Private Health Insurance in Maine: PPO and EPO Plans Outside CoverME.gov
FreedInsure doesn't sell CoverME.gov plans. In Maine, we offer private PPO and EPO plans that use the Cigna PPO network, plus supplemental and life coverage. Here's who these plans can fit, who should use CoverME.gov instead, what they cost as of fall 2026, and how applying works.
Compare Your Options ↓Can I Buy a PPO in Maine Outside CoverME.gov?
Yes. Private health insurance in Maine, as we use the term here, means health plans sold outside CoverME.gov, Maine's ACA marketplace. FreedInsure offers group-style PPO and EPO plans in Maine that use the Cigna PPO network. They are not insured by Cigna, they are not individual ACA plans, and they can't be paid for with a tax credit. For some Maine households they can cost less than a full-price CoverME.gov plan; for many others, CoverME.gov is the better buy.
A note on words: Marketplace plans are private insurance too, because private insurers sell them. On this page, “private plans” means the plans we offer outside CoverME.gov. In Maine, FreedInsure doesn't sell ACA Marketplace plans; we help with private PPO and EPO plans, supplemental coverage and life insurance. Short-term health plans aren't currently sold in Maine (see our Maine short-term health insurance page).
FreedInsure LLC sells through licensed agent Constantino Lardi, NPN 20230457, who holds a non-resident Maine producer license with Life and Health authority (license PRN508419; see all his state licenses). Our help is free to you: (844) 788-3733.
Quick answer (October 2026): Yes. FreedInsure offers private PPO and EPO plans in Maine, sold outside CoverME.gov, that use the Cigna PPO network. You can apply outside open enrollment, but approval depends on each plan's eligibility and underwriting rules. If you qualify for a tax credit or have a pre-existing condition, CoverME.gov is usually the better buy.
These plans use the Cigna PPO network and are not insured by Cigna. Cigna is a provider network, not an insurance company, and it doesn't pay claims. A plan that uses the Cigna network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
Last updated: October 7, 2026
Who Private Plans Fit in Maine, and Who Should Use CoverME.gov
Income is the first question, because a private plan can't use the premium tax credit. For 2027 coverage, tax credits apply at 100%–400% of the federal poverty level (FPL): about $15,960–$63,840 for one person or $33,000–$132,000 for a family of four, as of fall 2026 under current law. The enhanced credits expired at the end of 2025, and CoverME.gov says regular advance premium tax credits are still available to those who qualify.
Straight talk: A plan sold outside the Marketplace can cost less than a full-price ACA plan if you're healthy, earn too much for a tax credit, or want a specific network. But if you qualify for a tax credit or MaineCare, have a pre-existing condition, are pregnant or planning to be, or take expensive medications, an ACA plan from CoverME.gov is usually the safer buy, and the only way to get the premium tax credit is through the Marketplace. FreedInsure doesn't sell CoverME.gov plans in Maine, so if that's your better route, we'll tell you and point you to CoverME.gov (1-866-636-0355, TTY 711) before we quote anything. Call (844) 788-3733.
These plans are not sold through the ACA Health Insurance Marketplace (HealthCare.gov or your state's exchange) and are not individual-market ACA plans. You can't use a premium tax credit or cost-sharing reduction to pay for them. As HealthCare.gov puts it, “the only way to get the premium tax credit is through the Marketplace.” In Maine, the exchange is CoverME.gov.
✅ When a private plan can make sense
- Your 2027 household income is above 400% FPL (about $63,840 for one person or $132,000 for a family of four), so you'd get no tax credit under current law.
- You're self-employed or an early retiree not yet on Medicare, with income above that line.
- You're healthy with predictable, low use: no ongoing specialist care, generic drugs only, no planned surgery or pregnancy.
- You want the Cigna PPO network, with an out-of-network option on PPO designs, and you've checked that your doctors are in it.
- You can handle a stated in-network deductible of about $5,000–$9,000 for one person.
- You're between jobs, outside Open Enrollment and without a Special Enrollment Period, and want to ask whether a private plan can bridge you to the next Open Enrollment.
- You qualify through the plan's sponsoring group. We confirm this before you apply.
🏛️ When CoverME.gov is the better call
- Your income is between 100% and 400% FPL. The tax credit works only through the Marketplace, and below about 250% FPL, cost-sharing reduction silver plans also cut deductibles. The Maine Bureau of Insurance says more than 70% of people buying individual coverage through CoverME.gov receive advance premium tax credits.
- Your income is at or below about 138% FPL. MaineCare may cover you, and we'll point you to the state application.
- You have a pre-existing condition or ongoing treatment. All Marketplace plans must cover treatment for pre-existing medical conditions.
- You're pregnant or planning to be. On a Marketplace plan, pregnancy and childbirth are covered from the day the plan starts.
- You take expensive brand-name or specialty drugs.
- You want a firm out-of-pocket ceiling on covered in-network essential health benefits: $12,000 for one person or $24,000 for a family on ACA plans in 2027.
- You need guaranteed coverage. Open Enrollment and Special Enrollment Periods are the guaranteed routes.
Already on a CoverME.gov plan? Don't cancel it to switch before you've compared. If you cancel Marketplace coverage, you generally can't re-enroll until the next Open Enrollment unless you qualify for a Special Enrollment Period, and voluntarily dropping coverage doesn't create one (45 CFR 155.420(e)).
CoverME.gov vs Private PPO Plans vs MaineCare
Maine residents have three main routes to health coverage: a CoverME.gov plan, a private plan sold outside the marketplace, or MaineCare. Here's how they differ, as of October 2026.
| Feature | CoverME.gov ACA Plans | Plans That Use the Cigna PPO Network | MaineCare (Medicaid) |
|---|---|---|---|
| What it is | Individual ACA plans from private insurers, sold on Maine's state-based marketplace, operated by the Maine Department of Health and Human Services | Group health plans offered through a sponsoring employer or organization, sold outside CoverME.gov; not individual ACA plans | Maine's Medicaid program; MaineCare Expansion covers adults 19–64 who qualify on income |
| Sold by FreedInsure in Maine? | No. Enroll at CoverME.gov or call 1-866-636-0355 (TTY 711) | Yes | No. Apply through CoverME.gov or My Maine Connection |
| Tax credits | Premium tax credits at 100%–400% FPL; cost-sharing reductions on silver plans at or below 250% FPL | Can't use a premium tax credit or cost-sharing reduction | Not applicable (public program) |
| Usually fits | Anyone who qualifies for a tax credit or needs pre-existing-condition protection | Healthy people above 400% FPL who want the Cigna PPO network and qualify through the sponsoring group | Adults with income up to 138% FPL who meet the program's rules |
| Pre-existing conditions | Must be covered | Ask us to confirm in writing how a plan handles them before you enroll | Eligibility is based on income and program rules |
| Deductible and out-of-pocket | Vary by plan; 2027 out-of-pocket maximum is $12,000 for one person / $24,000 for a family | In the plans we reviewed: in-network deductibles of about $5,000–$9,000 and out-of-pocket limits of about $6,000–$9,000 for one person | Set by MaineCare rules |
| Network | Each insurer's own network | Cigna PPO network (not insured by Cigna); EPO designs cover in-network care only, except emergencies | Providers that accept MaineCare |
| When you can sign up | Open Enrollment, Nov 1, 2026 – Jan 15, 2027, or a Special Enrollment Period | You can apply outside open enrollment; approval depends on eligibility and underwriting, and the start date depends on the plan | Applications accepted year-round |
| What changes for 2027 | Anthem stops offering individual PPO plans through CoverME.gov; Mending Health is leaving the market | Prices on this page are as of fall 2026 and can change | Work requirements for expansion adults start January 1, 2027 |
Cigna is a provider network, not an insurance company, and it doesn't pay claims. A plan that uses the Cigna network sets its own benefits and pays claims through its own administrator. Before you get care, confirm your doctor or facility is in network using the directory and phone number on your plan ID card.
