Medicare plays a key role in providing health and financial security to beneficiaries residing in Maine. With more than 344,100 Maine beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Maine. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Maine?

Medicare covers most Maine residents who are 65 or older, and it also covers disabled Maine residents. In general, Medicare enrollment in Maine works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Maine Medicare Enrollments

205,460

Original Medicare Plans
(Part A and B)

138,648

Medicare Advantage & Other Health Plans

255,448

Stand-alone Medicare
Part D (Drug plans)

344,108

Total Medicare Beneficiaries
in Maine

Maine Medicare Advantage Plans (Part C)

About 36% of Maine Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Maine who are already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

As of 2020, 53 Medicare Advantage plans are available in Maine. The average monthly Medicare Advantage premium changed from $22.29 in 2019 to $21.88 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Maine.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 138,648 beneficiaries enrolled in Medicare Advantage and other plans in Maine. About 36% of Maine Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

Maine Medicare Supplement (Medigap) Insurance Plans

Maine has substantial consumer protections related to Medigap coverage.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Maine Medigap insurance is available to everyone with Medicare in the state, including those who are under 65 and are enrolled in Medicare. Often, Medigap plans in Maine can be more expensive if you don’t enroll during your Initial Enrollment Period and wait for an Annual Open Enrollment Period. 

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B.

During this period, an insurance company can’t use medical underwriting. 

As of 2020, there are 15 insurers that offer Medigap plans in Maine. Maine’s substantial Medigap regulations are designed to protect beneficiaries and ensure access to Medigap. To learn more about Maine’s Medigap regulations and provisions, see Maine’s Consumer Guide to Medicare Supplement Plans.

Maine Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of 2020, There are 125,843 Medicare beneficiaries in Maine enrolled in Part D prescription drug plans and 129,605 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 26, Part D plans available in Maine, with premiums ranging from about $15 to $98 per month.

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Maine

  • Senior Medicare Patrol (SMP): SMPs empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. SMPs are grant-funded projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL).
    Contact: Call 1-800-262-2232 or find your local Area Agency on Aging

  • State Health Insurance Program (SHIP): If you have Medicare insurance, or expect to have it soon, you may have questions or need help to understand your Medicare benefits. Trained health insurance counselors are available throughout Maine to provide you information about Medicare and other health insurance issues. You can also learn about programs in Maine that help lower the cost of prescription drugs and other out-of-pocket medical expenses. SHIP services are free, confidential, and available to older people and people who have Medicare because of a disability. SHIP Counselors do not sell insurance or recommend policies.
    Contact: Call 1-800-262-2232

  • Maine Health Insurance Consumer Assistance Program (MHICAP): MHICAP assists seniors and other state residents with a range of health insurance coverage concerns. The Maine Attorney General and the Maine Superintendent designated Consumers for affordable Health Care as the Maine Health Insurance Consumer Assistance Program with the support of a grant from the U.S. Department of Health and Human Services in 2010.
    Contact: Call toll-free 1-800-965-7476, Consumers for Affordable Health Care’s Augusta office at 1-800-838-0388, or by completing the contact form on the CAHC website.

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Maine. Our process makes it easier for you to access your Medicare eligibility in Maine so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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