Maine Health Insurance: 2021 Coverage Guide
Do you live in Maine and need to buy health insurance? If so, it’s important for you to compare rates the right way. If you’re an individual shopping for a plan or you’re buying coverage for a family, you can get the coverage you need for the best value by shopping with SmartFinancial. But there are a few things you should know first. For one thing, you may only enroll in a health plan during the open enrollment period, unless you have a qualifying event. Let’s get started.
When Is Open Enrollment in Maine?
November 1, 2020 - December 15, 2020. Coverage begins January 2021.
How to Get Health Insurance in Maine
To decide which type of plan and coverage tier works best to save you money, take a look at your health care needs from the previous year. See what you had to pay in copays and how many prescription drugs you need. The more coverage you buy, the more it will cost per month, but you’ll have fewer out-of-pocket costs and lower deductibles. So, it’s more economical to buy a higher tier plan if you require care because you’ll end up paying less over the course of the year.
The best way to get the lowest rates for the coverage you need is to compare health insurance companies and health insurance quotes. After you submit a brief form, you’ll get several options and access to an agent who can answer questions about the plans you’re considering.
What Types of Health Insurance Are Available in Maine?
HMOs, EPOs, PPOs and POS plans are the most commonly purchased types of health plans in Maine. Of those, most people buy an HMO or PPO plan. You can also choose how much coverage you want: bronze, silver, gold or platinum. Bronze plans cover the least (60%) while platinum covers the most (90%). This includes copays and medications, so don’t only look at premium costs to see which will save you the most money.
Does Health Insurance Cover Pre-existing Conditions?
Marketplace health plans cannot deny you health insurance coverage due to pre-existing conditions.
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Do I Qualify for a Special Enrollment Period?
Common reasons people qualify for a special enrollment period:
- Lost, quit or changed job. If for these reasons you lose health insurance you can buy insurance. You may also buy insurance if you have started your own business.
- Turned 26. If you were on your parents’ health insurance plan but need to buy an individual health plan, you can do so on your birthday or soon after.
- Moved to another state or out of a coverage area. Some health plans are restricted to certain areas. If you move and lose coverage, you can buy a new plan.
- Cobra coverage ended. When you reach the deadline of your Cobra health care extension, you can buy a new plan.
- Divorce. When you divorce a spouse with whom you shared a health plan, you can buy a new one.
- Marriage. When you marry, you can add your spouse to your plan or vice versa. Or you can buy a new one together.
- Birth or adoption of a child. If you add a new member to your family, you can buy health insurance for that child.
- Death of spouse or partner. If you were covered under your spouse or partner’s health plan but that person passed away, you can buy a new plan.
- Spouse or partner loses coverage. If you had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you can buy a new plan.
Is Health Insurance Required in Maine?
Only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC carry a tax penalty for having no health insurance. Even though it’s not required in every state, buying health insurance can prevent medical bankruptcy.
How Much Is Health Insurance in Maine?
The average cost of health insurance in Maine for a 40 year old is about $450 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.
How to Save on Health Insurance in Maine
The best way to save on health insurance in Maine is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.
Medicare in Maine
Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.
How Many People Are on Medicare in Maine?
25% of the people of Maine are on Medicare.
How Much Is Medicare in Maine?
If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income.
Original Medicare vs Medicare Advantage: What’s the Difference?
Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.
How to Get Medicare Coverage in Maine
If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.
Types of Medicare Plans Available
Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).
How Do I Qualify for Medicare?
To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.
How Can I Save on Medicare in Maine?
You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.
Maine State Health System Ranking
Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Maine Health System are listed below:
- Maine: Overall Ranking: 31 of 51
- Maine: Overall Performance: Below U.S. Average
- Maine: Access and Affordability: 21
- Maine: Prevention and Treatment: 12
- Maine: Avoidable Hospital Use and Cost: 21
- Maine: Healthy Lives: 26
- Maine: Health Care Disparities: 47
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Maine Health Insurance Coverage
The people of Maine have different kinds of health insurance while some Maine residents are not insured at all. See the breakdown below:
- Private coverage: 47%
- Medicaid: 22%
- Medicare: 25%
- Uninsured: 6%
Report: America's Health Insurance Plans
Maine Health Insurance Companies
- Anthem Health Plans of Maine, Inc (Anthem Blue Cross and Blue Shield in Maine)
- Harvard Pilgrim Health Care, Inc.
- Martin’s Point US Family Health Plan (ME)
- Cigna Health and Life Insurance Company - Maine
- Connecticut General Life Insurance Company - Maine
- Anthem Health Plans of Maine (Anthem Blue Cross and Blue Shield in Maine)
- Aetna Life Insurance Company (Maine)
- Aetna Health Inc. (Maine)
- Marine Community Health Options (Community Health Options)
- Compass Rose Health Plan
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Wondering how your little one is doing? Here are some healthy signs that he or she is doing just fine. But it’s always a good idea to have health insurance for your baby, especially the first year.
Choosing a higher deductible plan will help to lower your health insurance premium. So this is a smart financial move. As is keeping a small emergency fund to pay for medical expenses until you reach that deductible.
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It’s always a good idea to get acquainted with the way plans are set up and what you’re responsible to pay before open enrollment which takes place in late fall. If you have a qualifying event, like a new job or if you’ve moved, had a baby, gotten divorced or had any life change that affect your coverage, you may be able to buy a new health insurance plan today.
Like auto and homeowners insurance healthcare insurance also has a deductible which needs to be paid before insurance begins to cover expenses. However, healthcare deductibles work a little differently. For instance, your healthcare insurance will pay for some services even before you meet your deductible.
You may be shopping for health insurance because you got a new job, which doesn’t offer health insurance. Some people even prefer to have a health plan separate from their jobs. It’s usually a more expensive option to buy an individual health insurance policy when an employer offers to pay a portion of your premiums each month. However, some people prefer to choose their own insurance company and a plan that fits their needs.