Maine: Preliminary 2026 Open Enrollment Data Shows Rising Affordability Challenges for Mainers' Health Coverage

via the Maine Dept. of Health & Human Services:

CoverME.gov is Maine's state-based health insurance marketplace, administered by the Maine Department of Health and Human Services' Office of the Health Insurance Marketplace. The 2026 Open Enrollment period recently ended, during which individuals and families were able to compare and enroll in private health insurance plans and determine eligibility for financial assistance.

Preliminary data from the 2026 Open Enrollment period indicate several emerging trends in Maine's individual health insurance market. While many Mainers enrolled in coverage through CoverME.gov, early indicators point to declining enrollment and increased affordability pressures that may affect coverage stability for consumers and the broader health insurance system.

Key themes from this year's Open Enrollment:

• Declining overall enrollment
• Increased affordability-driven cancellations
• Higher premiums
• A shift toward plans with higher deductibles

While tens of thousands of Mainers enrolled in health coverage through CoverME.gov, early indicators suggest growing affordability pressure and coverage instability across the individual market, with implications for consumers, health care providers, and Maine's broader health insurance system.

Enrollment Trends Indicate Decline During Open Enrollment

After record levels of adult enrollment last year, the 2026 Open Enrollment period saw the lowest overall participation levels since Maine launched its state-based Marketplace in November 2021. According to preliminary data from the Office of the Health Insurance Marketplace (OHIM), key 2026 findings include:

58,523 consumers enrolled in health insurance, of which 8,577 were new consumers and 49,946 were returning consumers. This represents:

• A 9.5 percent decline in total enrollment from 2025 (from 64,678 to 58,523)
• A 24 percent decline in total new customers from 2025 (from 11,285 to 8,577)
• A 2.7 percent decline in the proportion of new consumers out of total customers (from 17.4% to 14.7%)
• A 6.5 percent decline in re-enrolled consumers (from 53,393 to 49,946)

In 2026, there was a notable increase in active plan selection among re-enrollees. Over 50 percent of re-enrollees actively selected a plan, compared with 33 percent in 2025, indicating increased consumer engagement amid significant increases in premiums and more typical annual changes in plan options.

Enrollment in stand-alone dental plans also declined, with 7,877 consumers selecting dental plan coverage for 2026, compared to 8,423 in 2025 (a 6.9% decline).

Fewer Consumers Receiving Financial Assistance

As a result of the expiration of Enhanced Premium Tax Credits (EPTC) at the end of 2025, fewer consumers remain eligible for tax credits that lower monthly premiums. In 2026, 75 percent of enrolled consumers received Advance Premium Tax Credits (APTC), compared to 85 percent in 2025. Learn more about premium tax credits at CoverME.gov's financial help page.

Between 2025 and 2026, the average APTC consumers received increased from $607 to $772 per month, though the average monthly premium of $178 remained the same. These increases in average subsidy amounts largely reflect higher underlying premiums and changes in the income distribution of enrolled consumers. Average net premiums remained stable due to significant shifts into plans with lower premiums and cost sharing for health services, an increase in the proportions of lower-income enrollees, and shifts in the age distribution of consumers. Additional analyses will examine these factors further.

Affordability Pressures Are Contributing to Coverage Loss

Since the start of 2026 Open Enrollment, 8,550 consumers cancelled Marketplace coverage. Of these consumers, 32 percent (2,722) cancelled because they felt that they could no longer afford the monthly premium.

Among consumers who cancelled coverage due to affordability:

• 41 percent have household incomes above 400 percent of the Federal Poverty Level (FPL guidelines). These households do not qualify for premium tax credits in 2026.

• 28 percent have household incomes between 200 percent and 400 percent FPL.

Moreover, 37 percent of all cancellations were consumers who qualified for tax credits in 2025 but did not qualify in 2026 due to federal eligibility changes for premium tax credits and/or an increase in household income.

These data indicate that affordability challenges are directly contributing to coverage disruptions.

Plan Selection Trends Indicate Higher Out-of-Pocket Exposure

Plan selection data shows a shift toward plans with higher deductibles and greater out-of-pocket exposure (understanding plan metal levels). Bronze plan enrollment increased by 13 percent and now represents nearly 60 percent of all enrollments.

The most commonly selected plan was an Anthem bronze plan with an $8,000 individual deductible and a $16,000 family deductible. Under this plan, a 52-year-old single adult in Androscoggin County making $64,000 a year would pay $829 per month in premiums without financial assistance. If this individual had a 55-year-old spouse and they had an annual household income of $85,000, they would be charged $1,776 per month to cover them both under this plan. If the couple made $80,000 a year, which would qualify them for financial assistance, they would pay just over $39 per month for this plan. If the 52-year-old single individual in the example above made $60,000 per year, their monthly premium for this plan would drop to $206 per month as they would qualify for financial savings.

This shift reflects consumers prioritizing lower premiums, potentially increasing financial risk when health care is needed.

Premium Increases and the Role of Enhanced Premium Tax Credits

An earlier analysis conducted by the Maine Department of Health and Human Services (DHHS) examined the combined effects of premium increases and the expiration of Enhanced Premium Tax Credits (EPTC).

If consumers who enrolled in Open Enrollment 2025 had selected the same plans in 2026, there would have been an average estimated premium increase of:

• 77 percent for all households
• 88 percent for households receiving APTC
• 62 percent for households under 200 percent FPL
• 44 percent for households between 200 and 400 percent FPL
• 120 percent for households over 400 percent FPL

If EPTCs had been extended, this analysis predicted average premiums would have decreased by approximately 9% for all households, and 19% for households receiving APTC, based on 2025 enrollment data.

Consumer Engagement Trends During Open Enrollment

During the 2026 Open Enrollment, CoverME.gov's Consumer Assistance Center handled 27,686 inbound calls, 3 percent fewer than 2025. Average call handle time decreased by 4.2 minutes.

Website activity showed mixed trends. During Open Enrollment, 336,526 visits were recorded, down nearly 32 percent from 2025. At the same time, unique website visitors increased by 22 percent, with 191,644 unique users accessing CoverME.gov (enrollment resources).

Timing Considerations and Potential Risks

The full impact of recent affordability changes on enrollment may not be realized until later in the first quarter of 2026 or beyond. Consumers who receive premium tax credits and have paid at least one month's premium have a three-month grace period before coverage can be terminated for non-payment.

It is possible that some consumers will maintain coverage in the short-term but may not be able to sustain higher premiums over time - particularly if they face unexpected expenses such as increased housing costs, vehicle repairs, or medical bills. As a result, additional coverage losses may emerge after the grace period concludes.