Private Insurance

The private health insurance market continues to change dramatically in Maine. While health insurance is available to those who can afford to buy it, the price for good coverage is out of reach for many Mainers. Most health care experts and policy makers now agree that action is needed to reverse these alarming trends. However, most Mainers are still faced with the choice between expensive private insurance that they can use, less expensive private insurance that doesn't cover what they need, or being uninsured. What you'll find on this page: Buying insurance outside of a workplace Buying group health insurance How to choose the right plan for you	...	Online Health Care Guide Helpful programs for the following groups of people: Kids and Parents Pregnant Women Young Adults Disabled or Elderly Adults Other Adults Other helpful programs for many groups of people: COBRA Dental DirigoChoice Hospital Programs Mental Health Prescription Drug Programs Private Insurance Substance Abuse Other Resources Getting Quality Health Care

Buying insurance outside of a workplace
Insurance policies offered outside of a workplace are called "individual" or "non-group" plans. These plans are available to anyone under 65 that can afford them. Both HMO and Indemnity plans are available in Maine.

Indemnity plans allow you to choose any health care provider you wish and will not interfere with medical decisions made by you and your doctor. However, all indemnity plans have a deductible-a certain amount that you are required to pay out-of-pocket before your insurance will begin paying for services. Deductibles usually range from $250 to as much as $15,000 per year per person. Indemnity plans may also require you to pay a "coinsurance" percentage of any bills you incur after reaching the deductible amount. Monthly premiums for indemnity plans for a single person range from about $150 for a plan with an extremely high deductible to about $950 for a plan with a low deductible. Adding family members to the plan will increase your monthly premiums significantly.

HMO plans generally cover more services and have much lower out-of-pocket costs than indemnity plans. However, HMO plans also limit your choice of doctors and can refuse to pay for a service if they decide it is unnecessary. A comprehensive HMO policy that includes prescription drugs is very expensive. For a single individual, monthly premiums can range from about $950 to over $1400. Adding other family members to a plan will raise the price significantly-often to well over $2,000 a month.

For more information on prices, coverage, and companies offering plans in Maine, click here for a guide from the Maine Bureau of Insurance.

Buying group health insurance
Information on insurance for small businesses, large businesses, and COBRA

Small business plans
Small business plans are available to small businesses with 2 to 50 employees who meet certain requirements. They tend to be less expensive than "individual" plans, although prices are quickly rising. However, small groups can enroll in a new program called DirigoChoice. You can get more information about Small Group Coverage from the Maine Bureau of Insurance at 1-800-300-5000.

Large group coverage
Large group coverage is available to employers that have 50 or more workers. It is generally the most affordable coverage for workers, although costs are quickly rising. Many companies with large group plans are "self-insured" which means they assume the risk and pay claims themselves. You can get more information from the Maine Bureau of Insurance at 1-800-300-5000.

COBRA
If you had health insurance through an employer with more than 20 employees, you may be eligible for a COBRA plan. This program guarantees continued insurance coverage after your employment ends. COBRA lasts at least 18 months, and in some instances for three years. Your employer is required to notify you if you are eligible, and you have two months to decide whether to participate. In COBRA, you are responsible for the full cost of the insurance, which could cost anywhere from a few hundred dollars to over $1,000 a month, depending on the type of coverage and number of family members covered. You can get more information from the Maine Bureau of Insurance at 1-800-300-5000.

How to choose the right plan for you
Not all plans are alike, and it can be confusing to decide which one is best for you, your family or your employees. We have identified some of the main aspects of health coverage. Using this worksheet to compare each plan will allow you to be sure you get what you need for the best overall price, including all costs, not just the monthly premium.