Medicare in Maine
- Review the Medicare plans available in Maine and find out more about where you can get information about and apply for these plans.
What Maine Medicare Plans Are Available
Maine residents who meet federal eligibility requirements may be qualified to receive health insurance coverage through Medicare. In fact, in 2020, 345,205 Maine seniors received benefits through the program, with 210,664 beneficiaries enrolled in Original Medicare and 134,541 beneficiaries enrolled in Medicare Advantage. Applicants have several options when enrolling in Medicare.
Original Medicare is a federally governed program that provides comprehensive healthcare benefits to seniors and other qualifying individuals. The program consists of two components — Part A and Part B — each offering a different suite of benefits.
Medicare Part A covers expenses related to inpatient care, which includes medical services, room and board. Coverage includes but is not limited to the following categories:
- Home health care
- Inpatient psychiatric care
- Short-term post-acute care or rehabilitation
- Skilled nursing facility stays.
Medicare Part B covers outpatient care and general medical services. Coverage includes, but is not limited to the following services:
- Preventative care, including routine checkups, vaccinations and diagnostic services
- Medical transportation
- Medical care and supplies required to treat an illness or injury
- Limited mental health care
- Outpatient drug and alcohol rehabilitation services
- Medications dispensed in a clinical setting, such as IV antibiotics
Sometimes referred to as Medicare Part C, Advantage plans offer seniors an alternative to Original Medicare. MA plans provide all-in-one benefits that cover inpatient and outpatient care, and they often include prescription coverage and extras such as hearing, dental and vision benefits. Part C coverage is provided by private insurers operating under Medicare-designated guidelines.
Medicare Advantage offers beneficiaries an array of coverage options, including:
- HMO plans, which require members to select a primary care physician and stay in-network for care but typically have fewer out-of-pocket costs
- PPO plans, which let members seek care from the physician and facility of their choice, although costs vary between in- and out-of-network providers
- PFFS plans, which let members receive care from any physician that agrees to the terms of the plan
- SNPs, which limit membership to beneficiaries with specific medical needs and tailor their networks to meet enrollees’ unique healthcare requirements.
Part D is Medicare’s prescription drug coverage plan. This optional component, which may be added to a Part A or B plan, pays for part or all of enrollees’ prescription medication costs. Many Medicare Advantage plans already come with prescription drug coverage bundled in.
Medicare Supplement Insurance (Medigap)
Medigap plans, which are also known as Medicare Supplement Insurance, are policies you can purchase from private insurers to work alongside your Medicare plan. They’re designed to cover out-of-pocket costs associated with Original Medicare such as:
Depending on the terms of the plan you choose, Medigap may fully cover these costs or they may pay for a percentage of them.
Who Is Eligible for Maine Medicare?
People aged 65 or older are eligible to receive benefits through Maine Medicare. The program is also available to younger individuals with qualifying disabilities or end-stage renal disease. Enrollment may occur automatically or by application during predetermined enrollment periods.
If you’ve been receiving retirement benefits from Social Security or the Railroad Retirement Board for four or more months prior to your 65th birthday, you’ll automatically be enrolled in Medicare Parts A and B beginning the first day of the month you turn 65.
If you're not eligible for automatic enrollment, you'll need to apply during one of Medicare's enrollment periods.
- Initial Enrollment Period: You may sign up for Medicare during your 7-month Initial Enrollment Period, which begins 3 months before the month of your 65th birthday.
- General Enrollment Period: If you’re missed your IEP, you may also sign up for Original Medicare during the yearly General Enrollment Period, which runs from January 1 through March 31.
- Special Enrollment Period: Applicants who experience qualifying circumstances, such as the loss of employer-sponsored private insurance, may qualify for a Special Enrollment Period. The SEP lasts for 8 months, beginning the month after the qualifying event. Enrollees who qualify for an SEP won’t typically have to pay a late-enrollment fee.
Signing Up for Medicare Advantage and Part D Prescription Drug Plans
Applicants who are interested in enrolling in a Medicare Advantage plan may sign up for one during the 7-month Medicare Initial Enrollment Period. For beneficiaries who want to enroll at a later time, or who wish to switch between Original Medicare and Medicare Advantage, the program has an Annual Enrollment Period between October 15 and December 7. If you have Original Medicare and haven’t signed up for a Part D plan, you may also do so at this time.
A second enrollment period runs from January 1 to March 31. During this period, enrollees may switch from one plan to another or return to Original Medicare.
How Do I Enroll in Medicare in Maine?
Unless you qualify for automatic enrollment, you may sign up for Medicare using the online form that’s available through the Social Security Administration. You may also apply by phone at (800) 772-1213 or in person by visiting your local Social Security office. The application typically takes fewer than 10 minutes and doesn't require supporting documentation.
Contact Information for Maine Medicare, Medicaid and Insurance Help
Understanding the fundamentals of federal and state health insurance programs can be challenging. If you’re having trouble navigating your options, help is available through the following agencies:
- HelpAdvisor: This organization provides advice and resources to help Maine citizens find suitable health insurance. You can speak with a HelpAdvisor benefits expert by filling out an online form or emailing contact@HelpAdvisor.com.
- The Maine State Health Insurance Assistance Program (SHIP): If you need help applying for Medicare, SHIP offers free, confidential assistance to seniors and individuals with disabilities. Trained SHIP counselors are available by calling (800) 262-2232 or emailing OADS@maine.gov.
- State of Maine Bureau of Insurance: Staff at Maine’s Bureau of Insurance is available to answer questions about Medicare and other types of insurance and to handle insurance-related complaints. The agency may be reached by phone at (800) 300-5000 or by email at firstname.lastname@example.org.
- Alpha One: Individuals with disabilities can learn more about Medicare by contacting Alpha One. The agency provides information, resources and referrals for people with disabilities as well as their families and caregivers. You can speak with someone by calling or emailing one of the agency's statewide locations.
Maine Low-Cost Drugs for the Elderly or Disabled Program (DEL): DEL pays for up to 80% of the remaining out-of-pocket expenses for prescription drugs after Part D. Maine residents may apply for DEL by filling out a brief online application. More information is available through your local Agency on Aging.