Marketplace Plans

CoverME.gov allows you to shop for and enroll in Marketplace plans, which are comprehensive health insurance plans that protect you from financial risk if you get sick or need care. Marketplace plans on CoverME.gov cannot turn you away or charge you more for having a pre-existing condition.

Essential Health Benefits

All plans offered on CoverME.gov are required to cover a certain set of benefits outlined in the Affordable Care Act, known as Essential Health Benefits. The Essential Health Benefits include:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalizations
  4. Maternity and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory Services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including some dental and vision care (included for children only)

For more information on Essential Health Benefits click here. 

Enrollment and Financial Assistance

There is financial assistance available to most people who shop for Marketplace plans on CoverME.gov. Open Enrollment begins November 1, 2023. You may still be eligible to enroll outside of Open Enrollment if you have experienced a qualifying life event -- like losing the insurance you get through your job, getting married or divorced, or having a baby. These events would qualify you for a Special Enrollment Period, which means you may be eligible to enroll in a plan outside of the annual Open Enrollment period. 

Metal Tiers

Health Insurance plans offered on CoverME.gov are categorized into four metal levels: Bronze, Silver, Gold, and Platinum. Metal levels indicate how you and your insurance plan split the cost of your health care expenses.  

As the metal category increases in value, so does the percentage of medical expenses that a health insurance plan covers, compared to what you are expected to pay in copays and deductibles. The metal level does not reflect the quality of care or service providers available through the plan. 

  • Bronze: The health plan generally pays 60% of total health care costs. You pay about 40%. Bronze plans have the lowest premiums and the highest levels of cost-sharing (deductibles, co-pays, etc.). 

  • Silver: The health plan generally pays 70% of total health care costs. You pay about 30%. People who qualify for premium tax credits may also qualify for more savings through cost-sharing reductions. These can only be applied to Silver plans. 

  • Gold: The health plan generally pays 80% of total health care costs. You pay about 20%. Gold plans have higher premiums and lower cost-sharing levels. 

  • Platinum: The health plan generally pays 90% of total health care costs. You pay about 10%. Platinum plans have the highest premiums and the lowest levels of cost-sharing. 

  • Catastrophic: Available to individuals under the age of 30 and those who qualify for a hardship exemption. This plan has a low monthly premium, but a very high deductible. This may be an affordable way to protect yourself from costs of a serious illness or injury if you do not qualify for financial assistance to purchase a plan with more comprehensive coverage. But you pay most routine medical expenses yourself. 

Rate Filings

In Maine, the Bureau of Insurance Reviews the prices of Marketplace Health Insurance Plans each year. More information about annual rate filings, and the process for public input on approval of health insurance prices, is available from the Bureau of Insurance.