Frequently asked questions about health insurance
coverage options in Maine
Maine uses the federally run health insurance marketplace, so residents in the state enroll via HealthCare.gov. But 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 (residents would not have noticed the change, as the state still uses HealthCare.gov for the time being).
And the state is planning to switch to a fully state-run exchange in the fall of 2021, and no longer use HealthCare.gov at that point. Read more about Maine’s health insurance marketplace.
The open enrollment period for 2022 coverage will begin November 1, 2021. Enrollments will need to be submitted by December 15, 2021 to have coverage effective January 1, 2022. But the Biden administration has proposed a permanent extension to open enrollment, allowing people until January 15 to sign up for a plan (with coverage effective February 1 if the enrollment is completed after December 15).
Outside of that open enrollment period, residents need a qualifying event in order to enroll in coverage or make a change to their plan. Enrollment is still possible in 2021 coverage, if the person has experienced a qualifying event.
Average premiums in Maine’s individual health insurance marketplace increased by about 1% in 2019, decreased by about 1.6% in 2020, and decreased fairly significantly in 2021, with an overall average rate decrease of 13%.
For 2022, insurers have mostly proposed another round of rate decreases, ranging from an overall average decrease of 5.4% for Maine Community Health Options, to an average increase of 1.1% for Harvard Pilgrim Health Care (note that these are revised rate filings; the insurers had initially all proposed single-digit average rate increases, but revised their rate proposals downward in July 2021).
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.)
During the open enrollment period for 2021 coverage, 59,738 people enrolled in private plans through Maine’s exchange. That was a reduction of about 4% from 2020, on the heels of a drop of more than 12% from 2019 to 2020.
But 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.
And an additional 9,145 people enrolled in private plans through the marketplace between mid-February and the end of July 2021. This was due to the enhanced premium subsidies created by the American Rescue Plan and the enrollment window that gave people a chance to enroll (without a qualifying event) through August 15, 2021. The enrollment volume during that window was more than double the number of people who have enrolled during the same time frame (with a qualifying event) in previous years.
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 three Obamacare CO-OPs have closed. Maine’s CO-OP (Community Health Options) is one of the three that have remained operational. Community Health Options briefly offered plans in New Hampshire as well, but has since opted to focus solely on Maine.
For 2021, CHO decreased its average premiums by nearly 14%.
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.
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.
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.
As of June 2021, there were 353,573 Maine residents enrolled in Medicare plans. That’s more than 26% of the state’s total population. Nationwide, just over 19% 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 46% 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 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.