Medicare Advantage Plans in Maine

Fact Checked
Published: June 18, 2021

Medicare Advantage is also known as Medicare Part C. Unlike Original Medicare, which is managed by the federal government, Medicare Advantage is offered by private health insurance companies. Medicare Advantage Plans provide all of the same coverage that comes with Original Medicare Parts A and B, and many of these plans also offer additional coverage, such as dental, vision, hearing, and prescription drugs.





  • In 2019, there were 38 Medicare Advantage Plans available in Maine.
  • 30% of the total Medicare population in Maine is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $8,841 per beneficiary in Maine, which is 12% below the national average.
  • Available Medicare Advantage Plans range from 24 to 34 across Maine’s 16 counties.

There are several types of Medicare Advantage Plans in Maine with different levels of service, copays, premiums, and deductibles. Your ability to select a particular program depends on where you live and the Medicare Advantage Plans offered. You can only select a plan that’s available in your service area, regardless of whether another plan seems like the better choice.

Medicare Advantage Plans in Maine

Types of Medicare Advantage Plans

Maines Medicare Advantage program offers four different types of plans, including HMOs, PPOs, PFFS plans, and SNPs. Each of these plan types come with their own rules about which doctors you can see and whether you need referrals to see a specialist. These plans also have different premiums, copays, and deductibles. Take time to research each plan type so you can find the right fit for your health care and budget requirements.

Health Maintenance Organizations (HMO)

With an HMO plan, you’ll pay less for your health care than with other plans. These plans require you to obtain care from the plan’s in-network providers, choose a primary care physician, and get referrals to see specialists. In some cases, you may need to continue to pay Part B premiums. You may also need to pay Part A premiums if neither you nor your spouse has paid Medicare taxes for at least a decade. Some, but not all, HMO plans include prescription drug coverage.

Preferred Provider Organizations (PPO)

PPO plans are more flexible than HMOs. While you can still use in-network providers, you have the option of seeking out-of-network care. However, you might incur an extra charge when doing so. You won’t need to choose a primary care physician or obtain referrals to see a specialist. Most PPO plans offer additional benefits, such as vision, hearing, and dental, and many also offer prescription drug coverage.

Private Fee-For-Service Plans (PFFS)

With a PFFS plan, the insurance company decides how much you pay for care and how much it pays. While most PFFS plans offer a network of providers who will only treat people with your plan, you can use any health care provider who accepts the terms of your plan. Not every provider will accept it, but all health care providers must accept your plan in an emergency. Most PFFS plans offer prescription drug coverage.

Special Needs Plans (SNP)

SNPs design their plans to best suit the health care needs of a specific group, including people who qualify for both Medicare and Medicaid, seniors who live in nursing care, and those who have diseases, such as AIDS, end-stage renal disease (ESRD), or cancer. Most SNPs require you to select a primary care physician and obtain a referral to see a specialist. These plans are legally required to provide prescription drug coverage.

Enrollment and eligibility for Medicare Advantage Plans in Maine

Eligibility

You must be aged 65 or older or younger with a qualifying disability, be a U.S. citizen or a permanent resident for the past five years, and be enrolled in Original Medicare Parts A and B but not in Medigap. Medigap, also known as a Medicare Supplement Insurance Plan, doesn’t work with any Medicare Advantage Plan.

Enrollment periods

  • Initial Enrollment period. This period starts three months before turn 65, includes your birth month, and continues for the three months following your birthday.
  • Open Enrollment period. During this period, which runs from October 15th and December 7th, you can switch from Original Medicare to a Medicare Advantage Plan or return to Original Medicare. You can also switch between different Medicare Advantage Plans.
  • Medicare Advantage Open Enrollment period. This period runs from January 1st to March 31st. During this period, you can switch between Medicare Advantage Plans or you can return to Original Medicare. However, you can’t switch from Original Medicare to a Medicare Advantage Plan. If you haven’t previously signed up for Medicare Part B, you can do so during this period. You can then select a Medicare Advantage Plan between April 1st and June 30th, and your coverage will start on July 1st.

You may be eligible for a Special Enrollment period if you move, lose your current coverage, or become eligible for an SNP.

Prescription drug coverage

Many HMO and PPO plans include prescription drug coverage, although some plans require you to pay an extra premium for this service. If the price is already included, that plan may be more expensive than other plans. If your HMO or PPO plan doesn’t include prescription drug coverage, you can’t purchase a separate Medicare Part D plan. If you do, you’ll be expelled from Medicare Advantage and returned to Original Medicare. Most PFFS plans include prescription drug coverage, but if your plan doesn’t, you can purchase a separate Medicare Part D drug plan. SNPs are legally required to provide prescription drug coverage.

Medicare Advantage Resources in Maine

Deciding between Original Medicare and a Medicare Advantage Plan can be a bit overwhelming. Maine has several organizations that provide free, unbiased counseling to help you, your family, or your caregiver make a good choice when it comes to selecting your Medicare plan.

Maine Association of Area Agencies on Aging (AAA)

Area Agencies on Aging connect seniors with information and resources in their local communities about both public and private long-term care resources. Available services include providing nutritious meals for needy seniors or transporting them to medical appointments. Counselors can also help you better understand your Medicare options through one-on-one counseling. The agency works with other local agencies to help provide for the needs of seniors in their communities and advocate for improved services on their behalf.

Contact Information: Website | 877-353-3771

Maine State Health Insurance Assistance Program (SHIP)

Through the Maine SHIP program, you can consult a trained health insurance counselor on the phone or in person, who can answer your health care questions and help you better understand your Medicare options. Counselors can also provide you with free and unbiased information about Medicare, Medicare Advantage, and Medicaid.

Contact Information: Website | 877-353-3771

Senior Medicare Patrol (SMP) 

Senior Medicare Patrol is a statewide program that works to educate you, your family, or your caregiver on how to detect, prevent, and report errors, fraud, or abuse in your Medicare coverage. The SMP conducts community outreach programs across the state, but their trained volunteers are also available to work one-on-one with you to help you understand when you are being defrauded or abused.

Contact Information: Website | 877-353-3771

Learn from our sources