You’re generally eligible for Medicare healthcare coverage when you turn 65 years old. Medicare is a federal health insurance program that offers plans across the state. Medicare Maine has several coverage options to choose from, so you can pick the best match for your needs.
Take some time to determine your eligibility, research various plans, and find out more about enrolling in Medicare plans in Maine.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Maine for the 2021 plan year:
- A total of 346,777 residents of Maine are enrolled in Medicare.
- The average Medicare Advantage monthly premium slightly increased in Maine compared to last year — from $19.80 in 2020 to $20.67 in 2021.
- There are 52 Medicare Advantage plans available in Maine for 2021, compared to 53 plans in 2020.
- All Maine residents with Medicare have access to buy a Medicare Advantage plan, including plans with $0 premiums.
- There are 12 different Medigap plans offered in Maine for 2021.
At first glance, Medicare can seem complicated. It has numerous parts, various coverage options, and a range of premiums. Understanding Medicare Maine will help you make the decision that’s best for you.
Part A includes:
- hospital care
- limited coverage for skilled nursing facility (SNF) care
- limited coverage for some part-time home healthcare services
- hospice care
Part B is the second part of original Medicare. You may need to pay premiums for Part B. It covers:
- doctors’ appointments
- preventive care
- equipment like walkers and wheelchairs
- outpatient medical care
- lab tests and X-rays
- mental health services
Medicare Advantage in Maine
Part C (Medicare Advantage) plans in Maine are offered through private health insurance carriers that have been approved by Medicare. They provide:
- the same basic coverage as original Medicare (parts A and B)
- prescription drug coverage
- additional services, such as vision, dental, or hearing needs
Some of the carriers of Medicare Advantage plans in Maine are:
- AMH Health
- Harvard Pilgrim Health Care Inc
- Martin’s Point Generations Advantage
Unlike original Medicare, which is a national program, these private insurance providers vary from state to state — even between counties. When searching for Medicare Advantage plans in Maine, be sure you’re only comparing plans that provide coverage in your county.
Medicare supplement plans in Maine
If you need help paying for copayments, coinsurance, and deductibles that are leftover with original Medicare, you can sign up for a Medicare supplement insurance (Medigap) plan.
Many companies offer Medigap plans in Maine in 2021. Some of the companies offering Medigap plans throughout the state include:
As you consider your options, it’s helpful to be aware of eligibility requirements for Medicare plans in Maine. You’ll be eligible for Medicare Maine if you:
- are 65 years old or over
- are under age 65 and have a chronic condition, such as end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)
- are under age 65 and have received Social Security disability benefits for 24 months
- are a U.S. citizen or permanent resident
When can I enroll in Medicare Maine plans?
If you’re eligible for Medicare, you can sign up at certain times during the year. These times include:
- Initial enrollment period. If you’re first eligible when you turn age 65, you can sign up during this 7-month period. It starts 3 months before the month you turn age 65 and ends 3 months after the month of your 65th birthday.
- Medicare open enrollment period. The annual open enrollment period happens between October 15 and December 7. At this time, you can join a Medicare Advantage plan or switch to a new plan.
- Medicare Advantage open enrollment period. If you’re already in a Medicare Advantage plan, you can switch to another one between January 1 and March 31 every year.
Certain life events, such as losing a job that provides you with health coverage, will trigger a special enrollment period. This gives you an opportunity to sign up for Medicare outside of the standard enrollment periods.
Tips for enrolling in Medicare in Maine
As you weigh your options and compare Medicare plans in Maine, follow these tips:
- Find out when you’re eligible for enrollment and, if possible, enroll during your initial enrollment period.
- Speak to your doctor’s office and find out which networks they belong to. Original Medicare covers most doctors; however, privately run Medicare Advantage plans in Maine work with specific network doctors in each county. Make sure your doctor is in the approved network of any plan you’re considering.
- If you’re considering a drug plan or an Advantage plan, make a full list of all your medications. Then, compare this list against the coverage offered by each plan in its formulary to make sure your medications are included.
- Look at how each plan has performed overall, and check the quality ratings or star rating system. This scale shows how well a plan ranked on quality of medical care, plan administration, and member experience. A plan with a 5-star rating performed very well. You’ll likely be satisfied with such a plan if it meets all your other needs.
The following state organizations can provide more information about original Medicare and Medicare Advantage plans in Maine:
- State of Maine Aging & Disability Services. Call 888-568-1112 or find more information online about community and home support, long-term care, and State Health Insurance Assistance Program (SHIP) counseling, as well as advice about Medicare.
- Bureau of Insurance. Call 800-300-5000 or check the website for more information about Medicare benefits and rates.
- Legal Services for the Elderly. For free legal advice about healthcare insurance, Medicare plans, Social Security, or pension benefits, call 800-750-535 or look online.
- More than 300,000 Maine residents are enrolled in Medicare.
- There are several private insurance companies offering various types of Medicare Advantage and Medigap plans throughout the state.
- Overall, monthly premium costs have slightly increased for 2021 Medicare Advantage plans in Maine.
- There are also several Medigap plan options if you live in Maine and are looking for additional coverage.