If you’re a Medicare beneficiary in Maine, and you have a lot of doctor visits, you might want to know about Medicare Supplement (Medigap) insurance. Medicare Supplement insurance is designed to help Medicare beneficiaries pay for health-care costs associated with Original Medicare, Part A and Part B. There are various Medigap plans available in Maine, depending on your zip code. Read on to learn about Medigap in Maine so you can decide if this type of coverage may fit your personal health and budget needs.
Medigap in Maine (as in the other states) can help you pay for Medicare-related out-of-pocket expenses, like copayments, coinsurance, and deductibles. There are 10 standardized Medicare Supplement plans available in 47 states, including Maine, each of which is identified by one of 10 letters (A, B, C, D, F, G, K, L, M, and N), with plans of the same letter offering the same benefits. For example, Plan K has the same coverage anywhere in Maine (or any state) that this plan is available, and no matter what insurance company you buy it from, although premiums may vary. Three states – Massachusetts, Minnesota, and Wisconsin – offer different types of standardized Medigap plans.
If you want to enroll in Medigap, you must be enrolled in Original Medicare, Part A and Part B. The Medigap Open Enrollment Period starts the first day that you’re both age 65 or older and enrolled in Medicare Part B, and lasts for six months. During the Medigap Open Enrollment Period, you can join any Medicare Supplement policy available in your area, with the insurance company you choose, and you cannot be denied coverage for pre-existing conditions. In most cases, if you decide to join Medigap at a later date, you may be denied coverage or charged more for your insurance plan.
It’s important to understand that Medigap plans in Maine, like those in the rest of the United States, supplement your Original Medicare coverage, so you have to stay enrolled in Original Medicare and keep paying your Medicare Part B premium. If you’d like to buy prescription drug coverage, you may want to consider adding a stand-alone Medicare Part D prescription drug plan, since Medigap plans don’t include this coverage.
Here’s a look at the 10 standardized Medicare Supplement plans that may be available in Maine. In this chart, X indicates that the service (or item) is 100% covered; a percentage indicates what percent of the service/item is covered; and a blank cell indicates it is not covered.
|Medicare Supplement Plans|
|Medicare Supplement Benefits||A||B||C||D||F*||G||K||L||M||N|
|Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B copayment or coinsurance||X||X||X||X||X||X||50%||75%||X||X***|
|First three pints of blood||X||X||X||X||X||X||50%||75%||X||X|
|Medicare Part A hospice care coinsurance or copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled nursing facility care coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B deductible||X||X|
|Medicare Part B excess charges||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%|
|Out-of-pocket limits apply.**|
*Medicare Supplement Plan F offers a high-deductible version in which beneficiaries pay a certain deductible amount before the plan begins coverage. This amount may change from year to year.
**Once you reach the out-of-pocket limits (including the Part B deductible), both Medicare Supplement Plans K and L pay 100% of covered services in the above chart for the remainder of the calendar year.
***Medicare Supplement Plan N pays 100% of the Medicare Part B coinsurance, except for a copayment of up to $20 on doctor visits and up to $50 on emergency room visits that don’t result in an inpatient admission.
As explained above, Medicare Supplement plans in Maine with the same letter designation don’t vary in coverage or benefits. However, each independent insurance company can determine its own monthly premium structure. For example, a resident of Portland in Cumberland County may pay more or less than a resident of Bangor in Penobscot County for an identical Medicare Supplement plan. With the possible differences in costs, it may be a good idea to compare all Medicare Supplement plans available in your area so you can find a Medigap plan that may fit your individual health and budget requirements.
View the following articles to get additional information about Medicare in Maine: