It’s never been more important to have health insurance. Help is here to keep you covered.

It’s never been more important to have health insurance. Help is here to keep you covered.

Many Mainers are losing income or the health coverage they’ve had through a job due to the COVID-19 pandemic. If you’re in that situation, or even if you’ve never had coverage, you’re not alone, and the State of Maine is here to help. Explore your options today to make sure you and your family can see your provider when you need to, afford your medications, and access other needed health care.

Need help? Call (800) 965-7476
for free, local help from Consumers for Affordable Health Care.

MaineCare: Free or Low-Cost Coverage for Mainers

If you qualify for MaineCare, it is your best option. And if you’ve lost all or most of your regular income due to the pandemic, even if only temporarily, you probably qualify. Don’t hesitate to apply. MaineCare is here for the people of Maine when they need it.

Do I qualify for MaineCare?

Mainers are eligible for MaineCare coverage if they meet certain requirements, including having a household income below certain limits. Different income limits apply to people with different circumstances, and depending on your situation, some people in your household may qualify but not others.

Maximum Monthly Household Income

Household SizeAdults
Ages 21-64
Young Adults
Ages 19-20
Children
Ages 1-18
Infants
Under age 1
Pregnant Women
Include expected babies in household size
1$1,468$1,712$1,723$2,085-
2$1,983$2,314$2,328$2,816$3,075
3$2,498$2,915$2,933$3,548$3,874
4$3,013$3,516$3,537$4,280$4,673
Each additional person+$516+$602+$605+$732+$796

Scroll/swipe sideways to view the full table if necessary

What counts as monthly income for MaineCare?

Do includeCurrent income earned by you, your spouse, and anyone else counted in your household
Do includeSeverance benefits (in the month received)
Do includeBase unemployment benefits
Do not includeSupplemental $600/week
unemployment benefits from CARES act
Do not includeTax rebates, including the recent $1,200/
person stimulus payment
Do not includeExpected future earnings
Do not includeSNAP benefits

People with disabilities and those with certain health conditions can qualify for MaineCare even at higher household income levels. You can find more detailed income limits in this 2020 summary of eligibility guidelines. Not sure if you or your family qualifies? Call (800) 965-7476 for free, local help from Consumers for Affordable Health Care.

What services does MaineCare cover?

MaineCare covers essential health care needs. This includes: visits to your doctor, prescription drugs, treatment for mental health needs and substance abuse disorder, surgery, emergency care, and more. Learn more about what’s covered in the MaineCare Member Handbook.

For applicants age 55 or older

If you are 55 or older, you may have heard that signing up for MaineCare could put your home or savings at risk if you need long term services and supports like nursing home care. Although in some cases federal law does require Maine to try to recover costs of care from a beneficiary’s estate, the State only pursues this option in certain circumstances and has policies in place to protect family members and individuals experiencing hardship. Learn more about estate recovery.

For applicants who are immigrants

As of February 24, 2020, the federal government has changed the rules they use to decide whether some people applying for green cards and certain visas are likely to depend on government resources in the United States. These new “public charge” rules mean that, in some specific cases, enrolling in MaineCare might make it more difficult to have an immigration application approved.

It is important that anyone who might be impacted understand when these rules do – and do not – apply. The new rules only impact people applying for family-based green cards and certain visas, and do not apply to refugees, asylees, asylum seekers, and people with other humanitarian statuses. Only the applicant individual’s use of benefits is considered under this rule, and it does not apply to enrollment in benefit programs by their family members. The organization Protecting Immigrant Families has a guide with more information if you’re wondering who is impacted by this change.

In April 2020, the federal government announced that testing, treatment, and preventive care (including a vaccine if one becomes available) for COVID-19 will not be considered in the public charge test. These services will have no negative impact, even if such treatment is provided or paid for by MaineCare. Learn more on the U.S. Customs and Immigration Control website. The information provided here is not intended as legal advice.

