Frequently Asked Questions

General FAQs

I received a letter from my insurance company with an estimate of my costs for 2025. Why is it more than I paid in 2024?

The letter you received from your health insurance company may include both an estimated monthly payment amount and an estimated monthly premium amount. The monthly premium amount may be more than you expected because it reflects the cost of your plan without any financial assistance for which you may qualify. The estimated monthly payment amount is that premium amount reduced by the amount the financial assistance you qualified for in 2024. This is the amount that your insurance company estimates you'll pay, but it may not be equal to what you will actually pay in 2025. 

How can I find out how much my actual monthly payment will be in 2025?

We will be sending notices to members to let them know if they qualify for financial savings in 2025 beginning October 21. Consumers with incomplete applications will be contacted to finalize their applications. Then, we will be notifying members about their 2025 monthly payments starting November 1. If you would like to get an estimate of what you will actually pay in 2025, as well as review alternate options for plans available to you, you can use our Plan Compare Tool beginning October 15. You can compare plans and find providers under the "shop" dropdown. If you need help reviewing alternate options, you may contact Consumers for Affordable Health Care at 1-800-965-7476 or find a free, local Broker or Maine Enrollment Assister

Do I need to do anything to get financial savings?

If you are a new consumer, you need to include your estimate income for 2025 on your application to see what you may receive in financial savings (also known as Advance Premium Tax Credit or APTC). If you are a current CoverME.gov member and your information has not changed since last year, then you do not need to do anything. If your information has changed, you should review your most recent determined application so we can accurately determine your eligibility for savings in 2025. Some of the most common reasons why APTC is not automatically renewing are:

  • You filled in an end date for your 2024 income on your application, so we don't have information about your 2025 income,
  • You have been determined eligible or potentially eligible for MaineCare,
  • Your consent for CoverME.gov to verify your information with the IRS has expired, or
  • You have missing or incomplete information on your last determined application.

We also encourage you to make sure that both your application and My Household have the same people marked as requesting coverage. Sign in to your account to review your information. 

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 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.

When can I enroll in coverage?

Open enrollment begins November 1, 2024. You may still be eligible to enroll in coverage or change your current coverage outside of the annual Open Enrollment period 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 losing insurance you get through a 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 assistance?

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.

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 begins November 1. Outside of Open Enrollment you can 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.

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 for the year
  • 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:

Learn more about who to include in your household here.

  • 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
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.

What should I do if my income or household size changes after I enroll?

If your income or household size has changed, you should update your application as soon as possible. These changes may affect the coverage or financial support you receive. For example:

  • If your income goes down or you gain a household member, you could qualify for more savings than you're currently getting to lower your monthly premiums. Or you could qualify for free or low-cost coverage through MaineCare.
  • If your income goes up or you lose a household member, you may qualify for less savings than you're getting now. If you don't report the change, you may have to pay back money when you file your federal tax return next year.

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 can 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.