With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Maine, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Maine
Maine ranked 20th in United Health Foundation’s 2014 America’s Health Rankings. 1 Its strengths included a low violent crime rate, low percentage of uninsured population and low prevalence of low birthweight. Maine’s challenges included a high prevalence of binge drinking, high rate of cancer deaths and limited availability of dentists.
Maine individual and family health insurance
When the Obamacare health insurance exchanges opened for 2014 enrollment, Maine elected to become part of the federally facilitated marketplace, healthcare.gov. Residents of Maine can use the federally facilitated health insurance exchange to find and purchase qualified health insurance plans.
Maine residents can also buy qualified health insurance plans in the private marketplace through websites such as HealthCare.com. To find out if you qualify for an Obamacare tax credit, use HealthCare.com’s tax subsidy calculator. If you are eligible for financial assistance, visit Maine’s health insurance exchange to shop and enroll in health insurance coverage.
The U.S. Department of Health and Human Services reported that 44,258 individuals in Maine selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Maine enrolled in a marketplace plan increased to 74,805 during the open enrollment period.3
|Maine’s health insurance exchange:||healthcare.gov|
|Maine department of insurance:||maine.gov/pfr/insurance|
Maine small group health insurance plans
Small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program marketplace, at healthcare.gov/marketplace/shop and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Maine’s small business owners may also find small group health insurance in the private marketplace through websites such as such as HealthCare.com. Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Maine’s health insurance exchange.
Maine state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Maine’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||Fewer than 20|
|Maximum continuation period – standard||1 year|
|Maximum premium Increase||Up to 102 percent of the full group rate|
|State legislation reference||Statute 24-A, Chapter 36 of the Main Continuity of Health Insurance Coverage|
|More information||800-300-5000 – ask for the Consumer Health Care Division|
Maine high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Maine did not expand its Medicaid program in 2014.7 A resulting coverage gap exists for those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping healthcare.gov.
Maine is said to be among the first states to provide subsidized health insurance coverage to its low-income residents; however, it was the only state in New England to decline federal funds to expand Medicaid.
The information below is specific to Maine’s Medicaid program, which is called MaineCare:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Maine Department of Health and Human Services|
|Where to apply online||healthcare.gov / maine.gov/dhhs/ofi/public-assistance|
|Open-enrollment period||Year-round in all states|
|Eligibility||Maine resident, U.S. citizen; apply to determine eligibility|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Maine’s health insurance program for low-income children:
|Where to apply||To obtain an application and learn more about application options, click on the link below maine.gov/dhhs/ofi/services/cubcare/Getting an Application.htm|
|Additional application options||kancare.ks.gov/apply.htm|
|Phone number||877-KIDS-NOW (877-543-7669)|
|Eligibility8||Children and teens age 18 and under, and pregnant women who meet gross monthly family income requirements; parents living with their children and teens age 18 and under with who meet monthly family income requirements and have assets of $2,000 or less—visit maine.gov/dhhs/ofi/services/cubcare/CubCare.htm to view the income eligibility chart and learn more|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 State of Maine Department of Professional & Financial Regulation. Bureau of Insurance. “COBRA & Mini -COBRA.” Last updated Aug. 22, 2012. Retrieved from http://www.maine.gov/pfr/insurance/faq/cobra_faqs.htm.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Maine.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/maine.html.
8 Maine Department of Health and Human Services. Office of Family Independence. “MaineCare: Free or Low-Cost Health Insurance for Families with Children and Pregnant Women.” Maine.gov. N.D. Retrieved from http://maine.gov/dhhs/ofi/services/cubcare/CubCare.htm.