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Augusta, ME
Change City

Health Care Open Enrollment Runs from November 1 – January 16, 2025

Posted on 11/01/24

Here are 9 things you need to know and where to get help in Maine:

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1. When to apply: The Marketplace Open Enrollment begins on Nov. 1, 2024 and

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

3. How do I find a plan and where do I apply?
Online: The best place to start is at www.CoverME.gov. That is where the majority of Mainers in the individual market will sign up for a plan.

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 at 1-855-806-7333 to find a Maine Enrollment Assister near you.

By telephone: You can also call the Marketplace Call Center at 1-866-636-0355 TTY: 711 and apply over the phone. It accepts calls Monday - Saturday during Open Enrollment. Remember, you can get plan estimates and learn about your coverage options before you enroll by visiting www.CoverME.gov and clicking on the “Plan Compare Tool” or by calling Consumers for Affordable Health Care at 1-800-965-7476.

4. What do the plans cost? The cost depends on your income. Many Mainers are eligible for help paying for their 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? Depending on their situation, some Mainers may see an increase or a decrease in their premiums. It is important to shop around. If you get a letter from your insurance company saying your plan will cost more next year, don’t panic! The price shown in the letter might not be accurate as it may not include the help you can get paying your monthly premiums. You can find estimates for how much plans will cost you by visiting www.CoverME.gov and clicking on the “See 2025 Plans”. It is important that you explore your options to make sure you get the best plan for you. The good news is that Maine has expanded MaineCare. Within a certain income bracket you may be 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 to start an eligibility determination. Your Enrollment Assister can help you with any questions you may have.

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 individuals who will be applying for

• Name of employer and income information for every member of your household, even if they aren’t all applying for coverage


7. What are the different types of plans? Remember the 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. Subsidies to lower out-of-pocket costs for Silver plans may also be available, depending on income.
Gold – High monthly premiums, lower out-of-pocket costs, low deductibles.
Platinum – 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 at www.CoverME.gov/learn-more/ marketplace-plans.

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. Your Enrollment Assister can help you with any questions you may have. If you don’t do anything by Dec. 15, 2024 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 manychanges in the 2025 plans and there are new plans available this year. You should make 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 the first day your plan is set to begin. If you enroll before Dec. 16, 2024, your plan will begin on Jan 1, 2025. If you enroll between Dec. 16 and Jan. 16, your plan will begin on Feb. 1, 2025. If you don’t pay your premium 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 line or Consumers for Affordable Health Care.

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This story is provided by AARP Maine. Visit the AARP Maine page for more news, events, and programs affecting retirement, health care, and more.

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