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Medicare Plans in Maine
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Finding 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 Different Medicare Plans in Maine?

Original Medicare Part A and 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.

Read more about Medicare Advantage Plans here »

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.

Read more about Medicare Prescription Drug Plans here »

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.

Read more about Medicare Supplement Plans here »

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 (IEP)

Key Fact: The General Enrollment Period (GEP) allows you to enroll in Original Medicare if you missed your IEP. This period occurs from January 1st to March 31st every year. Immediately following this period, you’ll be able to select a Medicare Advantage plan from April 1st to June 30th each year.

Medicare Supplement Plans

Once you’ve enrolled in both Medicare Part A and B, you can select the Medigap plan of your choice during your Medigap Open Enrollment Period. The enrollment period is a 6-month period that begins the month you are both 65 or older and enrolled in Medicare Part B.

Important Note: If you fail to enroll in a Medigap plan during your Medigap Open Enrollment Period, you’re subject to higher premiums or denial of coverage entirely.

Special Enrollment Periods

Some major life changes, like moving into a new coverage area or transferring to or from a care facility, are qualifying life events for a Special Enrollment Period (SEP). A Special Enrollment Period allows you to enroll or make changes to your coverage outside of the standard enrollment times. Our licensed insurance agents can help determine your eligibility for a Special Enrollment Period.

How Can I Compare Plans?

Our goal is to make it convenient for you to find the ideal coverage for your particular needs. We’ll help you sort through your options to find the right coverage for you and your budget. You can compare plans and enroll online by using the form below, or by calling us to speak with a licensed insurance agent.

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

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Disclaimers: Outside of the Medicare Annual Enrollment Period, members can enroll in a plan only if they meet certain criteria. A licensed insurance agent can help you determine whether you are eligible. Plan availability varies by region and state. Callers will be directed to a licensed insurance agent with a third-party partner of Medicarematchup.com who can provide more information about Medicare Advantage plans offered by one or several Medicare-contracted carrier(s). Enrollment in any plan depends on contract renewal. Medicare has neither reviewed nor endorsed the information contained in this advertisement. Not connected with, or endorsed by, the U.S. government or the federal Medicare program. This information is not a complete description of benefits. For a complete listing of Medicare plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week, or consult www.medicare.gov.