Know your options for Medicare Advantage Plans in Maine and find out how to enroll.
TABLE OF CONTENTS
When you turn 65, you qualify for Medicare, the federal government health insurance program. You can get your Medicare coverage through Original Medicare, which includes Medicare Part A and Part B, or choose to get coverage through a Medicare Advantage Plan.
Medicare Advantage Plans, also called Medicare Part C, are all-in-one bundled plans that include the same coverage as Medicare Part A and B into one plan. These plans also often provide the same coverage you’d get through a Part D drug plan but may provide even more additional coverage for things Original Medicare doesn’t cover, such as vision, dental and hearing.
Medicare Advantage Plans are offered through private Medicare-approved insurers, each of which can set its own coverage options and costs. This means each Medicare Advantage Plan is unique so it’s important to compare plans before choosing one for you. This guide will help you learn everything you need to know about Medicare Advantage Plans in Maine.
Compare ratings of insurance companies offering Medicare Advantage Plans in Maine:
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 54 Medicare Advantage Plans available in Maine, you likely have a few options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
With only 22% of Maine residents choosing a Medicare Advantage Plan, Plan C isn’t as popular in the state as it is elsewhere in the country. This may be because there are fewer plans available in Maine than in many other states, but these plans are still an option worth exploring.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Maine, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Maine Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|Maine Department of Health and Human Services||(207) 287-3707||The Maine Department of Health and Human Services (DHHS) is dedicated to promoting health, safety, resilience, and opportunity for Maine people|
|Office of MaineCare Services||(855) 797-4357||MaineCare provides health care coverage for Maine’s children and adults who are elderly, disabled, or with low incomes|
|Maine Bureau of Insurance||(207) 624-8475
|The Maine Bureau of Insurance regulates the insurance industry to protect and to serve the public|
|Maine Office of Aging and Disability Services||(207) 287-9200
|The Office of Aging and Disability Services (OADS) supports Maine’s older and disabled adults by providing Adult Protective, Brain Injury, Other Related Conditions, Intellectual and Developmental Disability, Long Term Care, and Aging and Community services to the people of Maine|
|Maine Office of Elder Services||(207) 287-3707||The Maine Office of Elder Services coordinates the state’s long-term care resources and services for older adults|
|Resource||Contact||How they help|
|Aroostook Area Agency on Aging||(800) 439-1789
|The mission of the Aroostook Agency on Aging is to improve the quality of life and promote the well-being of older people in our communities|
|Central Maine Area Agency on Aging | Spectrum Generations||(207) 622-9212
|The Central Maine Area Agency on Aging promotes and advances the well-being and independence of older and disabled adults, with the support of their care partners, to live in their community of choice|
|Eastern Agency on Aging||(207) 941-2865
|The Aging and Disability Resource Center (ADRC) seeks to address the frustrations many older adults, people with disabilities, and family members experience when trying to learn about and access long-term services and supports|
|Southern Maine Agency on Aging||(800) 427-7411||Southern Maine Agency on Aging offers a wide variety of caregiver support services including education programs, classes for people caring for someone with dementia, support groups and direct consultation, referral and assistance|
|Resource||Contact||How they help|
|American Hospital Association – Medicare Advantage||1-800-424-4301||The AHA provides education for health care leaders and is a source of information on health care issues and trends.|
|CMS.gov – Medicare Advantage Applications||N/A||This page provides important information on the application process for Part C Medicare Advantage plans.|
|Medicare.gov – Medicare Advantage Plans||1-800-633-4227||This government website provides information on the Medicare Advantage program.|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.