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Maine Health Insurance

Having a suitable health insurance protects you and your family against financial catastrophes rising from the happening of illness or injury. It is imperative to assess all the future risks and its influence on your financial standing. In the U.S., approximately 47 million people are uninsured, among whom a majority of families are exposed to the lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.

Maine is the 9th healthiest state to live in and obtain health coverage according to the 2008 America's Health Rankings. The state continues to enjoy a strong health care system; it was on the 7th and 9th spot in 2007 and 2006 respectively. Despite the state’s low public funding, the low violent crime rates and the low percentage of residents lacking health insurance has contributed to the steady ranking in its health care score. The state of Maine, with more than one million residents, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-cost coverage to the uninsurable citizens of Maine who meet specific eligibility requirements of age and income.

The Maine Bureau of Insurance manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, state has the lowest percentage of citizens without insurance, i.e. roughly 9.1%. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 46.4% of Maine’s uninsured citizens come under the above 200% FPL category.

Buying health coverage can often prove to be confusing. However, with the help of a licensed health insurance agent/broker, you can select a proper health insurance plan with benefits that suit your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Maine. These regulations apply to all insurance companies offering individual or family health insurance in Maine.

Medical Underwriting

Yes

Pre-Existing Condition Exclusion Period

12 months

Look Back Period

12 months

Look Back Standard

Prudent person

Mandatory Benefits

Cancer screening for women including screening of breast cancer and cervical cancer, mastectomy stay as determined by the surgeon, constructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as Primary Care Providers, eating disorder parity

Market Rate Restrictions

Yes

Guaranteed Issue Options

None

Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Maine. These regulations apply to all insurance companies offering small group health insurance in Maine.

Small Group Size

1-50

Employee Qualifications

Owner can count as an Employee

Guaranteed Issue

Yes

Premium Rating Factors

Adjusted Community Rating

Rate Adjustment Factors

20%

Look-Back Period

6 months

Pre-existing condition exclusionary period

12 months

Mandatory Benefits

Same as individual

State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Maine. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option

Yes

Eligible Group Sizes

2-19

Extension of Benefits Period - Standard

18 months

Extension of Benefits Period - Disabled

18 months

Maximum Premium Increase

102%

State Legislation Reference

Statute 24-A, Chapter 36 of the Maine Continuity of Health Insurance Coverage

Additional Notes

Mini-Cobra coverage is provided to eligible individuals that elect this option within 31 days.

State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Maine to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Maine does not offer health insurance coverage through state high risk pool program for individuals who are medically-uninsurable.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Maine provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name

MaineCare

Website

http://www.maine.gov/dhhs/OIAS/services/cubcare/CubCare.htm

Phone Number

877-kids-now

Apply Online

Yes

Age Limits

Under 18

Insurance Carrier

Length of Coverage

12 months

Residency Requirements

Maine resident

Other Eligibility Requirements

Income must be equal to or less than 200% of the FPL

Pre-Existing Condition Exclusions

None

Cost

There is no cost for most families. Some families must pay a small monthly premium between $8 and $64.00 for their children's coverage. Some parents must pay a small co-payment for services.

Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Maine:

Governing Agency

Department of Health and Human Services

Website

http://www.maine.gov/dhhs/oms/

Phone Number

800-442-6382, 207-287-2826, 207-624-7539

Residency Requirements

Maine resident

Federal Poverty Line Income Limits

Pregnant women at or below 200% FPL;
Infants at or below 185% FPL;
Working or nonworking parents with children
under the age of 18 at or below 200% FPL; Children age 1-20 at or below 150% FPL;
Working Disabled at or below 250%;

Additional Resources

Maine Health Care Options Matrix™ Guide

Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Maine’s public and private health care choices for individuals and groups with various demographic profiles.

Family Health Insurance Guide by HealthInsuranceFinders.com

The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

Maine: At-A-Glance

Provides exclusive health data of Maine. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.


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