Whether you recently lost coverage, moved to Maine, or just want to make sure you are not overpaying for health insurance, understanding your ACA eligibility is the first step toward affordable care. Maine runs its own state-based marketplace through CoverME.gov, giving residents access to subsidized health plans from four private carriers. Depending on your household income, you could qualify for MaineCare (Maine's Medicaid program) with little to no cost, or for premium tax credits that significantly lower your monthly payments on a marketplace plan. This guide breaks down the 2026 income limits, explains who qualifies for what, and walks you through exactly how to enroll. Want a quick answer? Use our free eligibility screener to check which programs you may qualify for in just a few minutes.
How ACA Eligibility Works in Maine
The Affordable Care Act created two main pathways to affordable health coverage, and your household income determines which one applies to you:
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MaineCare (Medicaid): Free or very low-cost coverage for individuals and families with incomes up to 138% of the Federal Poverty Level (FPL). Maine expanded Medicaid in 2019, so most low-income adults now qualify.
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CoverME.gov Marketplace Plans: Subsidized private health insurance for people with incomes between 138% and 400% of FPL. You pay a monthly premium, but tax credits can bring that cost down significantly.
Your eligibility is based on your Modified Adjusted Gross Income (MAGI), which for most people is very similar to the adjusted gross income on your tax return. Household size also matters because FPL thresholds increase with each additional person.
2026 Federal Poverty Level Guidelines
The U.S. Department of Health and Human Services updates the FPL each year. For 2026, the poverty guidelines used to determine ACA and Medicaid eligibility are:
| Household Size | 100% FPL | 138% FPL (MaineCare Limit) | 250% FPL | 400% FPL |
|---|---|---|---|---|
| 1 | $15,960 | $22,025 | $39,900 | $63,840 |
| 2 | $21,640 | $29,863 | $54,100 | $86,560 |
| 3 | $27,320 | $37,702 | $68,300 | $109,280 |
| 4 | $33,000 | $45,540 | $82,500 | $132,000 |
| 5 | $38,680 | $53,378 | $96,700 | $154,720 |
| 6 | $44,360 | $61,217 | $110,900 | $177,440 |
For each additional person beyond six, add $5,680 to the 100% FPL amount and calculate accordingly.
MaineCare Eligibility: Free Coverage for Lower Incomes
If your household income falls at or below 138% of the FPL, you likely qualify for MaineCare rather than a marketplace plan. MaineCare provides comprehensive coverage including doctor visits, hospital stays, prescriptions, dental, vision, mental health services, and more, with no monthly premiums and minimal out-of-pocket costs.
Who Qualifies for MaineCare in 2026
| Category | Income Limit (% of FPL) | Annual Income Limit (Individual) |
|---|---|---|
| Adults ages 19 to 64 | 138% FPL | $22,025 |
| Children ages 0 to 18 | 213% FPL | Approximately $33,996 |
| Pregnant individuals | 214% FPL | Approximately $34,155 |
| Parents and caretaker relatives | 138% FPL | $22,025 |
| Elderly and disabled individuals | 100% FPL | $15,960 |
A few important notes about MaineCare:
- Children get broader coverage. Kids in families earning up to 213% of FPL can qualify, which is significantly higher than the adult threshold.
- Pregnant individuals get extra protection. The income limit rises to 214% of FPL, and coverage includes prenatal care, delivery, and postpartum services.
- You can apply any time. Unlike marketplace plans, there is no open enrollment period for MaineCare. You can apply year-round.
- No premiums. MaineCare members pay no monthly premiums and face only minimal copays for certain services.
If your income is above these thresholds, the marketplace is your next stop.
CoverME.gov Marketplace Eligibility and Subsidies
Maine is one of a handful of states that operates its own health insurance marketplace rather than using the federal HealthCare.gov platform. CoverME.gov is the only place where Maine residents can access premium tax credits and cost-sharing reductions.
Premium Tax Credits
Premium tax credits lower your monthly insurance premium. You may qualify if your household income falls between 100% and 400% of the FPL. The lower your income, the larger the credit.
Here is what marketplace coverage might cost based on your income level:
| Income Level (% of FPL) | Individual Annual Income | Expected Premium (% of Income) |
|---|---|---|
| 100% to 150% FPL | $15,960 to $23,940 | Approximately 0% to 4% of income |
| 150% to 200% FPL | $23,940 to $31,920 | Approximately 4% to 6.5% of income |
| 200% to 250% FPL | $31,920 to $39,900 | Approximately 6.5% to 8.5% of income |
| 250% to 300% FPL | $39,900 to $47,880 | Approximately 8.5% of income |
| 300% to 400% FPL | $47,880 to $63,840 | Approximately 8.5% of income |
Important note for 2026: The enhanced premium tax credits that were available from 2021 through 2025 under the American Rescue Plan and Inflation Reduction Act were set to expire at the end of 2025. Unless Congress has extended these credits, some Mainers may see higher premiums for 2026 compared to previous years. Check CoverME.gov for the most current subsidy amounts based on your specific situation.
Cost-Sharing Reductions
If your income is between 100% and 250% of FPL, you may also qualify for cost-sharing reductions (CSRs) that lower your deductibles, copays, and out-of-pocket maximums. CSRs are only available on Silver-tier plans. This is one reason many people with lower incomes choose a Silver plan even if a Bronze plan has a lower monthly premium.
Who Offers Plans on CoverME.gov?
