Mainers have less than a month to sign up for Affordable Care Act coverage through the state’s own shopping portal, a tool being used for the first time this year.
CoverME.gov was passed by lawmakers last year with the goal of helping Mainers find affordable plans that are tailored to their specific needs. Maine is the 15th state to launch its own marketplace.
Enrollment opened at the beginning of November and ends on Jan. 15, although special enrollment periods will be available if eligible people miss signing up. To help Mainers understand how the portal works, the Bangor Daily News asked readers what questions they have about the marketplace and put them to experts during a Monday forum.
Here are the answers to some of their questions.
Can I enroll in the marketplace if my employer offers insurance?
Yes, but there are things to consider. A person is only eligible for the benefits that come with a marketplace plan if an employer’s plan is not considered affordable. That threshold is set at 9.6 percent of household income for self-only coverage. It also has to cover at least 60 percent of covered medical costs.
You cannot get tax credits or other marketplace savings if your employer offers insurance, even if you would qualify for those based on income otherwise. You will also have to fully cover the cost of the premiums yourself, as an employer usually contributes a portion of monthly costs.
Can I compare plans as I am shopping?
Yes. The state has a compare-plans function that will allow you to search by first entering in some demographic information, said Patty Lovell, a health care navigator for Western Maine Community Action. You can check for financial assistance through a tax credit that can lower monthly premiums or deductibles, as well as whether your provider accepts the insurance.
From there, you can compare monthly premiums, deductibles and out of pocket cost limits from providers. The tool also estimates how much a plan might cost depending on how much health care you might need in an average year based on your age, a year with no major incidents and a year with a hospital stay. It will also give you information on copays for certain services.
Is emergency care coverage the same across the country?
Emergency visits and urgent care should be covered no matter where you are by all marketplace carriers, said Kate Ende, policy director with Consumers for Affordable Health Care. But it can get complicated depending on the circumstances.
For example, if you are hospitalized and have an opportunity to make it back into your network after you become stabilized — but do not — that could affect your coverage, she said.
I found out through the website that I qualify for Medicaid, but I’ve heard I can lose my house after I die. Is that true?
Estate recovery is a concern for older adults who worry family members will lose access to property or liquid assets after they die. States are required to try to recoup the costs of care provided through Medicaid in order to receive federal dollars for the program. It is known to discourage people from signing up for coverage.
But there are exceptions, Ende said, including if they have children under the age of 21, if they have a living spouse or have children with disabilities of any age, that can delay recovery. Lawmakers changed state law this year through the two-year budget to allow Maine to only recover Medicaid costs that went to long-term care services, such as nursing homes, the minimum required under federal law.
Correction: An earlier version of this story gave the wrong end date for this year’s open enrollment period. It ends on Jan. 15, 2022.