As open enrollment for ACA health plans began in November 2022, and runs through January 15, 2023, it is important to know what to look for in health coverage plans. This article will walk you through the best plans in Maine for this persona we used: 30-year-old female, does not smoke, no disability, making $70,000 annually. However, the best plans for you may vary based on your household size, income, and other factors.
What are the Best Plans on the Maine Health Insurance Marketplace?
The Maine health insurance marketplace is called coverME. Maine offers a variety of health plans from different insurance companies, but only those best fit for the persona we chose are listed in the tables below. You can browse through plans by inputting your personal information in the plan comparison tool.
The two plan types listed below are HMOs and PPOs. You can find more information on the four main ACA health plan types along with HSAs later in the article.
Bronze Tier Plans
|Plan Name||Premium||Plan Type|
|Health Options Clear Choice Bronze $7500 HMO Tiered NE|
|Anthem Bronze X Tiered 7800|
|Anthem Clear Choice Bronze X Tiered 8000|
|Anthem Clear Choice Bronze X Tiered 7500|
|Health Options Clear Choice Bronze $8000 Healthy Maine HMO NE|
|Health Options Clear Choice Bronze $9100 HMO NE|
|Health Options Clear Choice Bronze $7500 HMO NE|
|Anthem Clear Choice Bronze X Tiered 6300 w/HSA|
|Anthem Clear Choice Bronze X Tiered 5900 w/HSA|
|Health Options Clear Choice Bronze $8000 Healthy Maine PPO NE|
|Health Options Clear Choice Bronze $9100 PPO NE|
|Health Options Clear Choice Bronze $7500 PPO NE|
|Health Options Clear Choice Bronze $7500 PPO NE Dental|
|Clear Choice HMO HSA Bronze 7000|
|Health Options Clear Choice Bronze $5900 HSA PPO NE|
|Clear Choice HMO HSA Bronze 6300|
|Clear Choice HMO HSA Bronze 5900|
|Health Options Clear Choice Bronze $7000 HSA Plus PPO NE|
|Anthem Clear Choice Bronze X PPO 6300 w/HSA|
|Clear Choice HMO Bronze 9100|
|Clear Choice HMO Bronze 8000|
|Clear Choice HMO Bronze 7500|
Silver Tier Plans
|Plan Name||Premium||Plan Type|
|Anthem Clear Choice Silver X Tiered 6000|
|Anthem Clear Choice Silver X Tiered 5500|
|Anthem Clear Choice Silver X Tiered 4200|
|Health Options Clear Choice Silver $4200 HMO Tiered NE|
|Anthem Silver X Tiered 5800|
|Anthem Clear Choice Silver X Tiered 3500|
|Anthem Clear Choice Silver X Tiered 3000|
|Health Options Clear Choice Silver $3500 HMO Tiered NE|
|Health Options Clear Choice Silver $4200 HMO NE|
|Health Options Clear Choice Silver $4200 PPO NE|
|Health Options Clear Choice Silver $3500 HMO NE|
|Health Options Clear Choice Silver $3500 HMO NE Dental|
|Health Options Clear Choice Silver $3000 PPO NE|
|Anthem Clear Choice Silver X PPO 6000|
|Health Options Clear Choice Silver $3000 PPO NE Dental|
|Health Options Clear Choice Silver $3500 PPO National|
|Anthem Clear Choice Silver X PPO 3500|
|Clear Choice HMO Silver 6000|
|Clear Choice HMO Silver 5500|
|Clear Choice HMO Silver 4200|
|HMO Silver 6800|
|Clear Choice HMO Silver 3500|
|Clear Choice HMO Silver 3000|
Gold Tier Plans
|Plan Name||Premium||Plan Type|
|Anthem Clear Choice Gold X Tiered 2500|
|Health Options Clear Choice Gold $2500 PPO NE|
|Health Options Clear Choice Gold $2500 PPO NE Dental|
|Anthem Clear Choice Gold X PPO 2500|
|Clear Choice HMO Gold 2500|
|Health Options Clear Choice Gold $1500 PPO NE|
|Health Options Clear Choice Gold $2500 PPO National Dental|
|Health Options Clear Choice Gold $1500 PPO National|
|Clear Choice HMO Gold 1500|
What are the Types of Health Plans?
The listed plan types above include HMOs and PPOs, with some having the option of an HSA. The table below outlines the types of plans you may come across when browsing.
Types of Health Insurance Plans
|Health Maintenance Organization (HMO)||This plan typically has lower premiums and out-of-pocket costs, and flexibility in choosing providers. You will have to pay completely out-of-pocket for out-of-network providers.|
|Point of Service Plan (POS)||This plan usually has higher premiums because they cover out-of-network providers and have a higher cost for in-network care.|
|Preferred Provider Organization (PPO)||This plan allows you to freely choose physicians out-of-network without referrals. It is a good option if you can afford high premiums and need frequent care.|
|Exclusive Provider Organization (EPO)||This plan is not commonly chosen and only covers in-network services.|
Some of the plans also include an option of adding an HSA (Health Savings Account). An HSA is an account in which you use tax-exempt money to pay for deductibles, co-payments, co-insurance, etc. which helps lower the cost of health insurance. These can only be used if you have a high deductible health plan (HDHP), so you will know whether the plan you choose is HSA eligible when browsing through them.
