Here’s the Rundown: If you are one of the over 340,000 people who get Medicare in Maine, as of February 2020, you may have some questions about how Medicare works.
Depending on where you live in Maine, you may have a lot of options for how you receive your Medicare coverage. These options may include things like:
- Original Medicare with a stand-alone Part D prescription drug plan
- Medicare Supplement insurance plan to cover out-of-pocket costs
- or an all-in-one Medicare Advantage plan.
Read on to learn about Medicare in Maine.
Original Medicare in Maine
Original Medicare is made up of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
To get Medicare, you have to be
- 65 or older
- A US Citizen or a permanent resident of 5 years
- Or be under 65 and have ESRD or ALS
Disabled individuals can get Medicare no matter how old they are. Their coverage will start after 25 months of getting disability benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB).
When do you enroll in Medicare in Maine?
Most people have enrolled automatically when they turn 65 or have been getting disability benefits for 25 months.
If you don’t get enrolled automatically, you may have to enroll during your Initial Enrollment Period. Three months before you turn 65, includes your birthday month, and ends three months after your birthday month.
If you don’t enroll during your Initial Enrollment Period, you can still sign up for coverage during the General Enrollment Period. But you might have to pay a higher monthly premium.
The General Enrollment Period runs from January 1st through March 31st every year.
You could qualify for a Special Enrollment Period. An example of how you would qualify, would be if you have health insurance through a job or union.
After your insurance ends you could qualify for a Special Enrollment Period and not have to pay a fine for getting Medicare late.
This Special Enrollment Period will last 8 months.
What does Original Medicare in Maine Include?
Under Medicare Part A, you have coverage for:
- Skilled nursing facility care
- Hospital care
- Short-term home health services
- Limited nursing home care
- Hospice care
Part B usually covers things like:
- Doctor visits
- Second opinion before surgery
- Vaccinations, like flu shots
- Ambulance services
- Durable medical equipment, like wheelchairs
- Mental health care
Medicare in Maine: Private Insurance
If you have Original Medicare but want extra coverage, you have these options:
- Medicare Advantage: These plans are another way to get your Original Medicare coverage. Medicare Advantage (MA) plans are sold through private insurance companies contracted through Medicare.
They cover at least the same things as those offered by Original Medicare. Except hospice care, which is still covered by Part A.
Medicare Advantage plans in Maine may also offer additional benefits such as routine vision, hearing, and/or dental coverage.
They also may be available for $0 per month.
Many Medicare Advantage plans include prescription drug coverage.
If you do enroll in Medicare Advantage, you will have to continue to pay for Medicare Part B.
- Medicare Supplement Plans (Medigap): If you decide to stay with Original Medicare, another option you may have is to sign up for a Medigap plan to help pay for Medicare’s out-of-pocket costs. Different health insurance companies offer different Medigap plans that pay different amounts toward out-of-pocket costs.
- Medicare Part D: If you need drug coverage to go along with your Original Medicare, you can get a Medicare Part D plan. These plans help cover prescriptions that aren’t usually covered by Medicare.
Depending on where you live in Maine, you may have different options for Medicare plans than someone else living in the same state or another state.
For example, if you live in Cumberland County you might have varying Medicare plan options than someone who lives in Androscoggin County.
It’s important to search for Medicare plans based on your health and prescription needs, in addition to where you live.
Medicare in Maine Resources
The state of Maine provides the following resources for free:
- State Department of Insurance
- State Department of Health and Human Services
- State Health Insurance Assistance Program (SHIP)
- State Hospice Organization
Learn more about how Medicare plans work in Maine, including: