maine guide to health insurance

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Maine health insurance exchange

About 50% of eligible Mainers enrolled on exchange

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More than 59,000 Maine residents selected a health plan through the health insurance marketplace between Nov. 15, 2014, and Jan. 9, 2015, according to a post on Health and Human Services (HHS) website. A snapshot taken at the one-month mark of 2015 open enrollment showed that 89 percent of Mainers who selected health plans qualified for financial assistance.

The Kaiser Family Foundation estimated that 124,000 Maine residents are eligible to purchase health insurance through the marketplace. With enrollment of nearly 60,000 at the mid-point of the 2015 open enrollment period, Maine now has about 48 percent of eligible residents enrolled in a marketplace plan. In comparison, the national average enrollment among eligible individuals in 2014 was 28 percent.

Feb. 15 is deadline to enroll or make changes

Open enrollment for 2015 ends Feb. 15. After that date you can’t sign up for coverage or make any changes unless you experience a qualifying life event.

Many people who had coverage in 2014 were automatically re-enrolled in a 2015 plan. While that coverage will protect you from owing a penalty, it may still have a negative effect on your finances. Everyone should consider new options for 2015 given that subsidy levels, personal circumstances, and health plans offerings can all change.

Even if you opted to keep your plan from last year, update your income and document any important life changes (like a new job or a baby) on With up-to-date information, can correctly calculate if you qualify for a subsidy or other help getting health insurance.

Higher tax penalty if you skip coverage

The penalty for not having insurance goes up this year. If you don’t qualify for an exemption, you’ll have to pay the higher of:

  • 2% of annual household income.
  • $325 per adult or $162.50 per child under 18.

This penalty calculator can help you figure out how much you may have to pay if you aren’t covered during 2015.

2015 rates and insurers

According to the Maine Bureau of Insurance, Maine Community Health Options (MCHO), Anthem Health Plan of Maine, and Harvard Pilgrim Health Care are offering about 40 individual polices through the exchange. These three insurers are also selling policies to small businesses through the SHOP exchange. Harvard Pilgrim is new to the Maine marketplace in 2015.

Aetna also sells health insurance in Maine, but is selling policies off the marketplace only. Mega, a Texas-based insurer, withdrew from the Maine market at the end of 2014.

Average premiums for 2015 are the same or slightly lower than 2014 rates. MCHO, which won a large percentage of 2014 enrollees, kept its rates flat for 2015. Anthem’s rates dropped an average of 1.1 percent.

Estimate what you’ll pay in 2015

A 2015 rate calculator, which includes data for plans available both on and off the marketplace, is available on the Bureau of Insurance website.

A review of 16 major markets — including Portland, Maine — by the Kaiser Family Foundation shows that premiums for the second-lowest cost silver plan for individuals decreased by 0.8 percent on average. In the Portland area, Kaiser estimates a 4.4 percent drop. The second-lowest-cost silver plan is important because it serves as the guide in establishing the dollar amount of the federal tax credit an individual is eligible to receive.

Uninsured rate dropped after 2014 open enrollment

According to a Gallup survey, Maine’s uninsured rate dropped 2.8 percentage points over the course of the 2014 open enrollment and was 13.3 percent as of mid-2014. More than 44,250 Maine residents enrolled in qualified health plans (QHPs) during the 2014 open enrollment period. In addition to QHP enrollment, 7,103 people qualified for Medicaid or the Children’s Health Insurance Program (CHIP). Ninety percent of those selecting a QHP qualified for subsidies to help pay the cost of their premiums, compared to 85 percent nationally.

History of the Maine marketplace

Maine’s health insurance marketplace is operated by the federal government. Gov. Paul LePage announced the state’s decision against a state-run model in November 2012. In a letter to then HHS Secretary Kathleen Sebelius, LePage said the Affordable Care Act has “severe legal problems” and state-run exchanges will be “actually controlled” by the federal government.

LePage’s administration did explore creating a state-run exchange. The governor appointed an advisory committee, and in September 2011 that committee recommended that Maine implement a state-run exchange. The committee also issued recommendations as to how the exchange should be structured and governed. However, Maine ultimately joined the Supreme Court case that attempted to overturn the Affordable Care Act, and the state legislature failed to pass exchange legislation in both 2011 and 2012.

Democrats in the Maine Legislature pushed for Medicaid expansion during the 2014 session, but could not overcome Gov. LePage’s ongoing opposition on the issue. LePage has vetoed five Medicaid expansion bills. The November election offered hope for a turnaround on Medicaid expansion, with two challengers supporting expansion and LePage was considered vulnerable. However, LePage was returned to office.

Maine health insurance exchange links


State Exchange Profile: Maine
The Henry J. Kaiser Family Foundation overview of Maine’s progress toward creating a state health insurance exchange.

Maine Quality Forum

 Maine Bureau of Insurance – Federal Health Care Reform