Finding affordable health care coverage as a Maine resident comes with some unique challenges – as well as benefits – compared to other parts of the country. We understand that the search can be tedious and complicated, but that doesn’t mean you should go without. You have plenty of affordable and easily accessible options as a resident of Maine. If you keep reading, you’ll learn everything you need to know about what those options are, whether or not you may qualify, and what you need to do to access them to keep you and your family happy and healthy.
Major Medical Insurance in Maine
Major medical insurance – also sometimes referred to as Obamacare, compliant coverage, an ACA health insurance policy, and the like – has been around since shortly after the Patient Protection and Affordable Care Act was passed back in 2010. Due to some legal mandates which make them uniquely comprehensive, they are the best type of health insurance coverage you can get in the United States right now. If you aren’t currently getting major medical coverage through your employer, then signing up for an ACA plan at HealthCare.gov is one of the next best things you can do for you and your family.
Most people choose to apply online at the official HealthCare.gov government website during Open Enrollment. Open Enrollment usually lasts between November 1st and December 15th each year, but those deadlines tend to change as the law itself changes and grows to meet demand. The questions you must answer on the application are fairly straightforward and mostly revolve around your health status, the health status of family members you need to insure, and your annual or monthly income. Some states have their own exchanges independent of the federal Health Insurance Marketplace – Maine does not, but there have been some rumors about creating a state exchange in Maine in the near future.
The primary reasons why people flock to major medical coverage include things like their guaranteed issue status, the guaranteed Essential Health and Wellness Benefits, and the federal subsidy. But let’s start by talking about guaranteed issue policies. When you apply for a policy that is guaranteed issue, you cannot be rejected for coverage – not even if you have a pre-existing condition or if you are in poor health. On top of this, your insurance provider cannot charge you an exorbitantly higher monthly premium unless one of the following factors is involved in that decision:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
There are also 10 guaranteed Essential Health and Wellness Benefits that must be included with every single insurance policy sold through the Health Insurance Marketplace. Providing the comprehensive list of benefits below is a large part of what defines them as major medical insurance:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Finally, there are the federal subsidies to consider. The average working citizen making anywhere between 138% and 400% of the federal poverty level will likely qualify for a substantial enough subsidy that it makes these insurance policies highly affordable. And if you make less than 138% of the federal poverty level, there is some good news: the state of Maine has recently accepted federal funds for Medicaid expansion. This means that those in the lower income brackets can qualify for free or low-cost health insurance through Maine’s MaineCare program.
|Household Size||Annual Income (138% of FPL)|
Maine was the final state in the Northeast to approve Medicare expansion in recent years. This expansion changed eligibility requirements for the state Medicaid program and made it available to tens of thousands of needy residents. If you don’t qualify for a federal subsidy through the Health Insurance Marketplace, then your next stop should be the Department of Health and Human Services to file an application for MaineCare. You can find more information about the program and whether or not you qualify by visiting their website.
Short Term Health Insurance in Maine
Unfortunately, an ACA plan may not be the best option for everyone who lives in Maine. One way or another, some residents will fall through the cracks and their ability to purchase major medical coverage through the Health Insurance Marketplace can be limited or non-existent. Under such circumstances, it may be worth considering a short-term health insurance plan.
The state of Maine has recently imposed some stricter regulations on short-term health insurance companies and as of this writing, no plans for 2020 coverage have been submitted to the Maine Bureau of Insurance from any short-term health providers who are licensed to operate in the state. But that doesn’t mean this won’t change in the near future – and if it does, there are some very important things you need to know about how these policies work if you decide to purchase one. Unfortunately, with short-term health insurance, you won’t receive the guaranteed issue status or the maximum amount of Essential Health and Wellness Benefits that you would receive with an ACA plan. But some short-term health insurance companies may let you customize your plan in order to get the benefits you need. Furthermore, although you won’t be protected against rejection or a price increase in your premiums due to pre-existing conditions, there are some consumer protections for you if your short-term health insurance provider fails to pay out on a claim. You can take them to court and try to get the money you are owed if you feel they have illegally violated your contract.
Part of the reason that short-term health insurance premiums are so affordable, however, is because they pass a greater share of your medical costs back to you. For instance, even while paying your monthly premiums on time and in full, you will still have to meet your deductible before most short-term health insurance providers will start paying out claims. This means you could have to face as much as $5,000 in out-of-pocket medical costs or more before you will receive a dime of help from your insurance provider. You will also have to worry about annual and lifetime benefit caps on top of that – meaning that you can only receive a certain amount of financial help in any given year or for the duration of your policy. Once you exceed this benefit limit, the costs of your medical care will be shifted back to you. That’s why most people who are relatively healthy and don’t need a lot of care but still want some sort of rainy day insurance policy against a catastrophic medical disaster tend to get the best financial benefit out of short-term health insurance.
