Your Right to Obtain Health Insurance in Maine

Health insurance is almost entirely regulated by the states, and the rules and regulations governing it vary widely from one state to another, permitting or disallowing barriers to access.  It is important to understand how health insurance functions in your state in order to evaluate what types of reform are needed, both on the state and federal level, to make quality, affordable health insurance available to everyone.
Your rights to obtain health insurance in Maine vary depending on whether you purchase insurance as an individual, under a group plan, or as a small business owner.

Getting health insurance as an individual in the open market

Every resident of Maine has the right to buy health insurance. You cannot be denied insurance or charged more because of your health status, age, gender, or occupation. However, you can be subject to a pre-existing condition exclusion period if you let your insurance lapse for 90 days or more. Insurers can count as pre-existing conditions those for which you received medical advice in the 12 months prior to the start of your policy. The amount of time you were covered under your previous insurer may be credited toward your pre-existing condition exclusion period if you have not had a break in coverage of 90 days or more.  This can cancel out or reduce the length of a pre-existing condition exclusion period. Coverage for pre-existing conditions can be excluded for a maximum of 6 months.

COBRA is a law that lets you keep the insurance you had through an employer or union for up to 18 months (sometimes longer) after you’ve left your job or become ineligible for benefits. COBRA coverage lasts up to 18 months (sometimes longer) after you’ve left or become ineligible for benefits. You will pay the full premium, i.e. both your share and the amount your employer or union was paying on your behalf. COBRA can be quite expensive, but may be cheaper than buying an individual policy on the open market.

In the case of an emergency, federal law protects you from being denied care in an emergency room, regardless of your insurance status or ability to pay. If you do not have health insurance and it’s not an emergency, hospitals are not required to treat you. However, some hospitals will anyway. In addition, some have charity care programs which set fees based on income for those who are uninsured.

Getting insurance through a group or small business
If you are insured through your employer, union, or some other type of group, you cannot be denied insurance because of your medical history. Insurers can however count as pre-existing conditions those for which you received medical advice in the 12 months prior to the start of your policy. If you had a break in insurance coverage of 63 days or more, you may face a pre-existing condition exclusion period. Coverage for pre-existing conditions can be excluded for a maximum of 12 months.

If you are self-employed with no other workers, you are eligible to buy a group health plan on your own. However, certain exclusions and stipulations may apply. Please contact Maine’s Department of Insurance for more information on your rights as a sole proprietor.

For more information on getting and keeping health insurance, please visit www.ahirc.org.