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Medicare in Maine

October 6, 2016

Maine Medicare beneficiaries are eligible for a number of health benefits under Original Medicare, Part A (hospital insurance) and Part B (medical insurance). In addition, in Maine, as in other states, you have the option of receiving Medicare benefits through an alternative means by enrolling in Medicare plans offered by private insurance companies.

Original Medicare for Maine beneficiaries

Original Medicare is made up of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). To enroll in Original Medicare, you must be 65 years of age of older and be a US citizen or permanent legal resident of at least five continuous years; or have end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals can get Medicare regardless of age, beginning the 25 month after receiving disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board.

The federal government enrolls most Medicare-eligible people automatically when they turn 65 or collect disability benefits for the specified length of time. If you aren’t enrolled automatically, in most cases you may enroll in Original Medicare three months before you turn 65, your birthday month, and three months after your birthday month. This is the seven-month Medicare Initial Enrollment Period. If you fail to enroll in Original Medicare during the Initial Enrollment Period, you can still sign up for coverage during the General Enrollment Period, which runs from January 1 to March 31 each year, but you may have to pay a late enrollment penalty in the form of higher premiums.

In some cases you may qualify for a Special Enrollment Period for Part A and/or Part B.  If you have group health coverage through an employer or union, you may delay your enrollment in Medicare Part A and/or Medicare Part B without incurring a penalty. You may then enroll in Medicare during a Special Enrollment Period when your group health coverage ends; you will have 8 months after your coverage ends to enroll.

Enrollment in Medicare Part A is free for most people, but you may have to pay a monthly premium if you didn’t work at least 10 years and make contributions into Medicare through Medicare taxes.  Under Medicare Part A, Medicare beneficiaries in Maine are eligible for the following benefits:

  • Skilled nursing facility care
  • Inpatient hospital care
  • Short-term home health services
  • Limited nursing home care
  • Hospice care

In Maine, as in other states, medical insurance is available under Medicare Part B, at a monthly premium, published by Medicare yearly. Medicare beneficiaries may also have to pay an income-related monthly adjustment fee if their income is higher than a certain limit set by Medicare. Part B generally provides benefits including, but not limited to:

  • Physician care
  • Second opinion when your doctor advises surgery
  • Vaccinations such as flu shots
  • Ambulance services
  • Durable medical equipment
  • Mental health services (inpatient, outpatient, and partial hospitalization)
  • Certain outpatient prescription drugs
  • Medicare-approved clinical research studies

You can apply for Medicare benefits through the Social Security Administration (SSA). If you are applying for retirement benefits, you can enroll in Medicare at the same time. You can apply:

  • Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA benefits as well) can use this application.
  • By calling Social Security at 1-800-772-1213.If you are a TTY user, you can call 1-800-325-0778. SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
  • In person at a local Social Security office. To look up office locations in Maine, click here.

Medicare private insurance in Maine

If you’re currently enrolled in Original Medicare but wish to enroll in a private Medicare insurance plan, you have several options:

  • You can sign up for a Medicare Advantage plan as an alternative way to receive Original Medicare coverage. Medicare Advantage plans are available through private insurance companies contracted with Medicare. They are required to cover at least the same hospitalization and medical benefits 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.
  • Many Medicare Advantage plans also include prescription drug coverage. These plans, known as Medicare Advantage Prescription Drug plans, combine health and prescription drug coverage into one comprehensive private insurance plan.

Maine Medicare beneficiaries should be aware that if they decide to enroll in any type of Medicare Advantage plan, they have to stay enrolled in Original Medicare and continue paying the Medicare Part B premium. Failure to pay the Medicare Part B premium may result in a permanent loss of health insurance coverage.

  • If you decide to stay with Original Medicare (Part A and Part B), another option you may have where you live in Maine is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Offered by private insurance companies, different Medicare Supplement plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
  • If you’re interested in receiving Medicare prescription drug coverage (Part D) and you don’t think a Medicare Advantage Prescription Drug plan is suitable to your circumstances and needs, you may enroll in a stand-alone Medicare Part D Prescription Drug Plan. Offered by private insurance companies contracted with Medicare, stand-alone Medicare Part D Prescription Drug Plans provide prescription drug benefits.  While the costs of stand-alone Medicare Prescription Drug Plans in Maine vary among insurance companies and from one area to the next, most will require you to a pay a monthly premium, annual deductible, and copayment or coinsurance.

A Maine resident may have different Medicare plan offerings than a resident of another state; similarly, a resident of Cumberland County may have different Medicare plan offerings than a resident of Androscoggin County. In this regard, it’s important to customize your search for Medicare plans based on your individual health and prescription needs, and also the county in which you live.

Maine resources for Medicare beneficiaries

The state of Maine provides the following resources at no cost to you.

Learn more about how Medicare plans work in Maine, including: