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Maine health insurance

Three insurers offer 2019 coverage on Maine's marketplace; short-term plans are now available with plan terms up to 12 months.

Health insurance in Maine

Maine’s health insurance marketplace

Maine uses the federally run health insurance exchange, so residents in the state enroll via HealthCare.gov. Open enrollment ended on December 15, but enrollment is still possible for residents who have qualifying events.

Maine’s individual health insurance market included three insurers offering coverage in 2017 – all statewide. But Anthem exited the exchange at the end of 2017, leaving just two insurers offering plans for 2018.

Anthem rejoined the exchange for 2019, however, so Maine is back to having three insurers offering plans in the exchange:

  • Community Health Options
  • Harvard Pilgrim HMOs
  • Anthem

Average premiums in Maine’s individual insurance market are about 1 percent higher in 2019 than they were in 2018. The increase would have been more significant without the implementation of Maine’s new reinsurance program.

But on the other hand, rates would likely have decreased for 2019 if not for the destabilizing actions of the federal government, including the elimination of the individual mandate penalty after the end of 2018, and the expansion of short-term and association health plans.

You can read more about rate changes and carriers in Maine on our page about the state’s health insurance exchange.

Medicaid expansion in Maine

For the first five years of the ACA’s Medicaid expansion, Maine has been the only state in the northeast to reject federal funding for Medicaid expansion. But that’s expected to change in 2019, when Governor-elect Janet Mills takes office.

Maine voters approved Medicaid expansion with a ballot initiative in 2017, but outgoing Governor Paul LePage has been blocking expansion throughout 2018. Mills, who has been serving as Maine’s Attorney General, has been working to follow the will of the voters and expand Medicaid, and will make that one of her first priorities upon taking office.

As of August 2018, CHIP and Medicaid in Maine had a total of 261,021 enrollees.

Read more about Medicaid expansion in Maine.

Short-term health insurance in Maine

Maine limits the initial term of a short-term plan to less than 12 months. State regulations allow for renewal, but the total duration of the plan cannot exceed 24 months.

 

Read more about short-term health insurance in Maine.

Maine and the Affordable Care Act

When Congress voted on the Affordable Care Act in 2010, Maine’s senators voted against the measures, while its two representatives voted for it. Sen. Olympia Snowe retired in 2013, and Sen. Angus King now represents Maine. King is generally supportive of the Affordable Care Act. Sen. Susan and Rep. Chellie Pingree remain in office. Rep. Michael Michaud, a Democrat, left office and was succeeded by Rep. Bruce Poliquin, a Republican, in 2015.

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

LePage is firmly opposed to the ACA. In addition to opposing a state-run marketplace, he repeatedly vetoed legislation to expand Medicaid. LePage faced current U.S. Rep. Michael Michaud, a Democrat, and independent Eliot Culter in the November 2014 gubernatorial election. Both Michaud and Cutler supported Medicaid expansion.

LePage was re-elected, ending hopes that the state might move ahead with expansion under a new governor. However, residents of Maine approved a 2017 ballot measure to expand Medicaid. Finding funding for it will be a priority for state lawmakers when the legislative session commences in January.

Is Obamacare affecting the uninsured rate in Maine?

Following the national trend, the uninsured rate in Maine dropped after the ACA’s individual mandate went into effect. According to U.S. Census data, the uninsured rate was 11.2 percent in 2013 in Maine, and 8.1 percent in 2017 (it had dipped as low as 8 percent in 2016, but rose slightly in 2017, as was the case in many states after the Trump Administration took office).

Maine’s CO-OP is one of just four still operational in the country

The Consumer Operated and Oriented Plan (CO-OP) Program was included in the Affordable Care Act to increase competition and consumer choice. Twenty-four CO-OPs, including Maine Community Health Options, received loans totaling $2.09 billion as of January 2014. Maine Community Health Options received about $64 million.

As of November 2018, all but four Obamacare CO-OPs had closed. Maine’s CO-OP (Community Health Options), which briefly offered plans in New Hampshire as well, but has since opted to focus solely on Maine, is one of the four remaining operational CO-OPs.

In an HHS report published in July 2015, Community Health Options was the only CO-OP with a positive net income in 2014. But CHO ended 2015 with $74 million in losses, and Maine’s Insurance Superintendent proposed putting the CO-OP in receivership and cancelling a portion of its plans. CMS did not allow this action to be taken.

CHO fared better in 2016. Claims were lower than expected, administrative costs were reduced, and the CO-OP did not have to draw down as much from reserves as anticipated.

For 2018, CHO increased their average premiums by 17.5 percent, but their average rate increase was less than 1 percent for 2019.

Medicare in the state of Maine

Maine Medicare enrollment reached 330,857 by September 2018, or nearly 25 percent of the state’s total population. Nationwide, 18 percent of the population is enrolled in Medicare, but Maine has the highest average age in the country, so it’s not surprising that a larger percentage of the state’s population is enrolled in Medicare.

Roughly 81 percent of Maine’s Medicare population is eligible based on age alone and 19 percent qualify as the result of disability. The federal government spent about $8,019 per Maine enrollee (for those enrolled in Original Medicare) in 2015, which was lower than the national average of $9,171 per enrollee.

Maine’s Medicare recipients can choose a Medicare Advantage plan instead of Original Medicare. These plans offer some additional benefits beyond traditional Medicare, and about 32 percent of Maine Medicare beneficiaries choose Medicare Advantage as of September 2018, compared with nearly 36 percent nationwide. Forty seven percent of Medicare beneficiaries in Maine have a Medicare Part D plan for stand-alone prescription drug coverage. Nationwide, 44 percent of Medicare enrollees have Part D.

State-based health reform legislation

Here’s a summary of recent state-level bills related to health reform: