UPDATED: SEPTEMBER 12, 2022 | 2 MIN READ
A Maine resident pays an average of $512 for an individual health insurance plan, although prices will vary based on zip code, age, and other factors. Here’s what you need to know about the Maine health insurance Marketplace, from types of plans to costs, so you can find a plan that works for your needs and budget.
Maine Health Insurance Demographics
Health insurance costs in Maine will vary based on age, zip code, gender, and other factors. The statistics below are relevant to the health care coverage cost in Maine:
- Median Household Income: Maine’s median household income is $59,489, around 8% more than the country’s median household income of $64,994.
- Median Age Range: The median age range in Maine is 5-17 years old at 13.9%. Maine’s largest age range is 35–54 at 24.9%.
- Education: Around 93% of Maine residents graduated high school, while roughly 33% are college graduates. Almost 5% of Maine residents are college students.
What Type Of Marketplace Does Maine Have?
In the fall of 2021, Maine transitioned to a state-run exchange. The DHHS Office of the Health Insurance Marketplace runs CoverME.gov, Maine’s health insurance Marketplace.
How many people are insured through the Maine health insurance Marketplace?
Before Maine transitioned to a state-run exchange, its private enrollment rates declined. Medicaid transitions and a COVID-related provision were among the reasons for this decline.
After Maine rolled out the new enrollment platform in the fall of 2021, 66,095 people enrolled in plans. This is more than a 10% increase from the previous year’s enrollment count at 59,738.
Did Maine implement the ACA’s Medicaid expansion?
Voters passed a Medicaid expansion ballot initiative in November 2017, with coverage effective by July 2018. The former governor refused to adhere to the vote. When Governor Janet Mills took office, her first executive order was to implement Medicaid expansion.
In April 2019, the Centers for Medicare and Medicaid Services approved Maine’s Medicaid expansion plan. The retroactive effective date allowed applicants to receive coverage when they first applied.
When can you buy ACA insurance in Maine?
Maine residents can buy ACA health insurance via CoverME during open enrollment. In 2023, the enrollment window ran from November 1, 2022, through December 15, 2022. You may apply outside the open enrollment window if you have a qualifying event.
Types of ACA Plans In Maine
In Maine, four plan tiers are available: Bronze, Silver, Gold, and Platinum:
- Bronze plans are the cheapest options. They’re best for very healthy people that don’t need routine care.
- Silver health plans are good options for the average consumer. They offer lower premiums and deductibles.
- Gold and Platinum plans may be cheaper in the long run for those with high health costs. The monthly premiums will be more expensive, but out-of-pocket expenses will be lower.
What carriers offer ACA health insurance in Maine?
In 2022, three insurers offer exchange plans in Maine: Community Health Options, Harvard Pilgrim HMOs, and Anthem.
How Much Does Health Insurance Cost In Maine?
Costs vary depending on the type of health insurance plan you get. Residents can expect to pay $512 for a Bronze health plan, $546 for Silver, and $714 for Gold coverage. Pricing will vary based on zip code, age, and other factors.
Cheapest Health Insurance By Metal Tier In Maine
Maine’s four levels of health insurance provide coverage options for most budgets. Below are the cheapest individual plans in the state.
|Metal Tier||Cheapest Plan||Monthly Premium||Deductible||Maximum Out-of-Pocket|
|Bronze||Health Options CC Bronze||$310||$8,700||$8,700|
|Silver||Maine’s Choice Plus HMO||$330||$4,250||$8,700|
|Gold||Anthem Gold X Clear Choice||$415||$2,500||$6,000|
|Platinum||Health Options CC Platinum||$555||$500||$3,000|
Cheapest Health Insurance By County
|County Name||Company||Plan||Individual, Age 40|
|Androscoggin||Maine Choice Plus||HMO Silver 4250||$375|
|Cumberland||Maine Choice Plus||HMO Silver 4250||$330|
|Kennebec||Maine Choice Plus||HMO Silver 4250||$365|
|Penobscot||Anthem||Silver X Clear Choice Tiered 5500||$440|
|York||Maine Choice Plus||HMO Silver 4250||$330|
Can You Purchase Off-Exchange Insurance Coverage In Maine?
The only major medical plans approved for sale directly to Maine residents (versus through an employer) are offered by Community Health Options, Harvard Pilgrim HMOs, and Anthem.
Can You Purchase Short-Term Insurance In Maine?
In 2019, Maine’s legislature passed legislation that limited short-term health plans. Maine allows short-term health insurance plans, but no insurers currently market those plans.
Health Coverage Options For Low-Income People In Maine
MaineCare provides free and low-cost health insurance and other help affording health care for people who meet specific requirements, such as medical conditions, income, or age. MaineCare covers doctor visits, substance use disorder treatment, emergencies, prescription drugs, and more.
There are also options for Maine residents with disabilities and certain health conditions, those who need long-term care, and young adults who have been in foster care.
What Medicare Options Are Available In Maine?
Four plans are available in Maine’s Medicare Advantage program: Health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service (PFFS), and special needs plan (SNP). Each MA plan offers flexibility in your network of care providers and varies in price.
Medicaid In Maine
MaineCare is Maine’s “Federal/State” program that assists eligible state residents with their health care payments.
Eligible recipients must be state residents in need of health care/insurance assistance, whose financial situation would be characterized as very low or low income. Annual household income (before taxes) must be within certain amounts, depending on how many people live in your home.
You must also be one of the following:
- Responsible for someone 18 years of age or younger, or
- Pregnant, or
- Blind, or
- Have a disability or a family member in your household with a disability, or
- Be 65 years of age or older.
Cheapest Health Insurance Plans In Maine
For the average consumer, the cheapest plan on the state insurance exchange is currently Maine’s Choice Plus HMO Silver 4250. For a 40-year-old, the plan costs $330 per month with a $4,250 deductible and $8,700 maximum out-of-pocket cost.
Cheapest health plan in Maine with low out-of-pocket maximums
If you have high health expenses, enrolling in a plan with higher monthly costs and low out-of-pocket maximums is best. If you have frequent doctor visits and prescription drug costs, you’ll reach your out-of-pocket limits, and your plan will cover the costs.
The cheapest option for a low out-of-pocket max plan is Maine’s Choice Plus HMO Gold 1200 from Harvard Pilgrim Health Care, costing the average 40-year-old $498 monthly.
Cheapest health plan in Maine with high out-of-pocket maximums
Low-cost plans with high out-of-pocket maximums are generally best for younger Maine residents, especially if they’re in good health with infrequent doctor visits. You’ll save on monthly premiums but also pay more for any medical services.
For a cheap plan with high out-of-pocket costs, the best option in Maine is Anthem Catastrophic X HMO 8550, offered by Anthem Blue Cross and Blue Shield, costing an average monthly rate of $174 for a 26-year-old.
Cheapest health plan in Maine with an HSA option
Health Savings Account (HSA) plans are another option when shopping for coverage. They’re generally inexpensive, allow pre-tax contributions, and earn you savings unless you use them for approved expenses.
The cheapest HSA plan in Maine depends on the metal tier. For all available tiers, the most affordable HSA plans are:
- Cheapest HSA Bronze Plan: Anthem Bronze X HMO 6700 at an average of $332 per month.
- Cheapest HSA Silver Plan: Community Core HSA plan from Community Health Options for an average cost of $502 each month.
Remember: these plans have high deductibles, so you may have to pay major medical expenses with your savings.
Cheapest HMO/PPO/POS health plans in Maine
In Maine, HMO plans are the most common plan type, as they tend to be the cheapest. Remember that you’ll need to stay within your network to have services covered. PPO plans are more expensive, but they offer a wider provider network. POS plans provide coverage both in and out of the network with a higher out-of-network coverage cost.
In Maine, the most affordable plans of each type are:
- Cheapest HMO Silver Plan: On average, Harvard Pilgrim Health Care’s Maine’s Choice Plus HMO Silver 6500 at $414 per month.
- Cheapest PPO Silver Plan: Community Health Options’ Community plan at a monthly average of $491.
- Cheapest POS Silver Plan: Anthem’s Anthem Silver X POS 5900 at an average of $517 per month.
What companies offer health insurance in Maine?
The only major medical companies in Maine (versus those available through an employer) are Community Health Options, Harvard Pilgrim HMOs, and Anthem.
Does Maine have free healthcare?
Maine law requires that free care must be provided to residents with income less than 150% of the federal poverty level. MaineHealth provides free care to all patients at 200% of the national poverty level.
How much does Obamacare cost in Maine?
Maine residents will pay an average of $512 per person for an individual health insurance plan via CoverME.gov, the state’s Marketplace.
What are the qualifications for MaineCare?
Eligible MaineCare recipients must be state residents whose financial situation would be characterized as very low or low income. Annual household income (before taxes) must be within certain amounts, depending on how many people reside in your home.
You must also be one of the following:
- Responsible for a child 18 years of age or younger, or
- Pregnant, or
- Blind, or
- Have a disability or a family member in your home with a disability, or
- Be 65 years of age or older.
What does MaineCare cover?
MaineCare covers doctor visits, X-rays and labs, emergency and hospital visits, behavioral health services, and prescription medications.
How To Buy Affordable Maine Health Insurance
Finding affordable Maine health insurance isn’t difficult. Once you have a general understanding of the type of policy you want, use our health insurance quote tool to compare rates.