Why is it important to get covered?
No one plans to get sick or hurt, but it happens. Health insurance from CoverME.gov protects you and your family members from the unexpected. All plans at CoverME.gov cover many preventive services with no co-pay. All plans at CoverME.gov also cover guaranteed essential benefits such as prescription drugs, maternity care, doctor visits, and more.
No one can be denied coverage because of a pre-existing condition like high blood pressure or asthma. With health insurance, insured Mainers won't be forced to put off a check-up or worry about going broke if they get sick.
What is CoverME.gov?
CoverME.gov is Maine’s official health insurance marketplace where you can shop for and buy health insurance coverage. This is the only place where Mainers can apply for financial help that can lower your monthly premium and out-of-pocket costs.
Why is my coverage switching from HealthCare.gov to CoverME.gov?
The Made for Maine Health Coverage Act, which was passed by the Maine Legislature in 2020, authorized the creation of a State-run Marketplace, CoverME.gov. This transition allows Maine to tailor the Marketplace shopping experience for Mainers, and to target outreach efforts to enroll even more residents in affordable coverage. All plans sold on CoverME.gov are Qualified Health Plans that provide comprehensive coverage.
Will my insurance plan change?
Your insurance plan will not change in 2021.
For 2022, all health plan members that were enrolled in 2021 coverage through HealthCare.gov and who elected to be auto-renewed have been automatically enrolled in the same plan (or most similar available plan) on CoverME.gov.
Even so, you should update your information on CoverME.gov, as you may be eligible for additional financial help to lower the cost of your plan.
When can I enroll in coverage?
Open Enrollment began November 1st, 2021 and ended on January 15th, 2022. You may still be eligible to enroll if you have experienced a qualifying life event -- like losing the insurance you get through your job, getting married or divorced, or having a baby. These events would qualify you for a Special Enrollment Period, which means you may be eligible to enroll in a plan outside of the annual Open Enrollment period.
Can I add or change plans outside of Open Enrollment? What is Special Enrollment?
If you’ve recently experienced certain life changes, you may be eligible for a Special Enrollment Period which will allow you to enroll in coverage outside of the Open Enrollment Period. These changes can include a change of job, marriage, divorce, pregnancy, or having a baby.
Who can use CoverME.gov?
CoverME.gov is available to anyone seeking more information about health insurance options throughout the state. Individuals who may want to consider health coverage through CoverME.gov include:
- People who are uninsured and do not have access to affordable health insurance through their job
- People who buy their own health insurance such as self-employed, seasonal, or gig workers
- People who work part-time and do not qualify for their employer’s benefits
What types of plans are offered through CoverME.gov?
CoverME.gov offers individual Marketplace plans, which are comprehensive health insurance plans that protect you from financial risk if you get sick or need care. These plans cover a core set of essential health benefits, including many preventive services at no out of pocket cost to you. Marketplace plans on CoverME.gov cannot turn you away or charge you more for having a pre-existing condition.
How do I know if I qualify for financial help?
There is financial help available to most people who shop for Marketplace plans on CoverME.gov. Depending on your income and family size, you may be eligible for financial assistance to help you afford your monthly premium and out-of-pocket costs.
CoverME.gov can also help you determine if you may be eligible for low-cost or no-cost coverage through MaineCare or Cub Care.
To see an estimate of the financial assistance you may qualify for, you can answer a few simple questions in our Plan Compare tool.
Open Enrollment for 2022 ended on January 15. You can still apply at CoverME.gov to receive a determination of your eligibility, but will only be able to enroll in a plan if you qualify for a Special Enrollment Period (SEP) or if you are eligible for MaineCare or Cub Care.
How do I calculate my income?
CoverME.gov, MaineCare, and Cub Care all use your Modified Adjusted Gross Income (MAGI) to determine your eligibility for coverage and financial help. MAGI is your adjusted gross income PLUS any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.
- For many people, MAGI is identical or very close to adjusted gross income.
- MAGI doesn’t include Supplemental Security Income (SSI).
- MAGI does not appear as a line on your tax return.
The CoverME.gov application will ask questions to calculate your MAGI. If you have questions, you can call our Consumer Assistance Center or get free help from a trained and certified Broker or Maine Enrollment Assister.
What information do I need to enroll through CoverME.gov?
You will need this information for yourself and anyone in your household applying for coverage:
- Home and/or mailing addresses
- Birth dates
- Social Security numbers
- Document information for legal immigrants, if applicable
- Employer and income information for every member of your household (for example, pay stubs or W-2 forms)
- Your best estimate of what your household income will be in 2022
- Policy numbers for any current health plans covering members of your household
Who do I have to include on my application?
You need to include everyone in your tax household, even if they do not file taxes or are not looking for health care coverage. This includes your spouse, if you have one, and anyone you plan to claim as a dependent in the year you’re applying for coverage. Everyone does not have to live at the same address to apply on the same application. Your income and family size help us decide which programs you qualify for.
Follow these basic rules when including members of your household:
- Include your spouse if you’re legally married
- If you plan to claim someone as a tax dependent for the year you want coverage, do include them on your application
- If you won’t claim them as a tax dependent, don’t include them
- Include your spouse and tax dependents even if they don’t need coverage
Learn more about who to include in your household here.
Why do I have to submit documents for verification after submitting my application?
If you receive a list of items that require verification after submitting your application, it means that information you entered may not match information we have in our records. If it looks like you are eligible for enrollment in a private health plan through CoverME.gov (with or without financial assistance), then you will be conditionally eligible for 90 days. During this time, you can sign up for a plan and begin receiving financial assistance. It is important that you submit documents within this time frame. Otherwise, your eligibility will be redetermined based on our data sources and you may lose coverage or have your financial assistance reduced. The notice you receive from CoverME.gov will contain detailed instructions for submitting documentation.
Broker & Assister FAQs
Who can help me fill out an application on CoverME.gov?
Both Maine Enrollment Assisters (MEAs) and Agents/Brokers can help you enroll in health insurance, at no cost to you.
You can also call the Consumer Assistance Center at (866) 636-0355 for live, free assistance with your application. TTY users should call 711. Assistance is available in many languages.
What is the difference between an Agent/Broker and a Maine Enrollment Assister?
Maine Enrollment Assisters provide unbiased information and help you apply for either MaineCare or a Marketplace plan, but they won’t endorse a specific plan choice for you. Agents/brokers can help you find a plan that fits your needs, and most can provide a referral if you need help applying for MaineCare. Brokers may be paid directly by insurance companies.
Both the use of brokers and assisters come at no cost to our consumers, and the use of one over another will NOT impact the cost of your health plan.
How do I search for a Broker or a Maine Enrollment Assister?
You can search for a Broker or Maine Enrollment Assister by using our Find Local Help Tool. Using this tool, you will be able to search for assistance based on your location and the type of help you’re looking for.
Native American/American Indian FAQs on Specific Benefits:
What are the special provisions for Native Americans?
What are the special provisions for Native Americans?
Health Coverage for American Indians and Alaska Natives:
- Tribal members with household income between 100% and 300% of the Federal Poverty Level (FPL) can enroll in a zero cost-sharing plan. This means no deductibles, copayments, or other out-of-pocket costs.
- Regardless of income or eligibility for premium tax credits, tribal members can enroll in a limited cost-sharing plan. This means no deductibles, copayments, or out-of-pocket costs when accessing health services from an Indian Health Service Provider.
- There are special provisions for the calculation of Modified Adjusted Gross Income for Native Americans, meaning that some revenue earned on reservations and from Federal Trust payments are exempt.
- Native Americans qualify for a Special Enrollment Period which allows them to enroll in coverage at any time of year, not just during the Open Enrollment Period.
- Your CoverME.gov eligibility results will also explain that members of Federally Recognized Tribes and ANCSA shareholders can change plans up to once a month.
What is a limited cost-sharing plan?
Limited cost-sharing plans are available to members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders regardless of income or eligibility for premium tax credits. People enrolled in this type of plan:
- Don’t pay co-payments, deductibles, or coinsurance when getting care through an Indian Health Service Provider
- Do need a referral from an Indian Health Service Provider when getting essential health benefits through a Marketplace plan to avoid paying co-payments, deductibles, or co-insurance
- Can get limited cost-sharing with a plan at any metal level on the Marketplace
- Don't need to have their income verified in order to enroll
Why do I need health insurance coverage if I get services from the Indian Health Service, a tribal program, or an urban Indian health program?
By enrolling in health coverage through the Marketplace, MaineCare (Medicaid), or Cub Care (CHIP), you have better access to services that the Indian Health Service, tribal programs, or urban Indian programs (known as I/T/Us) may not provide.
If you enroll in a Marketplace health plan, MaineCare, or Cub Care, you can keep getting services from your I/T/U the same way you do now. When you get services from an I/T/U, the I/T/U can bill your insurance program. This benefits the tribal community, allowing I/T/Us to provide more services to others.
What American Indian and Alaska Native income do I include on my application?
The Marketplace application asks you to provide income information that’s reportable on your federal income tax return. In general, you won’t report American Indian or Alaska Native (AI/AN) income that the IRS exempts from tax (income from treaty fishing rights, for example).
The Marketplace application will ask you to report income from various sources and will determine your eligibility for Marketplace insurance plans, MaineCare, and Cub Care.
Most AI/AN trust income and resources aren’t counted when determining eligibility for these programs. But per capita income derived from gaming is taxable and therefore counted for these programs.
Will I need my tribal documents when applying for coverage?
The special monthly enrollment periods and cost-sharing reductions apply only to members of a federally recognized tribe or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders. When applying through the Marketplace, you’ll need to provide documentation that you’re a member of a federally recognized tribe or an ANCSA shareholder.
- A document issued by a federally recognized tribe indicating tribal membership
- 2 A document issued by an Alaska Native village/tribe, or an ANCSA Corporation (regional or village) indicating shareholder status