Looking for an ACA PPO in Maine?
PPO choices on the marketplace are changing. The Maine Bureau of Insurance says Anthem will no longer offer individual PPO plans through CoverME.gov for 2027, though it will still sell PPO plans directly to individuals outside the marketplace and to small groups. A plan bought outside CoverME.gov can't use a premium tax credit. FreedInsure doesn't sell ACA plans in Maine, so for those options, go to CoverME.gov or the insurer. A “PPO” label also doesn't guarantee out-of-network coverage: some plans that use a PPO network cover in-network care only, except emergencies, so read the out-of-network column before you buy. Our EPO vs PPO guide explains the difference.
Private PPO and EPO Plan Categories in Maine (Fall 2026)
We describe the plans we offer by category, not by product name. Both categories below are group health plans that use the Cigna PPO network. Benefit figures come from the plans' own Summaries of Benefits and Coverage (SBCs); when a brochure and its SBC disagree, we use the SBC and the less favorable figure.
Category 1: group PPO plans with standard cost sharing
Some private PPO plans we offer are group health plans offered through a sponsoring employer or organization, not individual ACA plans. Their Summaries of Benefits and Coverage state that they provide minimum essential coverage and meet the federal minimum value standard. In the plan documents we reviewed, in-network deductibles ran about $5,000–$6,000 for one person, with out-of-pocket limits of about $7,000–$8,700.
Some designs let you see a primary care doctor or specialist for a flat copay before the deductible (for example $40 and $80), with generic drugs at $0. ER visits, imaging, surgery, hospital stays and childbirth are typically 30% after the deductible. Out-of-network care is covered at a higher cost: in the plans we reviewed, that meant 50% coinsurance after a separate, higher deductible. The plans' own coverage examples show a member paying roughly $6,400–$7,000 of a $12,700 normal delivery.
Out-of-network providers may bill you for the difference between their charge and what the plan pays. That amount doesn't count toward your out-of-pocket limit. Out-of-network preventive care and prescriptions are not covered.
Category 2: group EPO/PPO plans with an integrated gap benefit
Some group plans pair a high stated deductible with an “integrated gap benefit” that may pay down eligible in-network deductible and coinsurance costs, subject to the plan's terms and limits. In the documents we reviewed, the stated in-network deductible and out-of-pocket limit were $6,000–$9,000 for one person. Copays, penalties, balance billing and non-covered services may not be eligible for the gap benefit.
Before the deductible, office visits ran $25–$40 for primary care and $50–$60 for a specialist, and generic drugs were $0. Diagnostic tests, imaging, surgery, hospital stays and childbirth are 30% after the deductible. The plans' own coverage examples, before the gap benefit, show a member paying about $6,050 for a normal delivery. The EPO plans we reviewed cover in-network care only; out-of-network care isn't covered except for emergencies.
How the “integrated gap benefit” works: The plan's stated in-network deductible and out-of-pocket limit are higher than the reduced amount you may see advertised. The plan's integrated gap benefit may offset eligible in-network deductible and coinsurance amounts, subject to the terms and limits of the plan. Copayments, non-covered services, penalties, balance billing and other excluded charges may not be eligible. Ask us for the plan's Summary of Benefits and Coverage and the gap benefit's terms before you enroll.
Group plan notice (Categories 1 and 2): This is a group health plan offered through a sponsoring employer or organization, not an individual ACA plan. Its Summary of Benefits and Coverage states that it provides minimum essential coverage and meets the minimum value standard. If you are eligible for certain types of minimum essential coverage, you may not be eligible for the premium tax credit. Eligibility is set by the plan document.
Pre-certification: Some services, such as imaging, surgery and hospital stays, need pre-certification before you get them. If you skip it, the plan may charge a penalty ($500 in the plans we reviewed), and in most of those plans the penalty doesn't count toward your out-of-pocket limit.
