Medicare Plan Options

Seniors in Maine have a variety of Medicare options from which to choose. If your health is good, Original Medicare is a smart choice. A Medicare Advantage Plan could be a good option if you have more complicated health concerns because Medicare Advantage Plans include extra coverage such as vision, dental, hearing, and some plans include prescription drug coverage. If you select Original Medicare, you might want a prescription drug plan under Part D. Original Medicare and Medicare Advantage don’t provide long-term health coverage.

Original Medicare

Original Medicare is composed of two main parts: Part A covers hospice care, stays in a skilled nursing facility, hospitalization and home health care; and Part B covers doctor’s visits, preventative services, mental health, durable medical equipment and clinical services. With Original Medicare, you pay your monthly Part B premium of $148.50, then your share of an in-patient or an outpatient visit. There are no limits on what you’ll pay out-of-pocket under Original Medicare.

Medicare Advantage Plans

Residents of Maine have 38 different Medicare Advantage Plans from which to choose. However, you can only choose a plan if it’s available in the county in which you live in Maine. Medicare Advantage Plans include Original Medicare’s Parts A and B, along with vision, dental, hearing and some include access to fitness facilities. Many plans provide prescription drug coverage. You can select from one of four different types of Medicare Advantage Plans: HMOs, PPOs, Private Fee-For-Service Plans (PFFS) and Special Needs Plans (SNP). Some plans require referrals to see a specialist or only allow you to see their in-network providers.

Medicare Prescription Drug Coverage Plans

If you select Original Medicare,  you can select a Part D plan if you want prescription drug coverage. The cost of the plan depends on several factors: the tier of the drug, which pharmacy you use, and whether the company that produces a needed drug offers financial assistance to lower the price. Many Medicare Advantage Plans include prescription drug coverage. When you enroll in Medicare, you’ll be given the choice to choose a Part D plan. If you decide not to enroll or don’t have prescription drug coverage under a Medicare Advantage Plan, you can enroll later, but you may have to pay a penalty.

Medicare Supplemental Insurance Programs

Original Medicare might not cover all your medical costs. If you don’t want to get a Medicare Advantage Plan or aren’t happy with the selection of your county, consider a Medicare Supplemental Insurance Plan, also known as Medigap. These plans pay for copayments, coinsurance and deductibles, as well as some excess Part B costs. A Medigap plan will not, however, cover Part B’s $148.50 a month premium. If you need to travel outside the country and want some medical coverage, this can be provided by many Medicare Supplemental Insurance Plans. Medigap only supplements Original Medicare. It does not work with any Medicaid Advantage Plan.

Medicare in Maine By the Numbers

People enrolled in Original Medicare  Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
195,487 Plan A: $0 to $471 per month*

Plan B: $148.50 per month**

$8,841 -12%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Maine

It’s not always easy to choose the right Medicare option. When you approach your 65th birthday and begin to receive the many flyers and advertisements that detail the features of Original Medicare or promote Medicare Advantage Plans, it can be a bit overwhelming. However, Maine is home to several organizations whose purpose is to help guide seniors, their families or their caregivers towards good choices when selecting their Medicare plan.

Maine Association of Area Agencies on Aging (AAA)

Area Agencies on Aging are coordinating offices for many resources and information for seniors in their local communities. AAA offices help seniors understand their Medicare options and aid seniors who need public or private long-term care resources. They also work with other local agencies to address the needs of local seniors and advocate for improved services on their behalf.

Contact Information: Website | 877-353-3771

Maine State Health Insurance Assistance Program (SHIP)

The Maine SHIP program provides seniors with a chance to talk on the phone or in person with a trained health insurance counselor who can answer their health care questions and help them better understand their Medicare benefits. These SHIP services are provided free and are confidential. Counselors will never recommend a particular policy or try to sell insurance. They will, however, provide you with information about Medicare and other health care options, including ways to lower the cost of prescription drugs and other medical expenses.

Contact Information: Website | 877-353-3771

Senior Medicare Patrol (SMP)

A statewide program, the Senior Medicare Patrol works to educate Maine seniors, their families or their caregivers about how to detect, prevent or report errors, fraud or abuse in their Medicare coverage. The SMP holds community outreach programs across the state, and their trained volunteers are available to work one-on-one with Medicare beneficiaries.

Contact Information: Website | 877-353-3771

A high-quality legal volunteer organization, Legal Services for the Elderly, has a special Medicare Part D appeals unit. The unit works to help senior Maine residents and the disabled negotiate Medicare Part D appeals when you are denied coverage for a drug under your Part D plan. This help is provided free of charge.

Contact Information: Website | 800-750-5353

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