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Maine Health Insurance

Many state residents can now access Maine health insurance through the federal marketplace at HealthCare.gov. According to a Kaiser Family Foundation profile of Maine, Gov. Paul LePage announced in 2012 the state would not create its own marketplace. Maine is also one of 21 states not moving forward with Medicaid expansion at this time.

Maine residents may visit the federal health insurance marketplace at HealthCare.gov to register for an account and apply for coverage. Depending on answers to questions about income and family members, you might be directed to a list of private marketplace health plans, Medicaid or the Children’s Health Insurance Program, known as CHIP.

If you purchase a private marketplace plan might qualify for a subsidy, which comes in the form of an income tax credit, and these can be immediately applied to select plan premiums.

It is possible that different family members will qualify for different plans. For example, a family with a modest income may find that the adults qualify for premium subsidies for a private exchange plan while the children qualify for CHIP.

Do you qualify for a Maine health insurance subsidy?

According to a January 2014 Kaiser Family Foundation profile of Maine, more than half of previously uninsured people in the state might qualify for some type of financial assistance to help them get health coverage. The following changes have been enacted in the state.

Typically, eligibility for Medicaid and CHIP is determined using 2014 poverty level guidelines, and eligibility for subsidies is determined using 2013 guidelines.
People with income between 100 and 400 percent of the poverty level may qualify for a subsidy. This would be between $23,550 and $94,200 for a family of four and $11,490 and $45,960 for an individual.
About 45 percent of uninsured Maine residents qualify for subsidies to help pay for marketplace plans.
Children from families with incomes lower than 213 percent of the federal poverty level, or about $50,800 for a family of four, might qualify for CHIP.
In Maine, Medicaid eligibility for non-disabled parents of children is limited to families with incomes less than 105 percent of the poverty level. This is about $25,040 a year. Non-disabled adults without children remain ineligible for this program.

If you earn too much to qualify for a subsidy can still purchase a marketplace health insurance plan. Insurers cannot discriminate against applicants based on pre-existing medical conditions, and all marketplace plans must provide certain mandated benefits. Maine residents who already have affordable health insurance through an employer or public plan are not likely to qualify for subsidies, and they are free to keep their plans.

Health insurance companies operating in Maine

The Maine Bureau of Insurance lists health insurance companies that offer marketplace and off-marketplace plans for state residents. The most prominent participants include the following.

Anthem Health Plans of Maine
Anthem Blue Cross Blue Shield
Maine Community Health Options
Harvard Pilgrim Health Care
HPHC Insurance Co
MEGA Life and Health Insurance Co

Maine health and coverage statistics

Maine population (2013): 1,328,302
Population 65 and older (2012): 17 percent
Life expectancy (2010): 79.2 years
Number of Medicaid beneficiaries (2012): 308,900
Number of Medicare beneficiaries (2012): 176,900
Estimated number of uninsured residents (2012): 129,800

Overall state health ranking (2014): 16

Sources: Kaiser Family Foundation, U.S. Census Bureau, America’s Health Rankings 2014 report.