Health insurance in Maine
- Maine uses the federally run health insurance marketplace at HealthCare.gov, although the state is planning to switch to its own exchange platform in the fall of 2021.
- Open enrollment period for 2021 medical coverage in Maine will run from November 1 – December 15, 2020. A qualifying event is necessary to enroll outside of that window.
- In contrast to the LePage administration’s obstructionist approach, the Mills administration has actively worked to boost enrollment in private health insurance and MaineCare.
- Short-term health insurance plans can be sold in Maine with initial plan terms up to 12 months, but strict new rules took effect in 2020 and there are no longer any insurers offering short-term plans in Maine as a result.
- Anthem rejoined Maine’s exchange for 2019; rate changes were very modest, thanks in part to new reinsurance program. For 2020, average premiums decreased slightly, and for 2021, they’re decreasing by about 13 percent.
- Governor Janet Mills implemented Medicaid coverage expansion in Maine as soon as she took office in 2019, and her administration is promoting health insurance enrollment.
- Uninsured rate dropped from 11.2 percent in 2013 to 8 percent in 2018 and 2019.
- Maine’s CO-OP is one of just four still operational in the U.S.
- More than 25 percent of Maine’s population is enrolled in Medicare plans.
This page includes summaries and details of several types of health insurance that are available to Maine residents. We’ve included an overview of Maine’s health insurance marketplace and the open enrollment period that applies to individual market plans, a summary of how Medicaid expansion was eventually implemented in Maine, and details about Medicare coverage and the annual Medicare open enrollment period. You’ll also find information about short-term health plans and Maine’s new rules that tightened the restrictions that apply to those plans.
Maine’s health insurance marketplace
As a result of the Affordable Care Act (Obamacare), each state has a health insurance exchange/marketplace. Individuals and families use the marketplace to shop for health insurance, and the marketplace can provide financial assistance (premium subsidies and cost-sharing reductions) based on household income.
Maine uses the federally run health insurance marketplace, so residents in the state enroll via HealthCare.gov. But Maine plans to have a state-run exchange that uses the HealthCare.gov enrollment platform as of the fall of 2020, and a fully state-run exchange, with its own enrollment platform, as of the fall of 2021.
Anthem exited the Maine health insurance marketplace at the end of 2017, leaving just two insurers that offered plans for 2018. But Anthem rejoined the exchange for 2019, so Maine is back to having three insurers offering plans in the exchange:
- Community Health Options
- Harvard Pilgrim HMOs
All three of the insurance companies have statewide service areas, so Maine’s exchange enrollees can all select from among plans offered by three insurers.
Average premiums in Maine’s individual health insurance marketplace increased by about 1 percent in 2019, decreased by about 1.6 percent in 2020, and will decrease fairly significantly in 2021, with an overall average rate decrease of 13 percent. This rate stabilization (following sharp rate increases in 2017 and 2018) is due in large part to the reinsurance program that the state implemented as of 2019.
[But on the other hand, rates would likely have decreased in 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.]
In a departure from the LePage administration’s hands-off approach to health insurance outreach, the Mills administration actively worked to boost enrollment in Maine’s health insurance marketplace during the open enrollment period for 2020 coverage. The state launched a new website (coverME.gov) and a public outreach campaign designed to spread awareness of the state’s expanded Medicaid coverage as well as the private health insurance options available to individuals and small businesses.
Read more about the Maine health insurance marketplace.
Maine open enrollment period and dates
The open enrollment period for 2021 health plans will run from November 1 – December 15, 2020. Open enrollment is a chance for individuals and families to enroll in self-purchased health coverage. These plans are used by people who are self-employed, people employed by a small business that doesn’t offer health benefits to workers, and by people who have retired (and thus lost their employer-sponsored health benefits) prior to Medicare eligibility.
During the open enrollment period, people can newly enroll in health coverage for 2021, or renew or change existing coverage. It’s also an opportunity to update financial information on file with the exchange, to ensure that subsidies for 2021 are accurate.
The open enrollment period applies to all individual major medical plans, including those purchased in the exchange as well as those purchased directly from an insurance company. But the subsidies help to reduce monthly premium costs and the subsidies to reduce out-of-pocket medical costs are both available only to people who buy their coverage through the exchange. So it’s wise to start with the exchange when shopping for coverage, in order to determine eligibility for financial assistance.
Outside of the open enrollment period, Maine residents need a qualifying event in order to enroll in individual major medical coverage, both on-exchange and outside the exchange.
Medicaid expansion in Maine
For the first five years that the ACA’s Medicaid coverage 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 took office.
Maine voters approved Medicaid coverage 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 Medicaid coverage on her first day in office.
Read more about Medicaid coverage expansion in Maine.
Short-term health insurance in Maine
Maine tightened its short-term health insurance plan regulations as of January 2020, under a new law that was enacted in 2019. As of 2020, there were no insurers selling short-term health insurance plans in Maine, due to the state’s strict regulations.
Short-term plans in Maine are no longer allowed to extend past December 31 of the year in which they’re issued, so the maximum duration (which was already limited to 12 months) 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 health insurance 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, and banning the sale of short-term plans online or over the phone (an in-person meeting would be required to purchase a policy).
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 Collins 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 coverage, 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.
How has Obamacare helped 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 remained at 8 percent in 2019, which was lower than the 9.2 percent nationwide average.
Maine’s CO-OP is one of just three that will still be operational nationwide in 2021
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.
Since then, all but four Obamacare CO-OPs have closed. Maine’s CO-OP (Community Health Options) is one of the four that have remained operational. Community Health Options briefly offered plans in New Hampshire as well, but has since opted to focus solely on Maine.
And one of the remaining CO-OPs, New Mexico Health Connections, will close at the end of 2020, leaving just three CO-OPs — including Community Health Options — operational nationwide.
For 2018, CHO increased their average premiums by 17.5 percent, but their average rate increase was less than 1 percent for 2019 and again for 2020. And for 2021, CHO will decrease its average premiums by nearly 14 percent.
Medicare coverage and enrollment in Maine
As of August 2020, there were 346,777 Maine residents enrolled in Medicare plans. That’s more than 25 percent of the state’s total population. Nationwide, less than 19 percent of the population is enrolled in Medicare, but Maine has the highest average age in the country, so it’s not surprising that Maine has a larger population percentage of Medicare enrollment.
More than 43 percent of Maine’s Medicare beneficiaries are enrolled in private Medicare Advantage plans, while the rest are enrolled in Original Medicare (many of those enrollees have private supplemental coverage via Medigap and/or Medicare Part D prescription coverage).
Learn more about Medicare enrollment in Maine, including the state’s extensive consumer protections for Medigap enrollees.
Maine health insurance resources
- Maine Bureau of Insurance — Regulates and licenses health insurance companies that sell policies in Maine, as well as agents and brokers. The BOI can answer questions and address complaints about regulated entities in the state.
- Maine State Health Insurance Assistance Program — A local resource for Medicare beneficiaries and their caregivers; provides enrollment counseling and assistance.
Health reform legislation in Maine
Scroll to the bottom of this page for a summary of recent state-level bills related to health reform.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.