-run health insurance marketplace. However, the bills were not approved. Then governor. Paul LePage, a Republican, announced in late 2012 that Maine would default on the federally facilitated exchange.

LePage strongly opposed the ACA. In addition to opposing a state marketplace, he has repeatedly vetoed legislation to expand Medicaid coverage, blocking it for as long as he was in office. But Maine residents approved a 2017 ballot measure to expand Medicaid, and although LePage blocked it throughout 2018, that was his last year in office and his successor, Governor Mills, implemented the will of voters as soon as he got started.

How did Obamacare help Maine?

Following the national trend, the uninsured rate in Maine has fallen since the ACA's individual mandate came into force. According to U.S. Census data, the uninsured rate was 11.2% in 2013 in Maine and 8.0% in 2018. It remained at 8% in 2019, which was below the national average of 9.2%.

Maine's CO-OP is one of three that will still be operational nationwide in 2021

The Consumer Operated and Oriented Plan (CO-OP) has been included in the Affordable Care Act to increase competition and consumer choice. Twenty-four CO-PO, including Maine Community Health Options, received loans totaling $2.09 billion in January 2014. Maine community health options received about $64 million.

Since then, all but four Obamacare CO-PO's have closed. Maine's Community Health Options (CO-OP) is one of four remaining operational. Community health options have briefly offered plans in New Hampshire as well, but have since chosen to focus exclusively on Maine.

And one of the remaining CO-PO, New Mexico Health Connections, will close at the end of 2020, leaving only three CO-PO's nationwide operations, including community health options.

For 2018, CHO increased average premiums by 17.5%, but their average rate increase was less than 1% for 2019 and again for 2020. And by 2021, CHO will reduce its average premiums by almost 14%.

Medicare coverage and enrollment in Maine

As of August 2020, there were 346,777 Maine residents enrolled in Medicare plans. This is more than 25% of the state's total population. Nationally, less than 19% of the population is enrolled in Medicare, but Maine has the highest average age in the country, so it's no surprise that Maine has a larger percentage of the population enrolled in Medicare.

More than 43% of Maine Medicare beneficiaries are enrolled in private Medicare Advantage plans, while the rest are enrolled in Original Medicare (many of these enrollees have private additional coverage through Medicare and/or Medicare Part D prescription coverage).

Maine Health Insurance Resources

● Maine Bureau of Insurance - Regulates and licenses health insurance companies that sell policies in Maine, as well as agents and brokers. The BOI can answer questions and address complaints about regulated entities in the state.

coverME.gov

● Maine State Health Insurance Assistance Program - A local resource for Medicare beneficiaries and their caregivers; provides advice and assistance for registrations.