Be careful what you buy!
Qualified health plans include the 10 essential health benefits required by the Affordable Care Act. You may be eligible for help paying your monthly health insurance premiums if you enroll in a qualified health plan. You can enroll in a qualified health plan at CoverME.gov, Maine's Health Insurance Marketplace.
10 Comprehensive Health Benefits the ACA requires include:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Examples of "non-insurance" health coverage plans include:
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Health Care Sharing Products
These arrangements are not a form of regulated health insurance. These are health care funding co-ops that are alternatives to traditional health insurance plans. Members make contributions that go into a pool that members may be able to draw from to help pay for certain medical care. Coverage is not guaranteed and there is little or no protection in most cases for pre-existing conditions. Health sharing products have no obligation to provide coverage for the 10 Essential Health Benefits required by the ACA. For example prescription drugs and certain hospital services may not be covered. They may be known as Health Ministry Plans or Farm Bureau Plans.
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Indemnity Health Plans
These types of plans are not intended to pay for medical care directly. These plans pay you directly when you have medical care. Indemnity plans pay consumers fixed amounts when they use health care services. For example, they may pay $30 each time you see your primary care physician, $100 per day for a hospital stay, or $150 for an emergency room visit. You pay the rest of the bill, and if you do not have major medical coverage covering the 10 Essential Health Benefits, that could be a lot of money.
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Short Term Plans
These plans typically cost less than full coverage plans available on the Marketplace but they typically provide less coverage. Maine allows the sale of short-term limited duration plans, but restricts the manner in which such plans are sold. To protect consumers from what are called “skimpy” plans, sellers must be clear about what is and what is not covered, must include coverage for pre-existing conditions, and cannot use deceptive sales practices. Due to these consumer protections, restrictions, many insurance companies are not selling their short-term limited duration plans in Maine.
