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Maine health insurance

Three insurers offer coverage on Maine's marketplace; new restrictions for short-term plans take effect in 2020.

Health insurance in Maine

Maine’s health insurance marketplace

State legislative efforts to preserve or strengthen provisions of the Affordable Care Act

Could Maine be doing more to preserve the Affordable Care Act’s provisions? Compare its efforts to other state-level actions.

Maine uses the federally run health insurance exchange, so residents in the state enroll via HealthCare.gov. But Maine is considering the possibility of transitioning to a state-run exchange in the future — initially while still using HealthCare.gov, but the state may eventually establish its own enrollment platform.

Open enrollment for 2020 health plans runs from November 1 to December 15, 2019, both on HealthCare.gov and directly through the state’s insurance companies. Outside of that window, a qualifying event is necessary in order to enroll in an individual market plan.

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.]

2020: An average rate decrease and state outreach to encourage enrollment

For 2020, Maine regulators have approved an overall average rate decrease of about 1.6 percent, indicating ongoing market stability in the state. And in a departure from the LePage administration’s hands-off approach to health insurance outreach, the Mills administration is actively working to boost enrollment in Maine’s health insurance exchange during the upcoming open enrollment period (November 1 – December 15, 2019). The state has launched a new website (coverME.gov) and a public outreach campaign designed to spread awareness of the state’s expanded Medicaid program as well as the private health insurance options available to individuals and small businesses.

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 took effect in 2019

For the first five years that the ACA’s Medicaid expansion was available, Maine was the only state in the northeast to reject federal funding for Medicaid expansion. But that changed in 2019, when Governor Janet Mills takes office.

Maine voters approved Medicaid expansion with a ballot initiative in 2017, but then-Governor Paul LePage blocked expansion throughout 2018. Mills, who had been serving as Maine’s Attorney General, had promised to make Medicaid expansion one of her first priorities upon taking office, and she signed an executive order to expand coverage on her first day in office. By September 2019, enrollment in Maine’s expanded Medicaid had reached 38,000 people.

As of June 2019, CHIP and Medicaid in Maine had a total of 256,762 enrollees.

Read more about Medicaid expansion in Maine.

Short-term health insurance in Maine: New restrictions take effect in 2020

As of 2019, Maine limits the initial term of a short-term plan to less than 12 months. State regulations allow for renewal, although the total duration of the plan cannot exceed 24 months.

But Maine is tightening its short-term plan regulations under a new law that takes effect in January 2020. At that point, short-term plans will not be allowed to extend past December 31 of the year in which they’re issued, so maximum duration will vary depending on the date that a plan is purchased. The new law includes additional restrictions, such as banning the sale of short-term plans during the open enrollment period for ACA-compliant plans (November 1 – December 15) if they’re scheduled to take effect in the new year.

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. Poliquin served as a Maine Representative until 2019, when Democrat Jared Golden took his seat after defeating him in the 2018 election. Golden wants to strengthen and build on the ACA, while Poliquin wanted to repeal the ACA and replace it with a “free market” solution.

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

LePage was firmly opposed to the ACA. In addition to opposing a state-run marketplace, he repeatedly vetoed legislation to expand Medicaid, blocking it for the entire time he was in office. But residents of Maine approved a 2017 ballot measure to expand Medicaid, and although LePage blocked it throughout 2018, that was his last year in office and his successor, Governor Mills, implemented the will of the voters as soon as she took office.

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 8.0 percent in 2018. It has likely dropped lower in 2019, with the implementation of Medicaid expansion.

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 338,387 by July 2019, which is more than 25 percent of the state’s total population. Nationwide, about 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 a 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: