maine guide to health insurance

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Maine health insurance exchange / marketplace

60% of eligible Mainers enrolled on exchange

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A much larger percentage of eligible Maine residents opted to enroll in medical insurance through in 2015 compared to 2014. This year saw nearly 60 percent of eligible Maine residents (about 75,000 of 124,000) purchase coverage versus just 36 percent in 2014.

Owe a 2014 penalty? Get covered for 2015

If you are one of the many people who learned that you must pay a penalty for not having health insurance in 2014, you can fix that situation for 2015. (But you’re stuck for 2014.) announced a special enrollment period (SEP) for anyone who didn’t know about the penalty until completing 2014 tax forms. The SEP runs March 15 through April 30.

Individuals who get married, change jobs, or have another qualifying life event can also enroll in coverage outside the standard open enrollment period.

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.

Uninsured rate dropped after 2014 open enrollment

According to a Gallup-HealthWays survey, Maine’s uninsured rate dropped 4.5 percentage points between 2013 and 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