Four insurance carriers sell plans through Maine's marketplace for 2026:
- Anthem Health Plans of Maine (largest carrier by market share)
- Community Health Options (CHO) (a Maine-based nonprofit co-op)
- Harvard Pilgrim Health Care
- Taro Health
Most CoverME.gov plans follow "Clear Choice" standardized designs, making it easier to compare costs across carriers. The main differences between plans from different carriers are the monthly premium, provider network, and prescription drug formulary.
Step-by-Step: How to Check Your Eligibility and Enroll
Step 1: Estimate Your 2026 Household Income
Add up the expected annual income for everyone in your tax household. Include wages, self-employment income, Social Security benefits, unemployment compensation, and investment income. Do not include child support, gifts, or non-taxable veterans benefits.
Step 2: Determine Your Household Size
Count yourself, your spouse (if married), and anyone you claim as a tax dependent, including children who do not need coverage themselves.
Step 3: Check If You Qualify for MaineCare First
If your income falls below the MaineCare thresholds listed above, you should apply for MaineCare before looking at marketplace plans. You can apply:
- Online: Visit My Maine Connection
- By phone: Call the OFI Call Center at 1-855-797-4357 (Monday through Friday, 7:00 AM to 4:00 PM)
- In person: Visit your local DHHS district office
Step 4: Apply Through CoverME.gov for Marketplace Coverage
If your income is above MaineCare limits, apply through CoverME.gov:
- Create an account at CoverME.gov
- Complete the application with your household and income details
- Review your eligibility results. The system will tell you if you qualify for premium tax credits, cost-sharing reductions, or MaineCare
- Compare plans using the CoverME.gov Plan Comparison Tool
- Select a plan and confirm enrollment
- Pay your first premium to activate coverage
Step 5: Get Free Help If You Need It
You do not have to navigate this alone. CoverME.gov offers free assistance through:
- Certified Enrollment Assistors who can walk you through the process in person or by phone
- The Consumer Assistance Center at CoverME.gov
- Local navigators you can find through CoverME.gov's Find Help Near You page
According to CoverME.gov, more than 9 out of 10 members report a better experience when they work with an enrollment expert.
Open Enrollment and Special Enrollment Periods
The annual Open Enrollment Period for 2026 marketplace coverage typically runs from November 1 through January 15. If you missed Open Enrollment, you may still be able to get covered through a Special Enrollment Period (SEP) if you experienced a qualifying life event, such as:
- Losing other health coverage (including MaineCare, employer coverage, or a parent's plan)
- Moving to Maine from another state
- Getting married or divorced
- Having or adopting a child
- Turning 26 and aging off a parent's plan
- A change in household income that affects eligibility
You generally have 60 days from the qualifying event to enroll through a SEP. Visit CoverME.gov's SEP page to check if you qualify.
Remember that MaineCare has no enrollment period. You can apply for MaineCare at any time during the year.
What ACA Plans Cover in Maine
All marketplace plans sold through CoverME.gov must cover the ACA's ten essential health benefits:
- Ambulatory (outpatient) services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
- Preventive care and chronic disease management
- Pediatric services, including dental and vision
Preventive care, such as annual wellness visits, immunizations, and many cancer screenings, is covered at no additional cost on all ACA plans, even before you meet your deductible.
Frequently Asked Questions
What if my income is too low for marketplace subsidies?
If your income falls below 100% of the FPL ($15,960 for an individual in 2026), you likely qualify for MaineCare in Maine. Because Maine expanded Medicaid, there is no "coverage gap" like in some other states. Apply for MaineCare through My Maine Connection or by calling 1-855-797-4357.
Can I qualify for both MaineCare and marketplace subsidies?
No. If you are eligible for MaineCare, you cannot receive premium tax credits for a marketplace plan. MaineCare provides more comprehensive coverage at lower cost, so it is generally the better option.
What if my income changes during the year?
Report income changes to CoverME.gov or the MaineCare office as soon as possible. If your income drops, you may become eligible for MaineCare. If it rises, you might lose MaineCare eligibility but gain access to marketplace subsidies. Failing to report changes can result in owing money back at tax time.
Do I have to file taxes to get ACA subsidies?
Yes. To receive premium tax credits, you must file a federal tax return and reconcile the credits you received during the year. If you received more credits than you were entitled to based on your actual income, you may need to repay some of the difference.
Is there a penalty for not having health insurance in Maine?
There is no state-level penalty in Maine for being uninsured. The federal individual mandate penalty was reduced to $0 starting in 2019. However, going without coverage means you are responsible for the full cost of any medical care you receive.
How do I find out which doctors accept my plan?
Each carrier on CoverME.gov maintains its own provider directory. Before selecting a plan, check whether your preferred doctors, hospitals, and pharmacies are in that plan's network. You can typically search provider directories on each carrier's website.
What counts as income for ACA eligibility?
ACA eligibility uses Modified Adjusted Gross Income (MAGI), which includes wages, salary, self-employment income, Social Security benefits, unemployment compensation, alimony (for divorces finalized before 2019), and investment income. It does not include child support, gifts, supplemental security income (SSI), or veterans disability payments.
Next Steps
Not sure where you stand? Try our free eligibility screener to see which programs you may qualify for based on your income, household size, and location. It takes just a few minutes and covers ACA subsidies, MaineCare, SNAP, and other assistance programs available in Maine.
For more information about all the benefits programs available to Maine residents, visit our Maine Benefits Overview page.
Helpful resources:
- CoverME.gov for marketplace enrollment
- My Maine Connection for MaineCare and other benefits
- OFI Call Center: 1-855-797-4357
- 211 Maine (dial 211) for general resource information
