Medicare is a federal health insurance program for Americans who are over the age of 65, diagnosed with ALS or ESRD, or Social Security Disability Income recipients (for at least 25 months). The federal program is the same nationwide, but additional private plans (Medicare Advantage and Medicare Supplements) may be available in your area. In Maine, you may have quite a few options to sort through when it’s time to select your Medicare coverage, and it can get confusing. That’s what we’re here for.
Your costs for Medicare in Maine will depend on what coverage you enroll in and what savings programs you are eligible for. The federal Medicare program (parts A and B) generally pays for 80% of covered services, leaving you responsible for 20%. You also might owe some premiums and deductibles.
If you want coverage for your Original Medicare out-of-pocket costs, you can find that through certain Medicare Supplement plans.
The Part B deductible in 2019 is $185, and the premiums range from $135.50 per month to $460.50 per month (depending on your income). The Part A hospital benefit deductible is $1,364 in 2019, and the Part A premiums range from $0 to $437 per month based on how much you’ve worked and paid Medicare taxes throughout your life.
Original Medicare in Maine is the same as Original Medicare nationwide. Original Medicare consists of Part A, hospital coverage, and Part B, medical coverage. Part A covers things like hospital visits, hospice, and some home health services. Part B covers things like preventative wellness, mental health, lab tests/X-rays, durable medical equipment, and emergency transportation. If you’re looking for additional coverage, like for dental, prescription drugs, etc., you’ll need to invest in another form of coverage on top of your Medicare coverage.
If you’re looking for coverage beyond Original Medicare (parts A and B), you’ll need to compare Medicare Advantage, Medicare Supplements, and Prescription Drug Plans. We have a Medicare Plan Finder tool that can help you get started.
Maine Medicare Advantage Plans (MA)
You may have a choice between several different Maine Medicare Advantage plans, depending on where you live. Medicare Advantage plans are able to cover benefits that Original Medicare can’t, such as prescription drug coverage, fitness benefits, dental and vision, and more. Some MA plans are available for a $0 premium, but others will have premiums ranging anywhere from $30 to $300 per month. MA plans can be different in every state, county, and zip code.
Maine Medicare Supplement Plans (Medigap)
If Medicare Advantage isn’t right for you, Maine Medigap plans might be. Medigap plans, or Medicare Supplements, do not usually add health benefits like MA plans. Instead, they offer financial protection.
With a Medigap plan, you will owe a monthly premium. That premium can cover costs like copayments when you visit the doctor, your deductible when you have to stay in the hospital, etc. There are many different types of Medigap plans that cover different types of costs. Use our Medicare plan finder comparison tool to decide which cost coverage you need and which plan is best for you.
Maine Prescription Drug Plans (PDPs)
If you decided that Medicare Advantage plans with prescription drug coverage are not for you, you can enroll in a private prescription drug plan instead. Remember, Original Medicare does NOT include coverage for prescriptions, so this is crucial.
A PDP, or prescription drug plan, is a separate plan that you can have in addition to Original Medicare. You’ll pay a separate premium for it, with different copayments and deductibles according to your plan. Your PDP will come with a “formulary” that lists all the drugs that you are covered for and how much is covered.
You cannot have both Medicare Advantage and Medicare Supplements at the same time, but you can have both Medicare Supplements and a PDP at the same time. If you decided that Medicare Supplements are better for you than Medicare Advantage, you can get a PDP. If you decided that you like Medicare Advantage, you’ll want to look for a MA plan that includes prescription drug coverage.
A great way to find doctors in Maine who accept Medicare is by visiting Medicare.gov’s provider finder tool. However, remember that while a lot of doctors may accept Medicare, not all doctors will be a part of your private plan network. That means that if you have a Medicare Advantage plan, for example, you will want to see if your plan carrier has its own doctor finder tool. For example, Aetna’s Medicare website has its own doctor and pharmacy finder tool. Use your plan’s doctor finder or ask your agent for help to make sure that the doctor you like is in your network.
The beautiful state of Maine has allocated resources specific to its beloved older residents, many of whom have Medicare. We did some research and found the following great resources:
Maine Area Agencies on Aging: Area Agencies on Aging are nonprofit organizations that operate nationwide, but all have sectors operating in specific states and counties. In Maine, the Area Agencies on Aging can help you find the care you need and can advocate for you in the case of dispute or elderly abuse.
Some people are automatically enrolled in Medicare upon becoming eligible. This can happen if you receive benefits from the Railroad Retirement Board or Social Security. If you are not automatically enrolled, you can enroll through the Social Security website, in-person at a Social Security office, or by calling 1-800-772-1213.
To enroll in Part D, Medicare Advantage, or Medicare Supplements, start searching for Maine plans here or get in touch with an agent, here. You can also call our office at 833-438-3676 from 8 AM to 4:30 PM, Monday through Friday, and we’ll get you set up with an agent in your area.
By providing the information above, I grant permission for Medicare Health Benefits Independent Broker, MedicarePlanFinder.com, and its affiliated agencies to contact me to discuss Medicare Advantage, Prescription Drug Plans, or Medicare Supplement products. Not affiliated with or endorsed by Medicare or any government agency.