Maine Health Insurance

The cost of health care is a very real concern for residents of Maine. The state has the oldest population in the U.S., with a median age of 42.7 years, and, perhaps surprisingly, an alarmingly high rate of cancer diagnoses. Such statistics impact the costs of medical care and in turn the premiums you pay for health care coverage.

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Stats in Your State

We've gathered some health-related state statistics to help Maine residents compare health insurance plans and understand the options for health care coverage. The charts below compare Maine's single and family health insurance premiums to the premiums in other nearby states, as well as the national average. They also look at Maine's CHIP and Medicaid enrollment numbers and the number of Mainers who are uninsured.

Chip Medicaid reports that in 2009, 139,994 children in Maine were enrolled in Medicaid and that in 2010, that number increased to 142,931. The same source also reports that in 2009, 31,349 children in Maine were enrolled in the Children Health Insurance Program (CHIP). In 2010, that number increased to 32,994.

Individual Health Insurance Premiums

The Kaiser Family Foundation reports that the average single premium for employer-based health insurance in Maine in 2011 was $1,113, not including employer contributions. This amount is just above the national average, but lower than employee premiums in surrounding states, including Connecticut, Massachusetts, New Hampshire, Rhode Island, and Vermont.

Family Health Insurance Premiums

The Kaiser Family Foundation reports that the average family premium for employer-based health insurance in Maine in 2011 was $4,534. This dollar amount does not include employer contributions and is higher than the national average of $3,962. It is also well above the premium amounts paid for family coverage in Massachusetts, Connecticut, and Rhode Island.

SAHIE Health Insurance Uninsured

The Small Area Health Insurance Estimates (SAHIE) program of the U.S. Census Bureau releases estimates of specific demographics and income groups, both insured and uninsured, for each U.S. state. The most recent 2010 figures show that 132,154 Maine residents under the age of 65 didn’t have health insurance – a significantly higher total than the 119,750 uninsured residents back in 2007. Over the coming years, however, the Affordable Care Act may help decrease the number of Mainers without health insurance.

Rules in Your State

The Patient Protection and Affordable Care Act (PPACA) will impact health care coverage, including existing mandate laws (or "mandated health insurance benefits"), in all 50 U.S. states. Maine’s Bureau of Insurance provides information about current and upcoming changes to health care coverage as a result of the PPACA.

According to the Bureau of Insurance:

  • In Maine, you cannot be denied insurance, or charged more, because of a pre-existing condition.
  • New insurance policies must cover pre-existing conditions to the same extent as previous coverage, so long as the break in coverage doesn’t exceed a number of days specified by law. (Contact the Bureau of Insurance’s Consumer Health Care Division for more details.)
  • You have the right to see in writing the reason for a denial of a claim, know who made the decisions regarding your claim, and appeal any decisions made by your insurance company.

Alcohol & Your Health Insurance in Maine

Many people are not aware of how alcohol consumption can impact your coverage or that your insurance may pay for alcoholism treatment programs.

Losses Due to Intoxication:: The Uniform Accident and Sickness Policy Provision Law (UPPL) states that insurers “shall not be liable for any loss sustained or contracted in consequence of the insured’s being intoxicated or under the influence of any narcotic unless administered on the advice of a physician.” In the state of Maine, this law permits insurers to deny benefits for any insured person who has sustained an injury due to intoxication.

Health Insurance Parity for Alcohol-Related Treatment: The Federal government has passed legislation requiring that health care co-pays for mental health treatment be subject to “parity,” meaning they be no more expensive than co-pays for other types of healthcare. Maine is one of many U.S. states that require insurers to offer health insurance parity for alcohol-related treatment.

Representatives & Resources in Your State

Whether you are shopping for insurance, need information about your rights as a patient and consumer, or need to file a complaint against your provider, there are several resources and state representatives, accessible by phone or online, that are available for your needs.

Maine Bureau of Insurance
76 Northern Avenue
Gardiner, Maine 04345
Get Directions
Toll Free: (800) 300-5000 (In Maine)
Long Distance: (207) 624-8475
Fax: (207) 624-8599

Maine Health Insurance Consumer Assistance Program (MHICAP)
(Formerly Consumers for Affordable Health Care)
PO Box 2490
Augusta, ME 04338-2490
Toll Free: (800) 965-7476

Department of Health and Human Services
221 State Street
Augusta, ME 04333
Get Directions
Phone: 207-287-3707
Fax: 207-287-3005