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Maine Health Insurance

Maine Health Insurance for Individuals and Families

Maine is one of the few states where medical underwriting is not allowed. This means that insurance carriers are not permitted to review the medical history of prospective members. As a result, they are required to charge the same rate (or premium) to members regardless of their health status. This leads to very high premium costs. Due to the extreme cost, we (Health Plan One) currently do not offer individual health insurance in the state of Maine. Please contact the Maine Department of Insurance should you be interested in individual health insurance.

There is currently no high risk pool in Maine. All individuals are guaranteed health coverage.

Maine Group & Small Business (1-50 employees) Health Insurance

As previously mentioned, medical underwriting is not allowed in Maine. Rates are based on an adjusted community rate based on age, geography, occupation, and smoking status. For preexisting condition requirements, the carrier may look back in a consumer’s medical history 6 months and impose a 12 month exclusionary period for those that did not have prior medical coverage.

Visit our Maine Small Business Group page for more information.

Maine COBRA Health Coverage

Maine offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce.

Medicaid and Medicare in Maine

MainCare, also known as Medicaid, offers free health care coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes. MainCare also offers free or subsidized health coverage for uninsured children (also known as Cub Care). These prospective individuals must meet certain income and other requirements to be eligible.

Income requirements

Children
Children (ages 1-5)-150% of the Federal Poverty Level
Children (Ages 6-19)-150% of the Federal Poverty Level

Pregnant Women and Infants
Pregnant Women-200% of the Federal Poverty Level
Infants (ages 0-1)-200% of the Federal Poverty Level

Parents
Non-Working Parents-150% of the Federal Poverty Level
Working Parents-157% of the Federal Poverty Level

Other populations
Medically Needy Individual- 44% of the Federal Poverty Level
Medically Needy Couple- 35% of the Federal Poverty Level
Supplemental Security Income Recipients- 74% of the Federal Poverty Level
Aged, blind, and disabled- 100% of the federal Poverty Level

Covered Services
Hospital outpatient, rural health clinic, federally qualified health centers, laboratory and x-ray, nursing home, physician services, dental, early periodic screening diagnosis and treatment, family planning, clinic services, prescription drugs, case management, medical transportation, nurse midwife, extended services for pregnant women, and ambulatory prenatal care.

Co-Payments
Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about MaineCare at http://www.maine.gov/bms/.

Click here for information about Medicare in Maine.

Other Maine Health Insurance Programs

As mentioned above, Maine offers the MaineCare Program for children (Cub Care) under the age of 18 who are Maine residents and whose family income is up to 200% of the Federal Poverty Level. Please visit the MaineCare website for more detailed information at http://www.maine.gov/dhhs/OIAS/services/cubcare/CubCare.htm.