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Medicare Advantage in Maine

Last Updated on

October 6, 2016

If you’re a Medicare beneficiary in Maine, you have alternative ways to receive your Medicare benefits besides Original Medicare Part A and Part B, the program administered by the federal government. For example, did you know that you can get your Medicare Part A (hospital insurance) and Part B (medical insurance) benefits through the Medicare Advantage (Part C) program? Medicare Advantage plans are offered by private insurance companies contracted with Medicare to provide Medicare benefits to beneficiaries. Medicare Advantage plans may be available in Maine depending on where you live.

How Medicare Advantage works in Maine

In Maine, as elsewhere in the United States, Medicare Advantage plans are required to offer at least the same medical and hospitalization benefits as Original Medicare, Part A and Part B, with the exception of hospice care, which remains covered under Part A. In addition, some Medicare Advantage plans offer extra benefits, like routine dental coverage, routine vision coverage and/or prescription drug coverage, allowing you to enjoy a wider-range of covered services than those available to you under Original Medicare.

To sign up for Medicare Advantage in Maine, as in any other state, you must be enrolled in Original Medicare, Part A and Part B. You need to live in the Medicare Advantage plan’s service area. In most cases you are ineligible to join a Medicare Advantage plan if you have end-stage renal disease because provisions under Original Medicare provide coverage for kidney failure.

You’ll want to be alert to the enrollment time frames. There are specified times when you can sign up for a Medicare Advantage plan.

Your first chance to enroll in a Medicare Part C plan is during your Initial Coverage Election Period (ICEP). The Initial Coverage Election period is usually the same as the Initial Enrollment Period (the period of time during which you first become eligible for Medicare Part A and Part B).  The Initial Coverage Election period begins three months before you turn 65, includes your birthday month, and ends three months after your birthday month.

If you miss your ICEP, you have another opportunity to join a Medicare Advantage plan where you live in Maine. You can enroll in  a Medicare Advantage plan, or change Medicare Advantage plans  during the Annual Election Period (also called the Fall Open Enrollment season), which runs from October 15 to December 7 each year. Your new coverage goes into effect on January 1 of the following year. You may be able to make other changes to your Medicare coverage during the Annual Election Period.  For example, if you choose a Medicare Advantage plan that does not include Medicare prescription drug coverage, you can enroll in a stand-alone Medicare Part D Prescription Drug Plan during this time frame.

If you experience certain changes in your life that impact your Medicare coverage, you may be able to enroll in a different Medicare Advantage plan or enroll in a Medicare Advantage plan for the first time. For example, if you changed your place of residence and moved outside your Medicare Advantage plan’s service area, you’re required to select a new Medicare Advantage plan that provides coverage where you live or change to Original Medicare. You can make this change during a Special Election Period. These situations include, but are not limited to: changing your place of residence; losing your current coverage; or being affected by health benefit changes in your current plan. Special Election Periods may vary, depending upon your particular circumstances and  the reason you need to change plans.

If you’re enrolled in a Medicare Advantage plan in Maine (or any other state), but decide to switch back to Original Medicare, Part A and Part B, you may do so during the annual Medicare Advantage Disenrollment Period. This runs from January 1 to February 14, and you can add a stand-alone Medicare Part D Prescription Drug Plan during this time.

Types of Medicare Advantage plans in Maine

There may be several types of Medicare Advantage plans in Maine to choose from, depending on your zip code. Here’s a brief look at the different kinds of Medicare Advantage plans:

  • Health Maintenance Organization (HMO): An HMO plan usually requires you to visit doctors, health providers, and hospitals participating in your plan’s network to receive benefits from the plan unless you require emergency care. You may also have to get a referral from your primary care physician to receive coverage for certain health services.
  • HMO Point-of-Service: A more flexible option, an HMO-POS plan typically provides coverage if you go out-of-network for some health services, but usually your out-of-pocket cost is higher when you receive covered services from a provider who is not in the plan’s network than your cost when you receive care from a provider participating in the plan’s network.
  • Preferred Provider Organization (PPO)*: Most PPO plans let you choose doctors, health-care providers, and hospitals outside your plan’s network, but at a higher cost. This may be a more flexible option when compared to HMO and HMO-POS plans.
  • Private Fee-for-Service (PFFS): A PFFS plan usually reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits. The plan itself generally determines your share of each expense. Keep in mind that not all providers accept this plan, make sure you check with the provider before receiving services.
  • Medicare Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account. You can use the savings account to pay for your health-care expenses.
  • Medicare Special Needs Plan (SNP): A Medicare SNP is designed for beneficiaries with special situations or health needs, offering coverage tailored to suit those patients’ needs. There are Medicare SNPs for patients who qualify for both Medicaid and Medicare; who live in institutions, such as nursing homes; or who have health conditions including but not limited to dementia, diabetes, and HIV/AIDS.

Medicare Advantage Prescription Drug plan:  This type of Medicare Advantage plan combines health and Medicare prescription drug coverage into a single insurance plan. Keep in mind that even if you decide to enroll into a Medicare Advantage plan, you have to continue paying your Medicare Part B premium in order to retain your health coverage.

Comparing Medicare Advantage plans available in Maine

As a Medicare beneficiary in Maine, you may find it useful to compare Medicare Advantage plans available in your area.

The availability and cost of Medicare Advantage plans generally vary depending on your county of residence, the company offering  the plan, and the plan coverage details. Premiums for a Medicare Advantage plan with the same coverage and benefits might vary between different counties within the state of Maine. You may find that some Medicare Advantage plans in Maine offer premiums as low as $0. You will probably want to consider other costs besides the premium, however. Compare plans’ deductibles and coinsurance as well. Keep in mind to note if the Medicare Advantage plans have networks of participating providers. If so, check to see if your doctors, other health professionals and preferred hospital participate in the plan’s network.

Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B. You can decide if the extra benefits offered by a Medicare Advantage plan serving your area of Maine are valuable to you. For example, consider whether you would prefer to have Medicare prescription drug coverage included in your Medicare Advantage plan. If so, look for a Medicare Advantage Prescription Drug plan.

With all these options available in Maine, you can see why it  is prudent to examine and compare plans carefully to see which Medicare Advantage plan is best suited to your individual needs.

To start comparing Medicare Advantage plans in Maine, enter your zip code above for a customized list of plans available in your area. You can also enter your medications to further refine your search and cost estimates.

For additional information about Medicare in Maine, you can follow any of these links:

* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.