Medicare Plans in Maine
There are many Medicare options in Maine to choose from. However, sorting through all of the options to find the right coverage can be overwhelming; we don’t think it should be. We’ve created this guide to help navigate you through the different Medicare plans in Alabama so that you may find the coverage you need.
Who’s eligible for a Medicare Plans in Maine?
Medicare is a government-sponsored insurance program that provides health care benefits to those who qualify. Unless there is a qualifying illness or disability, most people become eligible for Medicare once they’ve reached 65 years of age. Qualifying illnesses for those under 65 include Amyotrophic Lateral Sclerosis (ALS) and End-Stage Renal Disease (ESRD). You may also qualify under 65 if you’ve been a recipient of Social Security Disability Insurance (SSDI) for two years.
To be eligible for Medicare, you must be an American citizen or permanent resident, having lived here for at least 5 years. You or your spouse must also have worked and paid Medicare taxes for at least 10 years.
If you have questions about your eligibility and/or options, we can help. Talk to a licensed insurance agent by calling the number above.
What are the Medicare Plans in Maine?
Orginial Medicare Part A & Part B
Original Medicare is the federally-sponsored program, which is comprised of two parts:
Part A (Hospital Insurance) covers certain services, like inpatient hospital care, care received at a skilled nursing facility, and hospice care.
Part B (Medical Insurance) covers outpatient medical services and supplies that are considered medically necessary. Part B also covers some preventive care, like flu shots and cardiovascular screenings.
It is important to note that Original Medicare does not cover everything. For example, Original Medicare generally does not cover prescription medications, hearing exams/hearing aids, long term care received at a nursing home, dental care, eyeglasses, etc. That’s why there are other types of Medicare plans available through Medicare-approved private insurance companies, to find the right level of coverage for your needs.
Medicare Advantage Plans (Part C)
Medicare Part C is an alternative to Original Medicare Parts A and B. Medicare Part C, known as Medicare Advantage plans, offer all the same coverage as Original Medicare Parts A and B (except hospice care, which is still covered by Part A), but can also include additional benefits not covered by Parts A and B, like dental, vision, and prescription drug coverage.
In order to enroll in a Medicare Advantage plan, you must first be enrolled in both parts of Original Medicare. Plan premiums and coverage will vary. In addition to this plan premium, you will also continue paying your Part B premium if you enroll in a Medicare Advantage plan.
Medicare Prescription Drug Plans (Part D)
Medicare Prescription Drug plans, or Medicare Part D, provide coverage for prescription medications. These plans are provided and coordinated by private insurance companies contracted with Medicare. Any beneficiary can sign-up for Medicare Part D if they’re eligible for Original Medicare, Part A and/or Part B and permanently reside in the service area of a Medicare Prescription Drug Plan. Medicare Prescription Drug coverage is optional, but if you don’t enroll in Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later.
Medicare Part D can come in the form of a stand-alone Medicare Prescription Drug Plan, working alongside Original Medicare, or with a Medicare Advantage plan known as a Medicare Advantage Prescription Drug Plan.
Out-of-pocket expenses for prescription drugs and monthly plan premiums will vary from plan to plan. Each medication covered by a Medicare Prescription Drug plan has a set cost in the form of a co-pay or coinsurance according to a tiered system. Every Medicare Prescription Drug plan has a formulary for your reference, allowing you to pick the plan with the lowest cost and best value for your prescription needs.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans work alongside Original Medicare Parts A and B to provide additional coverage. These plans are available through private insurance companies contracted with Medicare. Medicare Supplement plans are commonly referred to as “Medigap” because they help fill in coverage gaps. Medigap plans can help reduce your out-of-pocket costs by paying for certain healthcare costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
When Can I Enroll In A Plan?
Medicare Advantage and Medicare Prescription Drug Plans
You are first eligible to sign up for Medicare plans in Maine during your Initial Enrollment Period (IEP). Your IEP starts three months before your 65th birthday month and continues for an additional three months. This means you have a total of seven months to enroll.
After your IEP, you can make adjustments to your Medicare Advantage and Medicare Prescription Drug coverage during the Annual Election Period (AEP). This period begins October 15th and ends December 7th every year.
Medicare Initial Enrollment Period
7-Month Initial Enrollment Period | Begins 3 months before the month you turn 65
*Signing up for Parts A and B during months 5,6, and 7 may result in delayed coverage.
KEY FACT: The General Enrollment Period provides you an opportunity to enroll in Original Medicare if you missed your IEP. This period occurs every year from January 1st to March 31st. Then, you’ll have an opportunity to select a Medicare Advantage Plan from April 1st through June 30th.
Additional Medicare Resources in Maine
Trained health insurance counselors are available through Maine’s state health insurance assistance program (SHIP). SHIP is a free service for Medicare beneficiaries in Maine that provides free counseling to help them better understand their options and lower their out-of-pocket expenses.
MaineCare is available to help pay for certain medical expenses for Medicare beneficiaries who cannot afford to pay their medical bills.
Sources: Medicare.gov; www.maine.gov