Maine Medicare: Everything You Need to Know

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.

Click below to learn more about Maine Medicare:

• Maine Medicare Eligibility
• What Does Maine Medicare Cost?
• What Does Medicare Cover in Maine?
• Maine Medicare Plan Finder
• Finding Medicare Doctors in Maine
• Medicare Resources in Maine
• Getting Both Medicare and Medicaid in Maine
• How to Apply for Medicare in Maine

Maine Medicare Eligibility

You can qualify for Medicare in Maine by:

• Turning 65
• Getting diagnosed with ALS
• Getting diagnosed with ESRD

Entering your 25th month of SSDI

What Does Maine Medicare Cost?

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.

What Does Medicare Cover in Maine?

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.

Maine Medicare Plan Finder

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.

Finding Medicare Doctors in Maine

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.

Maine Medicare Resources

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.

Maine Department of Health and Human Services: This department provides links to all sorts of resources for seniors and Medicare beneficiaries such as Alzheimer’s-specific support, assistive living facility information, and more. 

Maine In-Home Senior Services: This company can help you get the services you need in your home and help you live at home longer, instead of having to move into an assisted living facility. 

Maine Office of Elder Services: This office can help you access home-delivered meals from Meals on Wheels as well as help you prevent falls in your home, find adult day care services, find legal services, and provide counseling. They also provide some support for caregivers.

Maine Senior Guide: This website is dedicated to helping Maine’s older residents find assisted and independent living facilities and navigate applications, moving, and more.

Of course, Medicare Plan Finder is also excited to be your resource for finding medicare plans!

Getting Both Medicare and Medicaid in Maine

If you qualify for both Medicare and Medicaid (Mainecare), you may be able to enroll in a Medicare Advantage Dual-Eligible Special Needs Plan. These plans generally have very low or no costs and provide benefits for Medicare and Medicaid covered services. Medicaid qualifications are based on income and other Maine state regulations.         

For help with finding plans in your area, call 844-431-1832.

How to Apply for Medicare in Maine

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 844-431-1832 from 8 AM to 4:30 PM, Monday through Friday, and we’ll get you set up with an agent in your area.