No doubt, health insurance is very important as it secures you from financial losses in the event of any health challenge. Health insurance provides financial protection from health care costs by covering most part of your routine and emergency medical care expenses.
Many residents in Maine get their health insurance as part of a benefits package from their employer. But if you are self-employed or cannot afford the coverage available to you, there are other ways you can get your health insured.
You can either buy through an insurance broker or agent, buy directly from an insurance company or buy through the government health insurance marketplace.
MaineCare/Medicaid In Maine
MaineCare is a government-provided healthcare program that provides free and low-cost health insurance to eligible Mainers. Qualification for this plan or program is based on income and household composition. Individuals with an income below 138% of the national poverty level are eligible for this plan.
There are also options available for people with disabilities and certain health conditions,people who need long-term care and young people in foster care.
- doctor visits,
- substance use disorder treatment,
- prescription drugs, and more.
Medicare In Maine
Medicare is also a government health insurance program but unlike Mainecare it is not entirely free. Although you’d be required to pay some money as a premium,it is still cheaper than purchasing health insurance from private companies. It is available to only the elderly and people with disabilities.
Medicare is divided into three parts:
This part is free. It pays for inpatient hospital stays,hospice care,some home health care services and nursing facility care.
Part B is the medical insurance and it covers preventive services, doctor’s appointments, outpatient care and necessary medical supplies. Monthly premium costs vary depending on your income level.
- Part D
This is also known as prescription drug coverage. The cost of prescription drugs and recommended vaccines are included in this coverage.your premium costs are dependent on the plan you choose.
Factors That Affect Health Insurance Premiums In Maine
Health insurance companies in Maine determine the amount you pay for monthly premiums by considering a number of factors. These factors can either lower or increase your premiums significantly.
Below are some of the factor we researched and found that can affect your premiums:
Age is a major determinant in your premium costs. In Maine, age is directly proportional to the cost of health insurance; the older you get, the more you pay on health insurance.
Body Mass Index
Your body mass index can also affect how much you pay on premiums in Maine. BMI is usually used to calculate body fat and is also used to determine if an individual is of a healthy weight. Having a high body mass index increases your chances of falling sick and having severe health conditions like, osteoarthritis,type 2 diabetes, cardiovascular diseases, hypertension,breast cancer and even depression and other related mental disorders.
Because of this increased risk, health insurance providers charge people with a high BMI higher on monthly premiums. Being able to maintain a healthy body mass index in Maine, not only cuts your costs but also improves your health in general.
Our places of work expose us to different dangers and hazards. This exposure is relative depending on where we work. For instance, a builder working on a construction site is more ;likely to sustain injuries compared to a school teacher. Invariably, the builder would be charged more on health insurance. So in Maine, your occupation also plays a role in deciding your premium costs.
Past Medical History
Health insurance providers in Maine access your past medical records when charging you. People with pre-existing ailments are charged more. Healthy individuals are charged the least on health insurance in Maine.
Where you reside also plays a role in determining your rates.Some areas in Maine have better access to healthy food options and more favourable climatic and living conditions. Typically these areas are charged less.
Some other determinants include the type of plan you choose, your policy duration and coinsurance features.
Private Health Insurance On The Maine Marketplace
Private health insurance providers in the Maine healthcare marketplace use a metal tier system in distinguishing and describing available plans and the coverage they offer. These metal tiers include; catastrophic, expanded bronze, silver and gold.
These tiers have varying monthly premium costs,out of pocket maxes, deductibles and even coverage limits.
Below is a breakdown of these tiers:
Catastrophic plans are the cheapest plans among all metal tiers. These plans have the least monthly premiums. However, they also have the highest out of pocket maximums and deductibles. These plans are not available to everyone, only people under the age of 30 and those with a hardship exemption are eligible for these plans.
- Expanded Bronze
Expanded Bronze is the next most affordable option for Maine residents that do not qualify for the Catastrophic plan. This plan is slightly more expensive than the catastrophic plan; the premiums are higher but have less out of pocket maxes. These plans cover up to 60% of your medical costs.
Silver plans are the perfect balance between the high premiums of the gold plans and the high out of pocket maxes of the catastrophic and expanded bronze plans. This tier covers up to 70% of your medical costs while you pay 30%. When shopping for health plans it’s best to start from the silver tier. You can also qualify for cost sharing reductions and premium tax credits which further reduces your premiums.
The gold plan or tier is the most expensive tier in Maine as it has the highest monthly premiums. However, it also has the least out of pocket maximums and deductibles. This plan covers up to 90% of your medical costs and expenses while you pay 10%. This is ideal for people who visit the doctor often, needing medical care and attention often and expecting high medical costs. This way you are able to hit your out of pocket limit and then your insurer takes over in paying your bills.
The following are the average rates for each metal tier in Maine are:
- Catastrophic: $250 per month
- Expanded Bronze: $391 per month
- Silver: $489 per month
- Gold: $550 per month
Most Affordable Health Insurance In Maine With High Out-of-Pocket Maxes
Younger residents in Maine may choose to purchase low-cost plans with high out-of-pocket maxes, especially if they’re in sound health and don’t visit the doctor often. However, bear in mind that although cheap health insurance plans in Maine can help you cut costs on monthly premiums, you’d pay more for any medical services you need.
The cheapest option in Maine is Anthem Catastrophic X HMO 8550 offered by Anthem Blue Cross and Blue Shield. The average rate of this plan for a 26-year-old is $174 per month.
Most Affordable Health Insurance In Maine With Low Out-of-Pocket Maximums
If you expect to have high medical costs, purchasing plans with high premiums and low out of pocket maxes might be ideal for you. Although you’d be paying more monthly, it’s cost effective. And while you continue to see the doctor, you’d hit your out of pocket limit early then your insurance companies will begin to pay for the health care services you need.
The cheapest option for a low out-of-pocket max plan is Maine’s Choice Plus HMO Gold 1200 from Harvard Pilgrim Health Care. This plan costs $498 per month on average for a 40 year old.
Most Affordable Health Insurance In Maine By County
Your place of residence in Maine affects the cost of your health insurance. Maine has 16 counties and is divided into four rating areas. The rating areas calculate health insurance premiums differently.
Cumberland is the most populous county in the state. The most affordable health insurance plan is Maine’s Choice Plus HMO Silver 6500 at $392 per month. This plan is provided by Harvard Pilgrim Health Care.
Most Affordable HMO/PPO/POS Health Insurance Plan In Maine
When looking for a plan, it is important to consider your healthcare needs and preferences. There are three types of plans having varying network coverage and policies.They include Health Maintenance Organisation(HMO), Preferred Provider Organisation (PPO) and Point of Service(POS) plans.
The HMO plans are the cheapest and most common plan type available in Maine. Purchasing this plan would require you to be within your network coverage and to be able to see a specialist, you would need a referral.
PPO policies on the other hand, are more expensive than the HMO plans but they have a broader network of providers. This plan gives policyholders in and out network coverage.
POS plans are a hybrid of HMO and PPO plans and they are more expensive.
The cheapest plans in Maine for each type are:
- Cheapest HMO Silver Plan: Maine’s Choice Plus HMO Silver 6500 provided by Harvard Pilgrim Health Care at $414 per month, on average.
- Cheapest PPO Silver Plan: Community Preferred from Community Health Options at a monthly average cost of $491.
- Cheapest POS Silver Plan: Anthem Silver X POS 5900 provided by Anthem Blue Cross and Blue Shield costs an average of $517 per month.