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.
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.
Medicare Part A
Part A includes:
- hospital care
- limited coverage for skilled nursing facility (SNF) care
- limited coverage for some part-time home healthcare services
- hospice care
Medicare Part B
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 Part C
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
Medicare Part D
Part D is prescription drug coverage offered through private insurance carriers. It provides coverage for your prescription medications.
Each plan covers a different list of drugs, known as a formulary. So, before enrolling in a Part D plan, you’ll need to make sure your medications will be covered.
If you enroll in original Medicare, you will receive government-sponsored health insurance coverage for a set list of hospital and medical services.
Medicare Advantage plans in Maine, on the other hand, offer unique coverage options and several premium levels, all designed to match the needs of older adults. 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.
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
You’ll be eligible to receive premium-free Part A coverage through Medicare Maine if you:
- paid Medicare taxes for 10 of your working years
- receive retirement benefits from either Social Security or the Railroad Retirement Board
- were a government employee
Initial enrollment period
The best time to enroll in Medicare plans in Maine is during your initial enrollment period. This allows you to get the coverage you need from the moment you turn 65 years old.
Your initial enrollment period is a 7-month window that begins a full 3 months before your 65th birthday, includes your birth month, and continues for an additional three months after your birthday.
If you qualify for Social Security benefits, you’ll automatically be enrolled in original Medicare Maine.
During this time frame, you can enroll in a Part D plan or a Medigap plan.
General enrollment: January 1 to March 31
Medicare coverage should be reevaluated every year as your healthcare needs change or as plans change their coverage policies.
The general enrollment period is from January 1 to March 31. It allows you to sign up for original Medicare if you haven’t already done so. You can also use this time to enroll in Medicare Advantage plans or Part D coverage.
Open enrollment period: October 15 to December 7
The open enrollment period lasts from October 15 to December 7. It’s another time when you can change coverage.
During this period, you’ll be able to switch between Medicare Advantage plans in Maine, return to original Medicare coverage, or enroll in prescription drug coverage.
Special enrollment period
Some circumstances allow you to enroll in Medicare Maine or make changes to your plan outside of these standard enrollment periods. You may qualify for a special enrollment period if you:
- lose your employer health insurance coverage
- move out of your plan’s coverage area
- move into a nursing home
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.
As you near your 65th birthday, start finding out more about Medicare plans in Maine and compare your coverage options. You may also want to do the following:
- Think about the healthcare services you’d like to access, and find a plan that matches not only your budget, but your healthcare needs as well.
- Use your ZIP code when searching for plans to make sure you’re looking at only those available to you.
- Call Medicare, or an Advantage plan or Part D provider, to ask any follow-up questions and begin the enrollment process.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.