Advocating the right to quality, affordable health care for every person in Maine.
Consumer Assistance HelpLine

1-800-965-7476

Frequently Asked Questions

Health Insurance Marketplace

MaineCare

Other Topics

Don’t see your question answered here? We can still help! Contact us with your question.

Health Insurance Marketplace

How much will a plan on the Marketplace cost?

The cost of plans on the Marketplace depends on a couple different things, including where you live, how old you are, and what kind of plan you pick. Some plans also cost more if you use tobacco. And remember, you need to factor in the tax credits and subsidies that you can get as well. These may lower the cost of the plans. To get an estimate about how much a plan will cost you, call our HelpLine at 1-800-965-7476, or visit Healthcare.gov to use an online premium estimator tool. Learn more about the Health Insurance Marketplace.

How do I sign up for the Marketplace?

You can apply for health coverage in the Marketplace  4 ways:

Applying online is the fastest way to get coverage. To find someone who can help you with your application, call our HelpLine at 1-800-965-7476, or visit enroll207.com/locator. Learn more about the Health Insurance Marketplace.

Who can help me with my Marketplace application?

You can get help from people who are trained and certified to help you understand your options and enroll.  This help is free, and available all over Maine. Find a certified assister by calling our HelpLine at 1-800-965-7476, or visiting enroll207.com/locator. Learn more about the Health Insurance Marketplace.

I can’t afford health insurance. Will I have to pay a penalty?

Someone who can afford health insurance in 2014 but does not have coverage in 2014 may have to pay a fee. This fee is sometimes called the “individual mandate,” “individual responsibility payment,” or “penalty.” But if you can’t afford health insurance, you might qualify for an exemption. This would mean you do not have to pay the penalty. Other exemptions are available, too. To learn more or find out how to apply for an exemption, call our HelpLine at 1-800-965-7476, or visit Healthcare.gov to learn more.

Why don’t I qualify for lower costs on Marketplace insurance?

Getting lower costs on Marketplace insurance depends on your income and your household size. If you make too little or too much, you might not qualify. For example, a family of 3 may qualify if they make between $19,530 and $78,120 a year. You also may not qualify if you already have insurance from another source. If you already have coverage from work, or from Medicare, MaineCare, TRICARE, or the VA, you may not qualify.

If your income is too low, you may not qualify for lower costs on the Marketplace. That’s because the Affordable Care Act (“Obamacare”) gave states the option of expanding their Medicaid program so that people with low income could get covered that way. The Maine State Legislature passed a bill to expand MaineCare, our Medicaid program, but it was vetoed by Governor LePage. To learn more or to find other options to get the care you need, contact our HelpLine at 1-800-965-7476, or see our Guide to Maine Health Care.

My Marketplace application is stuck! What do I do?

If you are stuck somewhere in the application, or if you are not getting the results you expected, you should try removing your application and starting over. Here’s how:

  • Login to your account.
  • Select the application you have in progress. Click the button that says “Remove.”
  • Log out, close your web page, and then log back in using the same account.
  • Create a new application.

If removing your application does not work, call our HelpLine at 1-800-965-7476. You may need to contact the Healthcare.gov Call Center (1-800-318-2596) and ask to work with a caseworker.

MaineCare

Can I apply for MaineCare?

Many families qualify for some level of free or low-cost MaineCare, even if they make up to than $50,397 per year for a household of four!  Unfortunately, some people can’t get MaineCare even if they have zero income.  You may qualify for MaineCare if you are a parent or childyoung adult, or are elderly or disabledDon’t fit in one of those categories?  Call our HelpLine (1-800-965-7476) or check out our Guide to Maine Health Care for more information on your options.

I am losing MaineCare. What do I do?

First, let’s double-check!  Sometimes coverage is lost because MaineCare doesn’t have all the information they need.  Call our HelpLine (1-800-965-7476) or check out our Guide to Maine Health Care for more information about MaineCare eligibility.  Then, if you really are losing your coverage, our HelpLine staff can talk you through your options, from discounted health insurance through the Marketplace (link) to helpful programs like Hospital Free Care or prescription drug programs, which may cover some or all of your health care costs.

What income counts for my household?

For those people properly counted in your household, count the income of all those who are REQUIRED to file taxes. Learn more about who counts as part of your household. To learn more about who is required to file taxes. visit IRS.gov or keep reading.

Who Is Required (Tax Dependents under 65) to file

Single dependents under age 65 must file a return if any of the following apply:

  • His/her unearned income was more than $950.
  • His/her earned income was more than $5,950.
  • His/her gross income was more than the larger of:
    • $950, or
    • earned income (up to $5,650) plus $300.

Married dependents under age 65 must file a return if any of the following apply:

  • His/her unearned income was more than $950.
  • His/her earned income was more than $5,950.
  • His/her gross income was at least $5 and your spouse files a separate return and itemizes deductions.
  • His/her gross income was more than the larger of:
    • $950, or
    • earned income (up to $5,650) plus $300.

Who Taxpayers can claim personal exemptions for:

  • Self & spouse
  • Dependents
  • A person may be a dependent even if he files a tax return (as long as s/he does not claim self as exemption)
  • Children & other relatives who meet certain requirements
    • Must be a U.S. citizen or resident of the US, Mexico or Canada

Who do I count as part of my household?

