Frequently asked questions about health insurance coverage options in Maine
Maine now has a fully state-run exchange, so residents enroll via CoverME.gov instead of HealthCare.gov. This transition took place in the fall of 2021, and more than 66,000 people signed up for private health plans through the state’s exchange during the open enrollment period for 2022 coverage.
Maine has implemented a variety of health insurance reforms in recent years: Pregnancy is a qualifying event, the state will have an “easy enrollment” system in place by 2024 (using 2023 tax returns), and standardized “Clear Choice” plans are now available for consumers to purchase. The state’s reinsurance program has been expanded to include the small group market as of 2023, and the individual and small group markets will be merged into a single risk pool starting in 2023.
Read more about Maine’s health insurance marketplace.
The open enrollment period for individual/family coverage runs from November 1 to January 15 in Maine. Outside of open enrollment, a qualifying event is necessary to enroll or make changes to your coverage.
Learn more about enrollment options in our comprehensive guides:
In Maine, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.
Mainers may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Maine.
Maine has three insurers offering plans in the exchange for 2022, but newcomer Taro Health is joining the exchange for 2023, with plans available for purchase as of November 2022. The following insurers will offer plans through CoverME for 2023:
- Community Health Options
- Harvard Pilgrim HMOs
- Anthem
- Taro Health (new for 2023)
All three of the existing insurance companies have statewide service areas. Taro Health is initially only offering coverage in the Portland area, but plans to expand into other parts of the state in future years.
For 2023, average premiums for Maine’s existing exchange insurers are increasing by about 11%.
But that has to be considered in conjunction with the fact that average premiums in Maine’s individual health insurance marketplace decrease for the three previous years (by about 1.6% in 2020, 13% in 2021, and 2% in 2022). So overall average rates are quite a bit lower in 2022 than they were in 2019. This rate stabilization (following sharp rate increases in 2017 and 2018) is due in large part to the reinsurance program that the state implemented in 2019.
During the open enrollment period for 2022 coverage, more than 66,000 people enrolled in private plans through Maine’s exchange. That was an increase of more than 10% from the year before (when 59,738 people enrolled).
The increased enrollment is due in large part to the enhanced premium subsidies created by the American Rescue Plan, and the longer open enrollment period for 2022 coverage (enrollment continued through January 15; in previous years, it had ended in mid-December).
Enrollment is still lower than it was in 2018/2019, 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.
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 2022, CHO decreased its average premiums by more than 5%, after also decreasing premiums, by about 14%, for 2021. For 2023, CHO’s average premiums are growing by more than 10%, but so are the premiums for Maine’s other insurers.
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% in 2013 in Maine, and 8.0% in 2018. It remained at 8% in 2019, which was lower than the 9.2% nationwide average.
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.
As of mid-2022, there were more than 95,000 people enrolled in expanded Medicaid coverage in Maine. Maine’s total Medicaid/CHIP enrollment stood at 349,362 people as of mid-2022.
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, and that continue to be the case in 2022.
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 – January 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 May 2022, there were 360,745 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 half 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.
- coverME.gov
- Maine State Health Insurance Assistance Program — A local resource for Medicare beneficiaries and their caregivers; provides enrollment counseling and assistance.