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Maine Health Insurance

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Facts and Figures

  • Place in State
    Health Report Card
  • Insured 1,174,770
  • Uninsured 134,700
  • Insurance
  • Number of
    Primary Care Physicians
  • Number of

Breakdown of Insureds

  • Employer-sponsored health insurance 53%
  • Private plans 4%
  • Medicaid 24%
  • Medicare 16%
  • Others 3%

Insurance Carriers

State Health Report Card

1. Smoking among adults in Maine has decreased from 23.8 percent to 18.2 percent over the last ten years, However, there are still more than 192,000 adults smokers in the state. 2. Obesity in Maine has increased over the last ten years from 22.7 percent to 27.4 percent of the state’s population. There are 289,000 obese adults in Maine. 3. Diabetes cases increased from 6.0 percent to 8.7 percent over the last ten years. 4. Children living in poverty has risen from 8.9 percent to 17.8 percent of those under 18 years. 5. Maine is ranked higher for determinants than for outcomes, a positive sign indicating an improvement on overall health over time.

Maine Health Insurance Laws and Regulations

Maine health insurance plans are required to be sold with a guaranteed renewability clause. With this, plan holders can renew their coverage as long as they want provided the premiums are paid in full and the contract is not violated. Insurers cannot cancel a policy without the subscriber’s consent. When writing new Maine health insurance plans, insurers can exclude coverage for a pre-existing condition. However, when switching to a different policy, this period will not re-set as long as the subscriber maintains continuous coverage. Maine does not allow insurers to consider health, age, or health risk when determining an applicant’s qualification. Also, an applicant’s health and gender cannot be used to increase premium charges, but other factors like age, family history, alcohol and tobacco use are allowed. Insurance companies are required to offer applicants two standardized health plans according to state laws. Small businesses with 2 to 50 employees can avail of group health plans being offered to other small businesses in the state. A minimum number of subscribers and employer contribution may be required. Premiums of health plans for small businesses may vary according to age, family history, and other risk factors. However, health and gender cannot be used to determine premium rates. Self-employed individuals in search of Maine health insurance quotes have the option to purchase group health plans even without any other employee. However, should they opt for an individual plan, they can deduct a portion of premium payments from their tax liability.

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s Maine health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Maine, more than 7,329 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed 12,865 Medicare policyholders in Maine to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 11,892 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $530 per person or a total of $6,306,962 was saved in Maine.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 30 individuals in Maine have benefited from this new law.

When looking at Maine health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. The 332,000 private policyholders in Maine will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Maine health insurance with no deductible or co-pays. In 2011, 187,251 Medicare subscribers and 226,000 individuals with private policies received such services in Maine.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 431,000 Maine residents have benefited from this law.

If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Maine received a total of $1 million.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Maine, 138 community health centers received a total of $16 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Maine has already received a total of $10 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered

Pre-Existing Condition Insurance Plan (PCIP)


This is a temporary high-risk pool created by the Health Care Reform run by the U.S. Department of Health and Human Services. This program provides coverage for individuals with a pre-existing condition who have a hard time finding private coverage. Coverage includes a wide range of benefits which includes hospital care, primary care, specialty care, and prescription drugs. Eligibility: 1. Must be a U.S. resident living in Maine. 2. Must be uninsured for at least six months. 3. Must have a qualified pre-existing health condition.


(Medicaid) 866-690-5585 800-977-6740 (Member Services) 207-287-3707 (TTY)

This is Maine’s Medicaid program. Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program should meet financial and other eligibility requirements. Benefits covered include physician services, inpatient and outpatient hospital services, transportation services, ambulance services, laboratory and x-ray services, ambulatory care and surgery, dental, vision, nursing services, home health, hospice, medical supplies and durable medical equipment, hearing aids, speech and hearing services, physical therapy, occupational therapy, and many more. Eligibility: 1. Must be U.S. citizens or qualified residents living in Maine. Pregnant women and children are qualified regardless of citizenship. 2. Must not exceed income limits. Pregnant women and their infants: 200% of the FPL. Infants of none Medicaid mothers: 185% of the FPL. Young adults between 19 and 20: 150% of the FPL with assets not exceeding $2,000. Aged, blind, and disabled, and medically-needy: 100% of the FPL. Assets not exceeding $2,000 for singles and $3,000 for couples. Parents and caregivers living with children between 0 and 18 years: 150% to 200% of the FPL with assets not exceeding $2,000.

Dirigo Choice

877-892-8391 207-287-9900(TTY)

Dirigo Choice offers coverage to all qualified individuals and employees who find it difficult to pay for their premiums and deductibles. Members are given discounts on monthly payments, deductibles, and out-of-pocket expenses. Benefits covered include preventive care, smoking cessation programs, inpatient and outpatient services, emergency care, prescription drug coverage, and more. Eligibility: 1. Sole proprietors: Must be Maine residents, contribute 60% of the cost for single coverage before discount is effective, no minimum contribution is required. 2. Small employers: Must be Maine residents, between 2 and 50 employees, contribute 60% of employees’ insurance cost, No coverage available for dependents. 3. Individuals and sole proprietors: Must complete a Certification Statement. 4. Part-Time Worker Coverage Voucher: Must be Maine residents, working 10-35 hours a week, be uninsured for 90 days prior to application, not exceed 300% of the FPL, have assets not exceeding $60,000 for singles and $120,000 for households with at least 2 household members.

Maine Children with Special Needs Program

800-698-3624 TTD: 800-438-5514

Maine Children with Special Health Care Needs offers coverage for treatment and other related services to families of infants, children, and adolescents with special health care needs. There is no income requirement for the program. Coverage includes medical treatment, diagnostic tests, and therapeutic interventions (medical, surgical, and corrective) for several disorders. Eligibility: 1. Must be a Maine resident. 2. Must be aged 21 years and below. 3. Must not exceed 250% of the FPL.


800-442-6382 877-543-7669

CubCare provides coverage to children 0 to 18 years and pregnant women. Services covered include doctor visits, preventive care, immunizations, check-ups, hospitalizations, mental, and dental. Eligibility. 1. Must be a Maine resident. 2. Must be children between 0 and 18 years. 3. Must not exceed income of 200% of the FPL. 4. There are no citizenship requirements for children and pregnant women.

Women-Infant- Children (WIC)

800-437-9300 207-287-3991 800-438-5514 (TTY)

Women-Infant-Children is funded by the federal government and offers nutrition program for women, infants, and children. Benefits include health screening, medical history, body measurement, nutrition assessment and education, breast feeding support and education, hemoglobin check, and vouchers for food supplements. Eligibility: 1. Must be a resident of Maine. 2. Must have nutritional or medical risk. 3. Must be pregnant or postpartum women and children not more than 5 years. 4. Must not exceed income limits of 185% of the FPL.

Maine Breast and Cervical Health Program

800-350-5180 207-287-8068 800-438-5514 (TTY)

Maine Breast and Cervical Health Program offers screening, diagnostics, and treatment to qualified low-income women. Benefits for this program include clinical breast exams, mammograms, breast and cervical cancer screenings, and Pap tests. Eligibility: 1. Must be a woman living in Maine. 2. Must be 40 years or older. 3. Must not exceed 250% FPL. 4. Must be uninsured or undersinsured. 5. Must not be eligible for MainCare, Medicaid, and Medicare Part B. 6. Women between 35 and 39 may also qualify under certain conditions.



This health care system is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

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