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 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:
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:
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:
If you’re currently enrolled in Original Medicare but wish to enroll in a private Medicare insurance plan, you have several options:
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.
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.
The state of Maine provides the following resources at no cost to you.
Learn more about how Medicare plans work in Maine, including: