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Maine Health Insurance

Maine Medical Insurance Overview

The state of Maine ranks high in terms of the overall health of its population, but its general health state shows that there is the potential for improvement.  The Patient Protection and Affordable Care Act will increase the amount of access to health insurance options, but also improvements to comprehensive policies nationwide.  While the health of the population of Maine is decent, there are many people in the state who are still uninsured.

In all of the states, the ACA has created restrictions for private health insurance companies with regard to their ability to deny enrollment to applicants.  Between now and 2020, we will see the gradual effects that the new health care law has created for consumers all over the nation.

Maine’s Health Care Issues
Maine is ranked in 15th place when compared to the other states in the country with regard to the health of its occupants.  While there are strong characteristics in the state of Maine’s residents, there are several areas that the state could stand to see some improvement in overall.

Among the state’s challenges are its high infant mortality rate, its high rate of pertussis and its major prevalence for excessive drinking among the population.  Its strengths include its high rate of immunizations among children, its low immunization rate for male adolescents for HPV and its low rate of violent crime.

Understanding Maine’s Uninsured Population
Maine’s percentage of uninsured people is at 9 percent overall.  A previous study revealed that the residents were mostly uninsured because of financial issues.  What was interesting was that even residents with some form of insurance coverage failed to attend doctor’s visits on a regular basis.  The uninsured portion of the state also didn’t take advantage of the free health care services that were provided by the state because of a lack of knowledge about the services or negligence overall.

Nine percent of people in Maine are uninsured as of 2014, with 47 percent covered under a group health plan by their employer.  In the state of Maine, many smaller companies don’t offer health insurance coverage to their employees.

See the below facts for more information on the uninsured population of Maine:

  • 9% of residents don’t have insurance coverage
  • Less than half of the companies in Maine offer group health benefits to works, compared to 51% of the companies nationwide
  • The vast majority of those without insurance in this state are adults with incomes of 139% of the Federal Poverty Level or under

Group Health Plans
In the state of Maine, the Department of Professional & Financial Regulation: Bureau of Insurance regulates HMOs and private health insurance companies.  There are regulations in place urge employers to offer health benefits, like making premiums paid by employers tax deductible, but it can be harder for smaller companies to offer insurance benefits.  It can prove to be quite expensive to enroll into a employer-sponsored health plan.  It is subsidized, but payments for premiums are automatically deducted from the employee’s paycheck.

Despite this information, it is more advantageous to seek coverage through your employer first.  You may be able to find affordable coverage through your workplace, but you should read over all of your options carefully.

Signing Up
Signing up for your employer’s group health benefits is an easy process and should be done during your employer’s open enrollment period.  For these specific dates that allow you to freely enroll or change your coverage, you should check with your HR department.  Prior to signing up for coverage under this plan type, consider all of the medical possibilities that you may face in the future.

Keep the following information in mind when considering joining a benefits plan through your workplace:

  • Find out all of your coverage options through the group health plan.  Some offer less coverage for higher deductibles and lower premiums and vice versa.  Consider your future medical needs before signing on the dotted line.
  • Dependent children under the age of 26 can remain covered under a parent’s insurance plan.
  • Self-employed persons can get group health insurance coverage through their spouse’s plan or by joining a trade organization that offers group benefits to its members.

Pre-Existing Condition Exclusion Periods
If you are plagued by a pre-existing condition, you will more than likely have to wait through an exclusion period before your insurance benefits become active.  The exclusion period in Maine can last no longer than 12 months with a look back period of six months for insurance companies to check if you have pre-existing conditions.

Some factors you should be aware of with regard to pre-existing condition exclusion periods are listed below:

  • Dependents 19 years of age and under are not subject to wait through an exclusion period under your group health plan.
  • You cannot be denied coverage for group benefits because of a pre-existing condition.
  • Genetic predispositions to disease and/or illnesses do not constitute pre-existing conditions in the absence of an official diagnosis by your doctor.

Affiliation or Waiting Periods
Affiliation periods apply after you complete the enrollment process and last two to three months depending on whether or not you enroll late.

Individual Health Plans
It can be hard to obtain coverage under an individual policy because of the freedoms allowed to insurance companies with regard to the underwriting they can do on these types of insurance plans.  According to the Foundation for Health Coverage Education, a healthy person in their twenties could obtain individual coverage for $57 per month, but the benefits would be very limited and the deductible would be quite high.

If you are self-employed, unemployed or working for a company that doesn’t offer insurance coverage, then you may have little other choice in the matter for getting benefits.

In the state of Maine, private insurance companies have a look back period of up to 12 months when checking through your history for a pre-existing condition.  Exclusion periods for those suffering from pre-existing conditions can be up to 12 months under this plan type.

Continuation Coverage
Continuation coverage is available under the COBRA program.  This coverage picks up where your group coverage left off and can last up to 18 months.  This is a great plan for individuals who have recently changed their job or marital status to continue coverage.  If your original group benefits package was with a company that employs over 20 workers, then you will be eligible for COBRA benefits.  The only downside to COBRA is that you will be responsible for the portion of premium payments that were previously covered by the company.  Once COBRA is exhausted, you can obtain continuation coverage through HIPAA.  A conversion plan is also available to trade out your group plan for an individual policy, but keep the same levels of coverage along with the original insurance provider.

Maine Health Benefit Exchange
Maine originally operated under the idea that they would allow the federal government to run their health benefits marketplace.  The state’s officials have since changed their mind and created the Maine Health Access Foundation of which consumers can get coverage options and compare plans.

Under the requirements of the Affordable Care Act, Maine’s benefits exchange was up and running by the year 2014.  These exchanges are created on the state level nationwide to provide many of the options for benefits to residents.

Maine State Insurance Programs
Maine has a variety of publicly available, state-funded insurance programs of which consumers can take advantage.  Thirty-eight percent of Maine’s population is covered by a state-sponsored program and there are plenty of programs of which you can use if you qualify based on factors discussed below.

Pre-Existing Condition Insurance Plan (PCIP)
The PCIP exists to provide medical services to people who have pre-existing conditions in the state of Maine.  Applicants who have had problems getting covered can use this program for medical services and are guaranteed coverage if they have lacked insurance for six months prior to approval.  To qualify, applicants need to provide proof that they have been denied coverage due to a pre-existing medical condition.

MaineCare
MaineCare offers coverage to people who earn low incomes and are medically needy in the state of Maine.  The program offers many benefits including nursing home care and in-home care and you may have to pay a portion of the premiums in order to receive benefits.

Dirigo Choice
This program was created to offer health insurance coverage to people without insurance, employees of small businesses who don’t offer health insurance coverage and people who are self-employed in the state of Maine.

Children with Special Health Needs
The mission of this program is to improve the quality of life of those children who have special needs with regard to their medical services.  In order to qualify, the medical condition, income of the parents and age requirements will be under scrutiny.

CubCare
Through CubCare, women and children can get medical services like immunizations, x-rays, therapy, case management, mental health treatment, substance abuse treatment and more.  Pregnant women are guaranteed coverage along with low income individuals who are under 19 and meet the specified income requirements.

Women, Infants, and Children (WIC)
The WIC program is available to women, infants and children who are in need of nutritional guidance, supplemental foods and resources on child safety.

Maine Breast & Cervical Health Program
Through this program, women can get early detection procedures for breast and cervical cancers.  Treatments are available to women who qualify based on age and income.

Medicare and the Medicare Prescription Drug Program
Medicare is available to disabled individuals, seniors and people suffering from end-stage renal disease.  If you or your spouse has worked in a Medicare-covered job and you qualify, you can get benefits under Medicare.  Qualifying seniors must be over the age of 65.

VA Medical Benefits Package
The VA package is a benefits program that is dedicated to military veterans who have completed 24 consecutive months of time served in any branch of the military.  Qualified veterans can get coverage as long as they have received an honorable discharge from the service.

Partnership for Prescription Assistance
The PPA is a program that is geared toward helping people find financial assistance to offset the costs of prescription drugs.

National Association of Mental Illness (NAMI) Helpline
Counseling, advice and resources are provided to those who suffer from mental illness through the aid of the NAMI Helpline.  Callers are connected to a network of volunteers who provide information on treatments and services available to the mentally ill.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA was designed to protect patient information in a medical setting from unauthorized use.  Now, with the Affordable Care Act in action, HIPAA has grown to regulate health insurance companies.  Under HIPAA, insurance providers cannot turn down enrollees into group health plans because of pre-existing conditions.  The law also limits the amount of time insurance companies can use for exclusionary periods.  It also covers continuation coverage under COBRA and an extension following the exhaustion of COBRA benefits.

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