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Maine.gov > PFR Home > Insurance Regulation > Affordable Care Act (ACA) FAQ > Special Circumstances and Population

 

QUESTIONS INVOLVING SPECIAL CIRCUMSTANCES AND POPULATIONS

Q 95: What is available for consumers with chronic conditions? Will the new law help them get better coverage?

Yes, under the ACA, insurance companies can’t refuse to cover preexisting conditions. The ACA also requires insurance companies in the individual and small employer markets to offer more comprehensive coverage than is currently available for some people with chronic illnesses.  Coverage for these benefits is available from the beginning of the policy coverage period, without a waiting period for that condition, even if there was no prior coverage.

Q 96: What options are there for consumers with children who aren’t citizens or legal residents?

Consumers won’t be able to buy a policy through Maine’s Health Insurance Marketplace for those children who aren’t citizens or legal residents, but they may be able to buy a policy directly from an insurance company or through an agent. Lawfully present children also may be eligible for the MaineCare.

Q 97: Are undocumented immigrants eligible for coverage through Maine’s Health Insurance Marketplace or for premium tax credits?

No, undocumented immigrants aren’t eligible for coverage through Maine’s Health Insurance Marketplace. They also aren’t eligible for advance payment of premium tax credits.

Q 98: Are incarcerated people eligible for coverage through Maine’s Health Insurance Marketplace or for premium tax credits?

People serving prison or jail sentences aren’t eligible for coverage through Maine’s Health Insurance Marketplace. They also aren’t eligible for advance payments of the premium tax credits. However, consumers who have not been convicted and are incarcerated pending the disposition of charges are eligible.

Q 99: Are tribal members eligible for coverage through Maine’s Health Insurance Marketplace or for premium tax credits?

Yes, American Indian/Alaskan Native tribal members may buy coverage through Maine’s Health Insurance Marketplace. They’re also eligible for premium tax credits. And, because of the federal government’s special trust responsibility, members of federally recognized Indian tribes are eligible to receive benefits not available to others, such as plans with no cost-sharing, under certain circumstances. For more information, go to www.healthcare.gov.

Q 100: Does coverage provided through a religious health care sharing ministry satisfy the individual mandate?

Yes, the ACA includes an exemption from the individual mandate for individuals who are members of a health care sharing ministry. Consumers should be aware that unlike a licensed insurer, this type of organization does not guarantee payment of health care claims or expenses.

 

Last Updated: October 8, 2013