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9 Things You Need To Know About ACA Enrollment & How To Choose A Health Insurance Plan

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1. When to apply: The Marketplace open enrollment period begins on Nov. 1, 2021 and ends on January 15, 2022.

  • You must enroll in a plan by December 15, 2021 for coverage to begin on January 1, 2022. 
  • If you enroll in a plan between December 16, 2021 and January 15, 2022, coverage will start on February 1, 2022.

2. Who should apply? People who do not have health care coverage through their job or through MaineCare or Medicare can purchase health insurance through the Affordable Care Act (ACA) Marketplace.  

3. How do I find a plan and where do I apply?

Online: Mainers will enroll in coverage for 2022 by visiting CoverME.gov

In person: Many nonprofit and community organizations have trained individuals, known as “Maine Enrollment Assisters”, to help you apply for coverage at no cost. Call “the statewide navigator line” 1-855-806-7333 to find a assister near you. 

By telephone: You can also call Maine’s Marketplace Call Center at 1-866-636-0355 and apply over the phone. It accepts calls Monday through Friday, 8am-8pm and on Saturday, 8am-5pmYou can get started and learn about plan estimates and coverage options before you enroll by visiting CoverME.gov and exploring its Plan Compare Tool. You can also call “Consumers for Affordable Health Care” at 1-800-965-7476.

4. What do the plans cost? The cost depends on your income but plans are more affordable than ever because of changes made by the American Rescue Plan. Many Mainers are eligible for more help paying their monthly premiums. During Open Enrollment, you can explore health plans that offer a variety of options to meet your health needs within your budget. Working with an assister can help you determine which plan will be best for you.

5. Will premiums increase this year? Most Mainers will see a decrease in their premiums.  It is important to shop around – make sure your doctors and the prescription drugs you need are covered in the plan you choose. You can find estimates for how much plans will cost you by visiting www.CoverMe.gov or by calling 1-800-965-7476. 

It is important that you explore your options to make sure you get the coverage you need.

The good news is that Maine has expanded MaineCare. Within a certain income bracket you may become eligible for a free health plan through MaineCare. If the Marketplace screens you as eligible for MaineCare, it will send your application to Maine DHHS for a final eligibility determination. Your Maine Enrollment Assister can help you with any questions you may have about MaineCare.

6. How do I prove my eligibility for the subsidy? You’ll need to provide detailed information on the application, including:

  • Social Security number for all people applying for coverage
  • Birth dates and home addresses for all people applying for coverage under the plan
  • Name of employer and income information for every member of your 
    household, even if they aren’t all applying for coverage
  • Estimated household income

7. What are the different types of plans? Marketplace plans fall into four categories:

Bronze – Lowest monthly premium, highest out-of-pocket cost, very high deductibles. 

Silver – The most popular plan. Moderate premiums, moderate out-of-pocket costs, deductibles are lower than Bronze plan.

Gold – High monthly premiums, lower out-of-pocket costs, low deductibles.

Platinum - The highest monthly premiums, lowest out-of-pocket costs, and deductibles. 

There is also a catastrophic plan, which includes all the benefits required by the ACA, including free preventive care. These plans carry low monthly premiums and very high deductibles. But they are only available to individuals under the age of 30 and to those who get an exemption from the Marketplace because, for example, they cannot afford coverage any other way. You can find out more about the various types of plans by using the Plan Comparison Tool at CoverME.gov

8. What if I’m already enrolled in a Marketplace plan? Remember that Maine has expanded MaineCare. Within a certain income bracket, you may become eligible for a free health plan through MaineCare. A Maine Enrollment Assister can help you with any questions you may have. If you don’t do anything by Dec. 15, 2021 you will most likely be automatically renewed in your current plan. If your plan is no longer available, the Marketplace will enroll you in the most similar plan, unless you are eligible for Medicare. If you are eligible for Medicare, the Marketplace will not enroll you into a new plan.

9. Does it pay to shop around for a plan? Yes, because there have been many changes in the 2022 plans and there are many new plans available this year. You should be sure to check if the plan you are considering covers your doctors, prescription drugs and hospitals you are likely to use. Premiums also vary from year to year. 

IMPORTANT: Your premium must be paid before January 1, 2022 for coverage to start on January 1, 2022. If you don’t pay on time, your plan might be canceled and you may have to wait until the next open enrollment period to sign up for another plan. If you have any questions, contact the statewide Navigator hotline or Consumers for Affordable Health Care.

REMEMBER, FREE HELP IS AVAILABLE.
You can go to CoverME.gov to Find Help in your local area.

In Maine, you can also call the statewide navigator line at 1-855-806-7333.

Maine’s Marketplace Call Center: 1-866-636-0355

Find a local assister: 1-855-806-7333 CoverME.gov

You can also call Consumers for Affordable Health Care (CAHC) with your Open Enrollment questions. 

Call CAHC’s Consumer Assistance Helpline at 1-800-965-7476 or go to www.mainecahc.org for more information.

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