What Should I Consider When Picking a Health Plan?
When looking for a health plan, you should consider a few things. First, you must consider your health needs, finances, and how much you can afford. These are things that will likely change as time goes on, but having an understanding before selecting will help you make the best decision.
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What are your health needs?
When picking a health plan, you want to consider your health needs. This includes what medications you currently take, chronic conditions like diabetes, and how often you need to see your medical provider. If necessary, do you need to see specialists? needing a referral from your PCP be more difficult than helpful? Finally, consider whether you plan on making any major life changes soon.
Life changes can include:
- Having a child
- Getting married
- Retiring early
- Switching careers
Once you’ve figured out what your health needs are, you can move on to the next step of deciding which health plan is best for you. Some health plans also provide you with dental and vision care.
If you’re looking for a health plan to cover you and your family, you can still consider the above to help you rank all your options. If you’re married, your spouse may receive health insurance through their job; check to see if their plan offers more benefits.
What’s your financial situation?
After you’ve thought about your health needs, take the time to calculate your budget moving forward. Including things like housing, transportation, and even entertainment costs is important. Then you can see how much of your budget can go toward health insurance.
If you’re someone with an income that fluctuates, such as a freelancer or short-term contracted employee, you should think about how this will impact your budget at its highest and lowest. For people who live in cities with a high cost of living, you will find that the average cost of health insurance for one person varies compared to cities with a low cost of living.
You’ve done your budget, and you understand how much your current lifestyle affects your finances. Be mindful not to blow all your money on health insurance as you still need a savings account. We’ve even figured out a few things you should keep in mind when trying to lower your expenses.
How much can you afford?
You have your health needs and budget figured out. Now you can select the health plan that will best meet your needs. If you find that you will have a high deductible, you can offset that with a service like Mira that offers a significant discount on lab tests and prescriptions.
If you decide to select a high deductible health plan (HDHP), you will find that you will have a lower monthly premium. These plans are typically helpful to relatively healthy people who don’t plan to have significant medical expenses. You can pair an HDHP with a Health Savings Account (HSA), which allows you use your pre-taxed funds towards medical expenses like copays and deductibles. However, you cannot use this to pay for your monthly premium.
Average Lowest Marketplace Premiums in Maine by Metal Tier
|Metal Tier||Premium Cost|
What if you frequently travel?
If you travel a lot and need coverage during this time, look at PPO plans. Preferred Provider Organization plans will give you access to out-of-network coverage and allow you to see specialists without a referral. These plans do often come with a high premium. Maine offers PPO plans, and you can see providers out-of-network for a higher cost than in-network providers.
What happens if you can’t afford any plan on the exchange?
If you cannot afford any plans on the state exchange, there are other alternatives to health insurance. Some of these options include care memberships, medical cost-sharing, and discount cards. There is no penalty if you choose to be uninsured in Maine. The federal law requiring tax penalties on those who are uninsured was repealed in 2019.
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How to enroll in an ACA plan?
Maine does not use the federal health insurance marketplace and instead has its own state exchange called coverME. You can browse through and compare ACA plans available in Maine through this website by inputting your personal information to find the plans that work best for you. There are options to get help with your application over the phone or through brokers and assisters.
ACA Health Plans in Maine Frequently Asked Questions (FAQs)
Below are some frequently asked questions about health insurance in X State we gathered for you.
What health insurance terms should I understand during this enrollment period?
We’ve gone over PPO, HDHP, and HSA. You should also know what a Flexiable Spending Account (FSA), Self-Pay Pricing (SPP), and Special Enrollment Period (SEP) are. We have a list with a few more insurance terms that will help you during this enrollment period.
What requirements do I need to meet to be eligible in Maine?
To be eligible for an ACA health plan in Maine, you must be a resident of Maine and be either a U.S. Citizen, U.S. National, or have qualified immigration status. Your eligibility for certain plans is determined by your estimated income. Health plans in Maine typically only cover providers and hospitals in the United States.
What are the benefits that my plan is required to provide?
Under the Affordable Care Act, there are ten benefits every plan is required to cover (essential health benefits). Included are doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. However, not every plan is the same, and you will see what is offered by each plan when you compare them.
When is the special enrollment period?
If you miss open enrollment and you’ve had a qualifying life event such as having a baby, a change in income, or health insurance loss, you may be able to apply 60 days prior or 60 days after the event to enroll in a health plan. To see if you qualify, go to healthcare.gov and fill out a few questions. The site will direct you to either answer more questions or to the site for Maine.
You can enroll in a Maine ACA health insurance plan through the state exchange, coverME. There are easy ways to browse through the available plans by inputting your personal information and deciding which one works best for you. You should compare plans based on metal tier and premium and deductible amounts. As open enrollment runs from November 1, 2022, to January 15, 2022, it is essential to become familiar with the enrollment process.
If you’re looking for a more affordable alternative to health insurance, Mira might be a great fit for you. For an average of $45 per month, members get access to low-cost urgent care visits, affordable lab testing, and discounted prescriptions at up to 80% off. Sign up today and start saving on healthcare.
Michelle Fleming is a sophomore at the University of Texas at Austin majoring in Public Health, focusing on biostatistics and informatics and minoring in Health Communications. Michelle is passionate about bridging the gap in health inequalities through advocacy and policy, especially within minority groups.