If you are a tax filer, you count all of your claimed tax dependents in your household as well as your spouse if married and filing jointly. Learn more about who counts in your household if you are a non-filer or if you are a dependent here below.

  1. If you are a tax dependent (meaning someone claims you on a tax return) then your household is usually the same as the person who claims you. But see if you meet any of these three exceptions: First, are you a tax dependent who is not a child or spouse of the person who claims you, or second, are you a child living with both parents who are unmarried or third, are you a child claimed by a non-custodial parent? If yes to any of these three exception see b, below:
  2. If you are a Non-tax filer AND not claimed by anyone as a dependent OR if you answered yes to any one of those three exceptions listed in a, above, then:
    1. Are you an adult? If yes, your household is you plus your spouse if you live with this spouse, and your children under 21, if they live with you.
    2. Are you a child under 21? If yes, your household equals yourself the child, plus siblings and any parents or stepparents that live with you.

How long will my application take?

It usually takes DHHS a couple weeks to make a decision. If it takes them longer than 45 days, you may be able to get temporary coverage until they decide. Call the HelpLine at 1-800-965-7476 if you want to learn more.

How do I apply?

You do not have to apply in person. There is a simple, two-page application for family MaineCare that is easy to fill out and can be mailed to the Department of Health and Human Services (DHHS). Or, you can start your application online at My Maine Connection. Call the HelpLine at 1-800-965-7476 if you have questions or would like us to send you a paper application.

Is __________ covered by MaineCare?

MaineCare is full coverage. It includes nearly all health services — doctor’s visits and treatment, hospital care, prescription drugs, physical therapy, mental health services, transportation to doctor’s appointments and much more!

Do assets count or not?

MaineCare does not look at assets for children, parents, pregnant women, or young adults. Assets do count if you have a disability or are 65 or older, but many assets do NOT count against you. You can have savings and retirement, a home, land the home sits on, cars and many other assets and still get MaineCare! Learn more about what assets are allowed.

Other Topics

I don’t have insurance. What are my options for getting health care I can afford?

There are a variety of programs that could help with the cost of health insurance or the cost of accessing health care services directly.  For example, MaineCare and the Marketplace are helpful ways to get free, low-cost, or discounted health insurance.  If you do not qualify for MaineCare or Marketplace discounts and cannot afford other private insurance, call our HelpLine (1-800-965-7476) or check out our Guide to Maine Health Care to identify programs that may help with cost for prescriptions drugs, primary and preventive care, emergency care and more.

What are my health insurance options?

Everyone’s situation is different.  Your health insurance options will depend on whether you have access to work-based insurance, your household size and income, and other factors like age and disability status.  Our free HelpLine (1-800-965-7476) and Guide to Maine Health Care are here to help you zero in on your options to make the best choice possible.

My claim has been denied. Can you help?

Understanding whether your insurance company has made a mistake, and figuring out how to fix it can seem like an impossible task!  We have been doing this work for over 25 years (link to about us), and are here to help you.  Our HelpLine (1-800-965-7476) and legal staff provide free legal support through every step of the private insurance appeals process.  In 2013, we helped consumers recover over $200,000 in benefits that had been initially denied by their insurance company.

Open Enrollment is the time of year you can sign up for health insurance.

Open Enrollment to get insurance for 2018 will start November 1, 2017. It will end December 15, 2017.

If you don't sign up for a health plan by December 15, 2017, you may not be able to get health insurance in 2018. If you don't have insurance, you might have to pay a fine when you file your taxes.

Visit HealthCare.gov or call our HelpLine at 1-800-965-7476 to learn more and find out how to apply!

Get Covered

Find free help from a “navigator” or other local assister in Maine — a service of enroll207.com. Search by city or zip code.

Workshops & Events

  • September, 2017
  • Sep
    26

    5th Annual HC4ME Conference!

    8:00 am - 4:00 pm

    Our conference theme this year is: The Future of Health Care in Maine: Defending Our Gains, Defining Our Vision.

    This year’s conference will offer two interchangeable tracks: a Policy Track, and an Enrollment Track.  The Policy Track will explore the current state-of-the-art in health policy, particularly around coverage and delivery system reforms. The Enrollment Track will explore information enrollment professionals will need or want to know.  The conference will also include panel discussions exploring the current state of health reform.

    ... More
  • October, 2017
  • Oct
    10

    Bangor MaineCare A to Z Workshop

    9:00 pm - 4:00 pm

    This workshop offers an in depth look at MAGI & Non-MAGI MaineCare eligibility rules for families, seniors, and people with disabilities. Participants will review and discuss recent State and Federal level changes to MaineCare related to the Affordable Care Act. Sponsored by Consumers for Affordable Health Care and Maine Equal Justice.

    ... More
  • Oct
    17

    Portland MaineCare A to Z Workshop

    9:00 pm - 4:00 pm

    This workshop offers an in depth look at MAGI & Non-MAGI MaineCare eligibility rules for families, seniors, and people with disabilities. Participants will review and discuss recent State and Federal level changes to MaineCare related to the Affordable Care Act. Sponsored by Consumers for Affordable Health Care and Maine Equal Justice.

    ... More
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