The individual health insurance market in Maine offers many choices in private individual health insurance plans to its residents. The state has just a 7% uninsured rate. Uninsured residents looking for private individual health plans have the option to enroll in a health plan either through the federally run exchange or directly from a private health insurance carrier. For 2021 coverage, the state uses the federally-run exchange for enrollment, but the state has oversight of the plans sold on the exchange. However, Maine plans to transition to a fully state-run exchange as of the 2022 plan year.
The state has made good progress in lowering the uninsured percentage due to the Affordable Care Act. Maine offers different health insurance solutions for individuals and families, who may even qualify for one of the programs that inexpensively insure them depending upon their income. The open enrollment period in Maine takes place every year from November 1 to December 15, and individuals are required to re-enroll each year in a health plan during this period to avoid a break in coverage. While enrolling or re-enrolling for a health plan in Maine, individuals can seek advice and assistance from our health insurance portal to find the best health plan. However, people qualifying for CSR subsidies or premium tax credits should directly buy the ACA plan from the marketplace.
Vital Updates on Maine Health Insurance Exchange
- Around 59,738 people enrolled in private plans through Maine’s exchange.
- The enrollment in private plans through the marketplace is likely to increase further in 2021 due to the enhanced premium subsidies created by the American Rescue Plan.
- A COVID-related enrollment window is open in the state that continues through August 15, 2021.
- During the first few months of this COVID-related special-enrollment window, more than 2,600 Maine residents signed up for coverage.
- People with income between 100 and 138% of the poverty level are eligible for premium subsidies to purchase private plans from the exchange.
- Maine has the federally run exchange for the 2021 coverage, but the state manages the plans sold in the health insurance exchange.
- Mains will transition to a fully state-run marketplace in the fall of 2021.
- Anthem Silver X POS 5900, Anthem Silver X HMO 5900, or Maine’s Choice Plus HMO Silver 6500 are the cheapest Silver health plan available in Maine.
Types of Health Plans in Maine
The state offers different types of health plans to its residents so that they can select the plan depending on their medical needs and financial situation. The health plans in the state are categorized into different metal tiers like Gold, Silver, and Bronze. Higher metal tier health plans like Gold plans have more expensive monthly premiums compared to lower metal-tier plans like Silver plans. Thus, all those individuals who have a medical condition or costly prescriptions should opt for a higher metal-tier plan, as these plans will turn out to be the best health insurance option for them. Despite the high monthly premium, the Gold plan proves cost-effective for individuals who expect to use their health plan often. This is because lower copays and deductibles of the Gold plan outweigh the higher monthly premium for people having recurring healthcare costs.
The next category of metal-tier is the Silver plan that is best for individuals having low income and average medical costs. Silver metal tier plans fall in between Gold and Bronze metal plans, and this plan is affordable in terms of both monthly premium as well as out-of-pocket costs. Besides, individuals who are a part of a lower-income household may also qualify for cost-sharing reduction subsidies that further lower individual’s out-of-pocket expenses. Silver plans cover about 70% of the healthcare costs but with CSR subsidies a Silver plan may cover up to 94% of the individual’s health care costs.
The next metal-tier plans are Bronze and Catastrophic health plans that are best for young and healthy individuals. These plans have the most affordable monthly premiums compared to Silver and Gold plans but have higher costs in the form of deductibles, copays, or coinsurance. These plans are not recommended to individuals who cannot afford the higher out-of-pocket expenses in the case of a medical emergency. The catastrophic health plans are only available for individuals up to age 30 and those with hardship exemptions.
Average Cost of Health Insurance in Maine by Metal Tier
|Type of Plan||Premium for 21-Year||Premium for 40-Year|
Private Health Insurance Options in Maine
Residents of Maine who are looking for affordable health care in the Pine Tree state will find several ways to access health care. People looking for private individual health plans can buy health insurance either through HealthCare.gov or directly from a health insurance company. Besides, residents also have the option to obtain health coverage through government-funded Medicare or Medicaid plans. Maine also has a community health option, which is a not-for-profit Consumer Operated and Oriented Plan or CO-OP plan.
Community Health Options provides health plans to individuals and families that include gold, silver, bronze, and catastrophic levels of coverage. Several Community Health Options plans include a support program for chronic illness and this program also lowers cost-sharing for in-network treatment of diabetes, asthma, chronic obstructive pulmonary disease, coronary artery disease, and hypertension.
Health Insurance Carriers in Maine
Individuals have the option to choose from three health insurance companies that are offering health coverage in 2021 under individual and family plans. The following three carriers are currently available:
- Anthem Blue Cross and Blue Shield of Maine
- Community Health Options
- Harvard Pilgrim Health Care