Maine Advances Toward State-Based Marketplace to Improve Access to Affordable Health Care

August 3, 2021

The Maine Department of Health and Human Services (DHHS) is on track and on budget to launch a State-based Health Insurance Marketplace (SBM) as planned on November 1, 2021, which will connect more Mainers to affordable health care and make it easier and more convenient to shop for health insurance coverage.

The Department’s progress reflects Governor Mills’ commitment to pursue a State-based Marketplace to allow Maine to capture funding currently going to Washington, D.C. and use those dollars to promote enrollment and customize outreach to fit Maine’s needs.

DHHS took the first step in the transition to an SBM during the 2021 Open Enrollment Period (from November 1, 2020 to December 15, 2020), by launching a hybrid Federal-State Marketplace, following Maine’s use of a fully Federal system since 2014. Maine has since continued its progress toward a fully state-run Marketplace and anticipates receiving Federal approval in the coming weeks.

Individuals and families will be able to use the Marketplace to check out health plan options, shop, and enroll in private insurance, with most people qualifying for Federal financial assistance to make premiums more affordable.

The hybrid Federal-State Marketplace system for the 2021 plan year allowed the State to assume greater responsibility for some Marketplace functions, such as marketing, outreach, and consumer assistance, while continuing to use the Federal platform to process applications, determine eligibility, and enroll participants. DHHS created and implemented targeted marketing and strategic community partnerships with the aim of increasing health insurance enrollment for Maine residents. These efforts included an outreach campaign via digital advertising, television, and radio to promote awareness of affordable health insurance options. DHHS also administered the Navigator grant program that provides funding to community organizations to reach and assist Maine residents in enrolling in health coverage. For the 2021 plan year, Maine awarded $200,000 in grant funding, more than doubling the amount of assistance provided by Navigator grantees.

This successful transition set Maine up to proceed to a fully state-run Marketplace for the 2022 plan year. DHHS is creating a new Office of the Health Insurance Marketplace (OHIM) to operate it. Maine will have more tools to improve consumer experience, including providing a longer annual open enrollment period, developing more user-friendly tools for plan comparison, the flexibility to design state-specific policies to encourage enrollment, and more closely coordinating with MaineCare to ensure that individuals and families are enrolled in the coverage that works best for them.

To prepare for the transition, OHIM has contracted with vendors to develop key technology and operational capabilities. IdeaCrew, a technology company that has supported other SBMs, is providing the state with a Marketplace technology platform which will allow consumers to apply for and enroll in coverage online. OHIM has also partnered with Maximus to provide a Consumer Assistance Center to take calls from consumers with questions or other needs as they apply for coverage.

OHIM has also worked with health insurance carriers, insurance brokers, consumer representatives and Assisters, and other stakeholders to prepare for the transition, with a focus on developing a Marketplace that will better serve key communities throughout Maine.

The ongoing operation of Maine’s SBM is funded by a user fee charged to health insurance companies that use the platform to sell their plans.

Currently, 15 other states run an SBM, including all other New England states except New Hampshire. Following the federal approval, OHIM will begin intensive outreach about the transition. This will include sharing training and certification requirements with brokers, navigators, and assisters. This fall, OHIM plans to launch a campaign to raise awareness of the transition and Maine consumers’ options for coverage through the SBM. In mid-October, Maine residents will be able to see the plan options for 2022 so they can begin thinking about their options.

COVID-19, the Special Enrollment Period, and Enhanced Subsidies

The COVID-19 pandemic exposed the critical need for expanded access to affordable health coverage. In response, the Biden Administration has not only implemented an additional Special Enrollment Period this year, but is also providing enhanced financial assistance. At the start of 2021, 59,738 people were enrolled through Maine’s Marketplace; 7,478 more people signed up during this special enrollment period from February to June.

Now, and until August 15, all Mainers can newly apply or reapply for coverage through to see if they are eligible for a lower cost plan, or improved coverage for a lower price. According to Federal data, average savings due to increased subsides are $50 per month for individuals and $85 per month for families. Mainers who have received enhanced unemployment benefits at any time in 2021 are also eligible for additional financial assistance to lower both premiums and out-of-pocket costs.

Maine people who aren’t sure what coverage they qualify for can visit or call Consumers for Affordable Health Care at 1-800-965-7476 to learn more about affordable options through both MaineCare and Eligible Maine people may enroll in MaineCare at any time of year.