If you aren’t, or a person you are helping to apply for MaineCare is not, a citizen or lawful permanent resident of the United States and you have questions about this rule change, contact Consumers for Affordable Health Care at 1-800-965-7476.

HealthCare.gov: Marketplace Health Insurance

Even if your income is still too high to qualify for MaineCare, you may be able to receive financial help to purchase a quality plan through the federal health insurance Marketplace at HealthCare.gov.

Am I eligible to apply for Marketplace insurance?

Although the annual open enrollment period has ended, you can still shop for a plan if you have experienced a “qualifying life event,” including losing health coverage through an employer or a family member’s employer. You have 60 days from when you lose job-based coverage to apply for a plan through the Marketplace, so don’t wait. Coverage starts on the first day of the month after you pick a plan.

What if I can’t afford my premium?

The federal government provides financial assistance to make plans more affordable for some people. This assistance is calculated based on estimated income for the full year. If you already have a plan purchased through the Marketplace and now expect to earn less in 2020 than you estimated when you signed up, make sure to update your income with HealthCare.gov — you may qualify for more help to make your premiums affordable.

If you already have marketplace insurance, have updated your income on HealthCare.gov, and are still having trouble affording your premium, you should reach out to your health insurance company immediately to discuss your options.

The State of Maine has ordered insurance providers to offer members flexibility on premium due dates, and has banned any plan terminations for nonpayment until at least June 1, 2020. More detail can be found in the order from the Superintendent of the Bureau of Insurance.

What counts as annual income for HealthCare.gov?

Do includeCurrent income earned by you, your spouse, and anyone else counted in your household
Do includeExpected future earnings
Do includeSeverance benefits
Do includeUnemployment benefits, including the $600 supplemental benefit from the CARES act
Do not includeTax rebates, including the recent $1,200/
person stimulus payment
Do not includeSNAP benefits

COBRA: Keep Your Employer-Provided Insurance

If you are losing a job that provided you with insurance, you may be able to keep your same insurance plan by paying the full premium, usually including any portion your employer previously paid.

Learn more about COBRA

Businesses with 20 or more employees are required to offer temporary continuation of health care benefits to employees losing coverage because of layoffs or closure. Employees who choose to extend their health plan are responsible for paying the full premium of the plan, so it is worth checking whether you qualify for MaineCare or a less expensive plan through the Marketplace before choosing COBRA coverage. You can learn more about COBRA from the U.S. Department of Labor.

People in Maine who are temporarily laid off by a business with less than 20 employees may still qualify for limited continuation coverage under Maine law. You can learn more about this option, known as “mini-COBRA” from the Maine Bureau of Insurance.

COVID-19 Resources for the Uninsured

If you have checked your eligibility for coverage and don’t qualify for an affordable option, there are special programs available to cover testing for COVID-19, and in some cases treatment.

COVID-19 testing for the uninsured

U.S. citizens, U.S. nationals, and eligible immigrants who are uninsured and earn too much to qualify for full MaineCare coverage can be tested for free through MaineCare’s COVID-19 Testing Coverage for Uninsured Individuals program. More information and a link to apply are included in this summary of the program.

Emergency MaineCare

People who meet income guidelines for MaineCare but are not eligible due to their immigration status can qualify for limited coverage in emergency circumstances, including if they need testing or treatment for COVID-19. Learn more in this guidance document.

Why get covered?

Listen to why these real Maine people are glad they signed up for their health plans:

“I have emphysema, and it was tough paying for my oxygen without health insurance. I’m ecstatic to be covered—and to get the word out to others. I can breathe again!”

“Like most home health aides, I’m not covered through my job. When I needed surgery after my car accident, I realized how important health insurance is. I got excellent help signing up, close to home.”

“I lost my health insurance because of a job change. It was a relief to find out I had options. With a genetic risk for breast cancer, I need to be tested often. I’m so grateful to be covered.”