Both categories set yearly limits on some services, for example 60 home-health visits, 35 rehab visits and 25 skilled-nursing days. Common exclusions include adult dental and vision, hearing aids, infertility treatment, bariatric surgery and acupuncture. The out-of-pocket limit doesn't cap everything: premiums, balance billing, pre-certification penalties and non-covered care fall outside it.
What these plans cost, as of fall 2026
Monthly premiums for Categories 1 and 2 combined, from our broker plan catalog:
Single adult
$500–$950/month, roughly, for a healthy single adult
Couple
$1,000–$1,800/month, roughly
One adult + child(ren)
$950–$1,700/month, roughly
Family
$1,600–$2,300/month, roughly
Plans in these two categories we see often run roughly $500–$950/month for a healthy single adult, roughly $1,000–$1,800/month for a couple, roughly $950–$1,700/month for one adult plus children and roughly $1,600–$2,300/month for a family, depending on age, state, network and underwriting. For a single adult, that's about $6,000–$11,400 a year in premiums before any care, on top of a stated in-network deductible of about $5,000–$9,000. Plans with an integrated gap benefit sit higher in the price range. See our private health plan price report for every category.
Pricing note: Price ranges are examples of monthly quotes we commonly see as of fall 2026, not offers or guarantees. Your rate depends on age, state, household size, network, plan design and each plan's eligibility and underwriting rules. Premiums are separate from what you pay when you get care (deductibles, copays and coinsurance). Some quotes in this range include a separate hospital and accident gap policy.
Monthly rates for some plans include a separate hospital and accident gap plan. Gap benefits are subject to that policy's own terms, limits and exclusions. The medical plan's deductible and cost sharing are shown before any gap benefit.
Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan's own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage.
How Applying and Underwriting Work
You can apply for these plans outside CoverME.gov's Open Enrollment, but approval depends on each plan's eligibility and underwriting rules, and the start date depends on the plan. We don't promise a start date, because each plan sets its own in its enrollment materials. Here's how it works with us:
- Income first. We ask about your expected 2027 household income. If you may qualify for a tax credit or MaineCare, we'll tell you and point you to CoverME.gov before we quote anything.
- Quote by category. We show the plans that fit with each plan's Summary of Benefits and Coverage: deductible, out-of-pocket limit, yearly limits and exclusions, not just the premium.
- Confirm the sponsoring group. These are group health plans offered through a sponsoring employer or organization. We confirm whether you qualify before you apply.
- Check your doctors. Search the directory for the network named on the plan and confirm with your doctor's office.
- Apply. The plan reviews your application under its own eligibility and underwriting rules. Approval isn't guaranteed, and not every plan may be available to you.
- Get it in writing. Before you pay, get the start date from the plan's enrollment materials, and ask us to confirm in writing how the plan handles pre-existing conditions. Marketplace plans must cover them.
Maine's free-look rule
Maine law requires individual health insurance policies to let you return the policy within 10 days of delivery for a refund of the premium paid, if you're not satisfied for any reason (24-A M.R.S. §2717). The rule doesn't apply to nonrenewable accident policies or individual credit health policies. The private PPO and EPO plans we offer are group health plans, so before you enroll, ask us what cancellation or refund terms the plan's own documents give.
Hablamos español. Two of our licensed staff speak Spanish. Call (844) 788-3733 and ask for an agent who speaks Spanish.
CoverME.gov Open Enrollment 2027 and Maine Contacts
Open Enrollment for 2027 coverage on CoverME.gov runs November 1, 2026 – January 15, 2027. CoverME.gov lists two deadlines: enroll by December 15, 2026 for coverage that starts January 1, 2027, or by January 15, 2027 for coverage that starts February 1, 2027. CoverME.gov is Maine's state-based marketplace, so Maine residents enroll there, not on HealthCare.gov.
Outside Open Enrollment, you need a Special Enrollment Period, usually triggered by a life event such as losing job-based coverage, moving, marriage or having a baby; it generally lasts 60 days. MaineCare accepts applications year-round if your income qualifies: apply through CoverME.gov, which screens applications for MaineCare, or at My Maine Connection.
