Maine health insurance marketplace guide 2023

Maine residents no longer use HealthCare.gov to enroll in individual/family health coverage. The state-run exchange, CoverME, is now the platform that residents use instead. More than 66,000 Maine residents enrolled in coverage through Maine’s exchange during the open enrollment period for 2022 coverage, which was an increase of more than 10% over the year before.

Maine is one of three states that transitioned away from HealthCare.gov in the fall of 2021 in order to operate their own state-run exchanges. Maine residents who already had coverage through HealthCare.gov had an account waiting for them on CoverME and were able to claim it in the fall of 2021 and then complete the process of selecting or renewing a plan for 2022.

Starting in the fall of 2020, Maine took on more oversight of the exchange, with a transition to a state-based exchange using the federal enrollment platform (ie, the state still used HealthCare.gov). But Maine transitioned to a fully state-run exchange as of the 2022 plan year. CMS granted conditional approval for the fully state-run exchange in September 2021.

The state implemented a variety of other reforms, including a merged risk pool for individual and small group plans, and standardized health plans. Legislation to get the ball rolling on the state-run exchange and merged risk pool was enacted in Maine in March 2020.

Maine has one of the few remaining ACA-created CO-OPs (Community Health Options, or CHO), which is one of only three CO-OPs (nationwide) offering coverage as of 2022. CHO will continue to offer coverage in Maine in 2023.

The open enrollment period for individual/family health coverage runs from November 1 to January 15 in Maine. Enrollments must be submitted by December 15 in order to have coverage effective January 1. Enrollments submitted in the final month of the open enrollment window have an effective date of February 1 instead.

Outside of open enrollment, a special enrollment period is necessary in order to enroll or make changes to your coverage. In most cases, a qualifying event is necessary in order to trigger a special enrollment period, but there are some special enrollment periods that don’t rely on a specific life event. Learn more in our comprehensive guide to special enrollment periods.

After three years of overall average rate decreases, Maine’s three existing marketplace insurers implemented an overall average rate increase of 11.4% for 2023 (a little lower than the 14.7% average rate increase the insurers had initially proposed). The following average rate changes were approved by the Maine Bureau of Insurance:

• Anthem: Average increase of 10.3%
• Harvard Pilgrim: Average increase of 12.9%
• Maine Community Health Options: Average increase of 10.7%
• Taro Health: New for 2023, so no applicable rate change

But weighted average rate increases don’t paint a full picture:

• They only apply to full-price plans, and very few enrollees pay full price for their coverage (89% of CoverME enrollees were receiving premium subsidies as of early 2022; this was higher than usual, thanks to the American Rescue Plan, and the subsidy enhancements have been extended by the Inflation Reduction Act). For people whose premiums are subsidized, net rate changes depend on how their specific plan’s rates are changing, as well as any changes in their premium subsidy amount (which depends on the cost of the benchmark plan, as well as the enrollee’s projected income for the coming year).
• The entry of a new insurer (which applies to CoverME residents in the Portland area for 2023) can potentially bring significant changes to subsidy amounts in that area. If the new insurer takes over the benchmark spot with premiums that are lower than the existing insurers’ rates, it can drive down subsidies in the area.
• Overall average rate changes don’t account for the fact that premiums increase with age, so people who maintain individual market coverage for several years will continue to pay more each year — just due to the fact that they’re getting older — even if their health plan technically has an overall rate change of 0% during that time.
• A weighted average, by definition, lumps all the plans together. But the specific rate change that applies to a given enrollee can vary quite a bit from the average.

For perspective, here’s a summary of how premiums have changed in Maine’s exchange in prior years:

• 2015: Average premiums were the same or slightly lower than 2014 rates. Maine Community Health Options, which won a large percentage of 2014 enrollees, kept its rates flat for 2015. Anthem’s rates dropped an average of 1.1%. Harvard Pilgrim was new to the exchange for 2015, so had no applicable rate increase.
• 2016: Average rate increase of about 0.7%. For Community Health Options, rate changes ranged from an average 1.73% decrease to a 0.54% increase (note that Community Health Options plans for 2016 were no longer for sale in the individual market after December 26, 2015, and in hindsight, the rates that were approved for 2016 were too low). Anthem BCBS, which had most of the remaining market share, had average rate changes that ranged from a 1.1% decrease to a 5.49% increase. Harvard Pilgrim’s average rates decreased slightly for 2016.
• 2017: Average rate increase of 23.5%. As was the case in most of the country, rate increases were much more significant for 2017 than they had been in the prior two years. Anthem increased their average rates by 18%, Community Health Options (which had the bulk of the exchange market share) increased their average rate by 25.5%, and Harvard Pilgrim HMOs increased their average rate by 21.1%.
• 2018: Average rate increase of about 25%. The cost of cost-sharing reductions (CSR) began to be added to on-exchange silver plan premiums as of 2018 (this has continued to be the case). Regulators in Maine initially approved rate increases that were based on the assumption that the federal government would continue to reimburse insurers for the cost of CSR. But in October 2017, just two weeks before the start of open enrollment for 2018 coverage, the Trump administration announced that the federal government would no longer fund CSR (but insurers were still obligated to provide CSR to eligible enrollees). Anthem left the exchange at the end of 2017 due to the lack of federal funding for CSR. Community Health Options and Harvard Pilgrim continued to offer plans, but they both added a substantial additional premium increase to silver plans to account for the cost of CSR.
• 2019: Average increase of 1%. Because Maine’s reinsurance program was approved and implemented, Anthem rejoined the exchange as of 2019. The Maine Bureau of Insurance had insurers file two sets of rates for 2019: One based on the assumption that the reinsurance program would be implemented, and the other based on the assumption that it wouldn’t. The rate filings are available via SERFF, and the Bureau of Insurance included the SERFF filing number for each insurer. The Maine Bureau of Insurance posted an overview of the state’s new reinsurance program. At ACA Signups, Charles Gaba calculated a weighted average rate increase of 1% for Maine’s individual market for 2019. It’s noteworthy that Community Health Options’ rate filing indicated that 5 percentage points of their rate increase were due to the repeal of the individual mandate penalty after the end of 2018, and another 5 percentage points were due to the Trump administration’s new rules expanding access to short-term plans and association health plans. So without those changes, CHO would have implemented a significant rate decrease instead of a slight rate increase.
• 2020: Average rate decrease of about 1.6%. Maine regulators approved average rate decreases for Anthem and Harvard Pilgrim, and a slight increase for CHO. Initially, all three insurers had proposed modest rate increases, but they revised their filings in July 2019, with Anthem and Harvard Pilgrim proposing rate decreases instead, which were approved by state regulators.
• 2021: Average rate decrease of about 13%. Rates for Maine’s three individual market insurers were approved by the Bureau of Insurance in late August, with an overall average rate decrease of 13.1%. Without Maine’s reinsurance program, premiums would have increased by 5% to 15%. Although rates were fairly stable nationwide for 2021, with small average decreases in many areas, Maine’s overall average decrease was much more significant than we saw in most states. But Maine’s rate decreases in the first two years its reinsurance program was in effect (2019 and 2020) were much less significant than the initial rate decreases we’ve seen in many of the other states that have implemented reinsurance programs. So it could just be that the reinsurance program had a delayed impact in Maine, with the major rate decrease coming a few years in, as opposed to right out of the gates.
• 2022: Average rate decrease of 2%. Across all three insurers, there was a weighted average rate decrease of just over 2% for 2022. Maine’s new Clear Choice standardized plans became available for purchase as of November 2021. Insurers had the option to keep existing plans as Alternative plan designs for 2022 if they choose to do so, but all insurers are also offering the Clear Choice plans as of the 2022 plan year. The state noted that “most” individual market plans in Maine are Clear Choice plans as of 2022.

During the open enrollment period for 2022 coverage, 66,095 people enrolled in plans through Maine’s exchange, using the new CoverME enrollment platform. That was an increase of more than 10% from the year before, when 59,738 people enrolled.

Enrollment is still lower than it was in 2018/2019, but that’s Maine expanded Medicaid in early 2019, so enrollment in private individual market plans was expected to decline. People with income between 100% and 138% of the poverty level are eligible for premium subsidies to purchase private plans in the exchange if the state has not expanded Medicaid, whereas they’re eligible for Medicaid instead once the program is expanded.

According to the initial actuarial analysis of Maine’s 1332 waiver for reinsurance, the number of people insured in Maine’s individual market was projected to decrease by about 19% in 2019, due to the expansion of Medicaid that voters approved in the 2017 election. But Medicaid expansion didn’t officially happen until after open enrollment for 2019 individual market coverage ended.

Maine residents were able to start enrolling in expanded Medicaid in early 2019, and more than 13,000 people had done so by March 2019 — but that had increased to more than 95,000 by mid-2022, due in part to the impact of the COVID pandemic (nationwide, Medicaid eligibility redeterminations are paused until the end of the COVID public health emergency). Some of those new Medicaid enrollees likely had income between 100% and 138% of the federal poverty level and enrolled in QHPs through the exchange during open enrollment in the fall of 2018, but subsequently switched to Medicaid.

Here’s a summary of Maine’s QHP enrollment over the years since the exchange opened for business in the fall of 2013 (all numbers are based on plans purchased during open enrollment; attrition throughout the year means that effectuated enrollment declines throughout the year):

• 44,258 people enrolled for 2014.
• 74,805 people enrolled for 2015.
• 84,059 people enrolled for 2016. Like many other states, 2016’s enrollment was the highest that Maine’s exchange has had to date.
• 79,407 people enrolled for 2017. As was the case in many states, enrollment declined for 2017 due to a variety of factors, including sharply higher premiums for people who didn’t receive premium subsidies and the nascent Trump Administration’s decision to cut advertising funding for the exchange in the final days of open enrollment (President Trump took office January 20, 2017, and open enrollment ended that year on January 31, 2017).
• 75,809 people enrolled for 2018. Average enrollment once again declined nationwide (particularly in states that use HealthCare.gov) for 2018. Premiums grew significantly for people who don’t get premium subsidies, and there was considerable uncertainty about the status of the individual mandate penalty and the ACA itself (after months of GOP-led repeal efforts in 2017). In addition, the Trump administration sharply reduced funding for exchange marketing and enrollment assistance just before the start of open enrollment for 2018 coverage.
• 70,987 people enrolled in private plans for 2019.
• 62,031 people enrolled in private plans for 2020. The sharp drop-off in enrollment was expected, given that Medicaid was expanded in Maine in 2019.
• 59,738 people enrolled in private plans for 2021. Continued transitions to Medicaid, coupled with the COVID-related provision that ensures that people do not lose their Medicaid coverage until after the COVID pandemic emergency period ends, have resulted in a further decrease in private plan enrollment.
• 66,095 people enrolled in private plans for 2022. Medicaid enrollment has continued to increase in Maine: As of mid-2020, there were about 55,000 people enrolled under Maine’s Medicaid expansion guidelines, and that had grown to more than 95,000 as of July 2022.

Yes. As of 2022, Maine offers a 60-day special enrollment period due to pregnancy (note that this is not an opportunity to switch from one plan to another; it only applies to people who are not already enrolled in a health plan through CoverME).

There are only a handful of other states that offer a special enrollment period due to pregnancy. The birth of a baby is always a qualifying event that creates a special enrollment period. In most states, however, pregnancy itself is not a qualifying event (although a person who is pregnant will qualify for Medicaid at higher income levels and will count as two people for the purpose of Medicaid eligibility determination, making that coverage more available during pregnancy).

Maine lawmakers have created an “easy enrollment” program that will take effect in early 2024, using 2023 tax returns.

The idea was pioneered by Maryland, which debuted a system in 2020 that lets uninsured residents check a box on the state tax return, allowing their relevant data to be shared with the state’s health insurance exchange.

If the person is determined to be eligible for Medicaid, CHIP, or subsidized health insurance in the exchange, they are notified and provided with enrollment assistance (including a special enrollment period if they’re eligible for exchange coverage, since open enrollment ends before the tax filing season begins). Several other states have since created their own easy enrollment systems, or are considering doing so.

Maine’s legislation is LD1390, which passed both chambers of the state legislature in 2021, but was then carried over to the 2022 session and signed into law by Governor Mills in April 2022.

The legislation creates an easy enrollment system that will utilize Maine’s state tax return to facilitate enrollment in Maine Care (Medicaid) and qualified health plans through CoverME. For people who are eligible for a plan through CoverME, the legislation calls for a special enrollment period that would begin the date the tax return is filed and end 35 days after the marketplace notifies the person of their eligibility to enroll.

One insurer currently offers dental plans through the Maine marketplace. Learn about dental coverage options in Maine.