Looking for health care in the Pine Tree State? According to a study by US News, Maine has the 22nd best health care in the nation thanks to access, quality, and public health.
Health insurance choices in Maine
According to the Maine Bureau of Insurance, there are several ways for residents to access health care:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Maine residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 48% | ||
| Individual or family | 6% | ||
| Medicaid | 18% | ||
| Medicare | 17% | ||
| Military | 2% | ||
| Uninsured | 8% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Eight percent of Maine residents are uninsured, less than the national average. That’s great news, as more uninsured people bring higher rates for policyholders.
Maine health insurance companies
Maine residents have multiple health insurance providers to choose from. These companies offer both individual and family plans in your state:
- Anthem
- Community Health Options
- Harvard Pilgrim Health Care
Your coverage options and rates will vary based on the county you live in.
Maine health insurance costs and rate factors
Maine residents spend an average of $9,531 per year on health care, more than the national average. So, what decides your health insurance rates in Maine? Prices vary person to person, but are based on these factors:
Health insurance plan type
Marketplace plans come in metal tiers: bronze, silver, and gold. It's no surprise that the more coverage you want, the more you’ll pay in monthly premiums.
How much should you expect to pay in your state? These are the average monthly premiums for a middle-aged ME resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $384 | $506 | $609 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Premiums for a gold plan cost about 59 percent more than a bronze plan. That’s because gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent of costs.
You may also qualify for a catastrophic plan, the lowest level of coverage available in the marketplace. Catastrophic plans have low premiums, but a high yearly deductible of $8,150. Because of that high deductible, you may save money by investing in a bronze or silver plan.
Body mass index
A high body mass, according to the CDC, leads to serious health conditions. That’s why insurance companies analyze your BMI to determine your health care rates. A high BMI leads to high premiums.
In 2019, ME had a 32 percent obesity rate, the 28th highest rate in the country. Out of the many state residents who used QuoteWizard to compare health insurance plans, 25 percent have a BMI in the obese range.
Tobacco use
Tobacco users spend more on health insurance due to the high risks from smoking. About 20 percent of ME residents are smokers, the 37th lowest rate in the country.
Age
According to HealthCare.gov, older people are charged up to three times more for health care than younger people. ME residents who used QuoteWizard to shop for health insurance are, on average, 44 years old.
Location
You zip code plays a big role in your premiums. That’s because every state has different rules, regulations, and providers surrounding their insurance marketplace.
Insurance companies also use community-rating to determine your prices. So, prices are based in part on the combined claims that everyone files. If your city or state files a high number of insurance claims, your prices could rise.
That’s why your state’s overall health influences your rates. According to America’s Health Rankings, ME is the 23rd healthiest state in the country.
Maine health insurance laws
The Affordable Care Act mandates what insurance companies can and can’t use to determine your premiums.
- Pre-existing conditions: Before the ACA, people with pre-existing conditions paid more for health insurance. Luckily, insurance companies can no longer charge higher rates to people with pre-existing conditions.
- Gender: The ACA limits insurance companies from charging men and women different prices for the same plan. That’s good news, especially considering women historically pay more for health care.
- Insurance and medical history: Insurance companies used to analyze your medical history and your past insurance coverage. People with previous medical problems or lapses in insurance paid significantly more for health insurance.
There’s a limit to how much you’ll pay out-of-pocket for a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Maine law requires that health insurance companies offer some coverage for the following services:
- Mental health services
- Home health care
- Hearing aids
- Chiropractic services
- Diabetes education
- Clinical trials
- Contraceptives
- General anesthesia for dentistry
- Cancer screenings
There are additional services that providers need to offer coverage for. Find the full list on cms.gov.
Medicare and Medicaid in Maine
Medicare and Medicaid are both federal-funded health care programs. Medicare covers seniors, whereas Medicaid helps low-income families and children.
Medicare
State residents 65 years and older qualify for Medicare. There are several coverage options within the program, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for one of these Medicare Savings Programs with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid aids low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Maine Bureau of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Eric A. Cioppa
- Insurance Hotline:
- (800) 300 – 5000
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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