What's changing in Maine for 2027
- Rates: the Maine Bureau of Insurance approved an average increase of 14.8% for 2027 individual-market rates and 13.5% for small employers (August 14, 2026).
- Insurers: Mending Health, formerly Taro Health, is leaving the market, and Anthem will no longer offer individual PPO plans through CoverME.gov.
- MaineCare work requirements: starting January 1, 2027, MaineCare Expansion adults need to meet new work requirements: $580 a month in earnings, or 80 hours a month of work, volunteering, school or a work program, or a mix (Maine Office for Family Independence). Our Medicaid work requirements guide explains the rules.
- Short-term plans: still not sold. The Maine Bureau of Insurance says no short-term plans that meet Maine law have been submitted for approval, so none are available for sale.
Maine Bureau of Insurance: the state regulator for insurance companies and agents, including us. Call 800-300-5000 (toll-free) or 207-624-8475; TTY via Maine Relay 711. Website · File a complaint · Check a license (our Maine license: PRN508419).
Sources
- FreedInsure broker plan catalog, fall 2026 — monthly premiums by household rate tier, plus the plans' Summaries of Benefits and Coverage and brochures (internal data; product names withheld).
- CoverME.gov: Open Enrollment — November 1 through January 15; 2027 coverage deadlines; phone 1-866-636-0355 (TTY 711).
- CoverME.gov: Expiration of the enhanced premium tax credits — enhanced credits expired at the end of 2025; advance premium tax credits remain for those who qualify.
- CoverME.gov: MaineCare — MaineCare eligibility.
- CoverME.gov: Apply for MaineCare — applications are reviewed for MaineCare eligibility and transferred to the Office for Family Independence for a final decision.
- HealthCare.gov: Medicaid and CHIP — you can apply for Medicaid and CHIP any time of year.
- Maine Bureau of Insurance: 2027 individual and small group premiums (August 14, 2026) — 14.8% and 13.5% average increases, Anthem PPO and Mending Health changes, share of CoverME.gov buyers receiving advance premium tax credits.
- Maine OFI: Work Requirements for MaineCare Expansion Adults — requirements starting January 1, 2027.
- Maine Bureau of Insurance: short-term health insurance guide — no short-term plans currently for sale in Maine.
- 24-A M.R.S. §2717 — 10-day right to return an individual health policy.
- HealthCare.gov: pre-existing conditions — Marketplace plans must cover treatment for pre-existing conditions; pregnancy and childbirth are covered from the day the plan starts.
- HealthCare.gov: premium tax credit — the only way to get the premium tax credit is through the Marketplace.
- HHS ASPE poverty guidelines — 2026 guidelines of $15,960 for one person and $33,000 for a family of four, which 2027 Marketplace credits use.
- CMS 2027 benefit-year parameters — $12,000 / $24,000 out-of-pocket maximum.
- 45 CFR 155.420 — Special Enrollment Periods; voluntary termination doesn't count as a loss of coverage.
- NIPR Producer Database report for Constantino Lardi, NPN 20230457, dated September 9, 2026 — Maine non-resident producer license PRN508419, Life and Health, active.
How FreedInsure Helps
FreedInsure LLC is an independent insurance agency; its licensed agent, Constantino Lardi (NPN 20230457), is licensed in 42 states, including Maine. Our help is free to you. We don't sell CoverME.gov plans in Maine, so before we quote any private plan, we'll ask about your income and tell you if a tax credit or MaineCare makes CoverME.gov your better route. Two of our licensed staff speak Spanish.
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A licensed advisor prices private PPO and EPO plans for your Maine household and tells you if CoverME.gov looks like the better buy. Free, no obligation. Hablamos español.
Important: Plans sold outside the ACA Marketplace may be subject to underwriting, age limits, state availability and each plan's own eligibility rules. Not all plans are available in all states. Rates are not guaranteed and can change. Benefits, limits and exclusions are set by the official plan document or policy, which controls if it differs from this page. This page is a general summary, not a contract or an offer of coverage.
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