A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
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Maine uses a fully state-run exchange known as CoverME.gov for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the Maine exchange include dental coverage with their health plans, but pediatric and adult dental coverage can be purchased as a stand-alone plan through CoverME.gov.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $21 to $54 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Maine in 2022 was $48.36.
If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.
In Maine, the exchange-certified pediatric stand-alone dental plans available will comply with the ACA’s rules for children’s dental coverage.. This means out-of-pocket costs for kids dental care will not exceed $375 per child in 2023 (or $750 for all the children on a family’s plan), and there is no cap on medically-necessary pediatric dental benefits.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the state’s essential health benefits benchmark plan.
You can see details here for Maine’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, two insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Maine. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through CoverME.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in Maine. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Maine Bureau of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Here’s what you need to know about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Adults enrolled in Medicaid in Maine, known as MaineCare, are eligible for limited emergency dental services. Children (under age 21) who are enrolled in MaineCare are eligible for more comprehensive dental benefits.
MaineCare also administers Maine’s CHIP, which provides comprehensive dental coverage to uninsured children up to age 19.
Maine transitioned to a fully state-run exchange (CoverME) in the fall of 2021. Maine debuted standardized health plans in the fall of 2021. A fourth insurer, Taro Health, joined the exchange as of 2023, and the state has also merged its individual and small group markets as of 2023. An "easy enrollment" program will debut in Maine in early 2024, allowing residents to use 2023 tax returns to be connected with health coverage.
healthinsurance.org has been a guide for individuals and families since 1994. Compare plans, get a free quote, & check your subsidy eligibility today.
Maine expanded Medicaid in early 2019, after voters passed a Medicaid expansion ballot initiative in the 2017 election. By late 2021, nearly 85,000 people were covered under Maine's expanded Medicaid program. Gov. Mills also withdrew the LePage administration's Medicaid work requirement.
For all information on Medicare in Maine, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
