Maine is Going Independent for 2021!

In 2020 Maine is still using the federal healthcare marketplace system but in 2021 the plan is to switch over to a new private state-run program.

Starting November 1, 2020, Maine residents will no longer enroll in coverage through HealthCare.gov. Instead, they’ll use the new state-run website.

Enroll for 2021 as soon as November 1, 2020.

Maine State Medicaid expansion

In 2019, Maine expanded MaineCare programs to cover more people. For information on MaineCare and how to enroll, go here: http://www.maine.gov/dhhs/ofi/

Maine’s Governor announced plans late last year to opt for more state control over its Individual Health Insurance Market.

The Administration, together with Maine’s Board of Insurance (BOI) and the Department of Health and Human Services (DHHS), is transitioning to become a State Based Marketplace on the Federal Platform (SBM-FP), which will allow the State to take a more active role in promoting health insurance coverage and supporting local consumer assistance programs, while still making use of the federal enrollment platform.

The transition is one component of the Made for Maine Health Coverage Act, which was signed into law on March 18, 2020 after it was passed unanimously by the Maine State Legislature.

Maine has submitted its application or Blueprint to become a State-Based Marketplace and with federal approval will begin operating as a State-Based Marketplace on the Federal Platform effective for the Marketplaces Open Enrollment period starting on November 1, 2020.

DHHS will continue to promote coverage through the CoverME website, and will launch another public awareness campaign to coincide with the open enrollment period this fall.

Individuals are encouraged to visit CoverME for more information about their coverage options, including MaineCare, prior to open enrollment this fall or if they are currently without health coverage.

The Administration is also assessing the option of becoming a full State Based Marketplace (SBM).

In the SBM model, Maine would oversee all aspects of the Individual and Small Group markets, including offering a state-specific enrollment platform to replace the federal site.

Additionally, under a provision of the Made for Maine Coverage Act, BOI has contracted with Gorman Actuarial, Inc. to review the impact of merging the Individual and Small Group markets using different scenarios.

The Bureau released the Gorman report last month and held a public virtual meeting on September 3rd to review the modeling and impacts of the scenarios, which include extending the MGARA reinsurance program to Small Group plans.

If a merged market or expanded reinsurance program are pursued, the Bureau will need to submit another Federal 1332 Innovation Waiver. The BOI-approved Small Group Market rates for 2021 reflect a relatively modest weighted average increase of 5.3 percent.

The 2021 Individual and Small Group rates have been submitted to the federal Centers for Medicare & Medicaid Services (CMS) for final approval and to be uploaded to the website for open enrollment, which runs November 1 to December 15.

The BOI has posted a 2021 Individual Rate Calculator to its own website, to help individuals prepare for Open Enrollment. A 2021 Small Group Rate Calculator has also been posted.

Consumers with questions about insurance matters can contact the Bureaus consumer divisions by calling 800-300-5000 (TTY call Maine Relay 711) or e-mailing Insurance.PFR@maine.gov.