Christian Health Plans/Health-Sharing Plans in Maine
Christian health plans have been around for a while, but received a big boost in popularity within the first few years after the ACA was passed. This is largely due to the individual mandate. Back before the individual mandate was eliminated, every taxpaying American adult had to legally purchase some sort of qualifying major medical coverage or pay a tax penalty. For millions of Americans, the religious nature of these Christian health plans gave them a religious exemption to the individual mandate. But as far as the state of Maine is concerned, the federal mandate was eliminated at the beginning of 2019 and there are no plans for a state mandate anytime soon. But if your choice is between purchasing a membership from a Christian health plan provider or paying for all of your medical costs out-of-pocket, choosing one of these plans may be worth it.
The cost for your monthly premium (which is actually referred to as a “monthly share amount” for mostly legal reasons) is comparably priced compared to short-term health insurance in the state of Maine – assuming you can find short-term health insurance in Maine for coverage year 2020. If you are trying to decide between either short-term health insurance or a Christian health plan, you should know that they also have the following in common:
- These plans are NOT guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed essential health benefits
Before you get hung up on their similarities, you should also know about the differences between these two types of plans. There are significantly fewer state and federal government regulations when it comes to these types of health plans. In fact, you will most likely not be able to take a Christian health plan provider to court if they ever fail to honor their part of the bargain and refuse to pay out on the claims you were promised. In addition to some of the nomenclature being different, Christian health plans replace things like co-payments, deductibles, and coinsurance with a “personal responsibility amount” or an “unshared amount”. And you will likely have to honor certain “participation guidelines” if you want to join and get your medical expenses reimbursed as a part of a Christian health plan. This usually involves declaring fealty to a Christian faith. You may also need to adopt certain biblical ways of living, promise to cease certain unhealthy behaviors (such as tobacco use), or all of the above in order to remain in good standing with the organization.
Fixed Indemnity Plans in Maine
Fixed indemnity plans in the state of Maine can either come in the form of fixed indemnity insurance, which offers a variety of benefits for things like doctor visits, urgent care, or surgical procedures; or it can come in the form of a dental plan. The good thing about these plans is that they don’t come with restrictive medical networks. But at the same time, they’re not an adequate replacement for major medical coverage for several reasons.
The way a fixed Indemnity plan works is that it pays out benefits on a per day, per week, per month, per incident, or per visit basis, based on the details of your plan. It may pay a portion of your medical expenses upfront in cash, or it may require you to show them a bill first so that they can reimburse you later. Regardless, it is rare for an indemnity policy to cover as large of a share of your medical expenses as, say, a silver plan from the Health Insurance Marketplace. As a matter of fact, indemnity plans are usually sold right alongside major medical coverage so that you pay less money in out-of-pocket medical costs. But like short-term health insurance and cost-share plans, you may have to worry about lifetime and annual caps on your benefits – so keep that important info in mind when you’re shopping around for a policy.
Discount Cards in Maine
Maine is one of the few special cases where you can choose between either a medical discount card from a private company, or the Maine Rx Card. The Maine Rx Card is a prescription drug discount card which is free to each and every eligible resident who lives within the state of Maine. There aren’t any qualification restrictions of any kind, and is accepted at over 68,000 pharmacies across the country. Most people who choose to participate in the Maine Rx Card program can save at least 30% off their prescription costs – but some can save up to 80%. And it is sponsored by the state of Maine, so you know you aren’t getting scammed by an unscrupulous actor.
However, you may find a better value with a medical discount card sold by a private company. It’s a good idea to do a little digging first, though, as not all medical discount card programs are created equal. For example, if they claim they are a legitimate replacement for major medical insurance, they are likely a scam and possibly breaking the law. Medical discount cards are, unfortunately, not an adequate replacement for major medical coverage. But there are also no claims to file or reimbursements to wait for. When you sign up for membership in a medical discount card program, you pay a monthly or an annual fee in order to gain membership and then wait for your card in the mail. Once you get it, be sure to present it when you purchase prescriptions or get care in order to get a discount right there at the register. Best of all, medical discount cards can be easily paired with any other type of health insurance coverage in order to keep your out-of-pocket costs as low as possible.