Introduction to Medicare Part C in Maine (Medicare Advantage)

Medicare Advantage may also be referred to as Medicare Part C, or “Medicare Replacement”. It is a form of private insurance designed to protect retirees from the potentially high costs of the gaps in Traditional Medicare Coverage (that is, Medicare Parts A and B). This private health insurance policy effectively replaces your federal Medicare benefits. Instead of the federal government paying out on your claims, the private insurance company which manages your policy will handle these claims instead.

Federal Regulations for Medicare Advantage

In order to protect seniors from being sold inferior health coverage, Medicare Advantage policies are closely regulated by the federal government. These laws ensure that your Advantage plan will have at least the same coverage as that offered by Medicare Parts A & B. Usually, though, your Medicare Advantage policy will include much more than that. It will likely come with benefits which protect you from Traditional Medicare coverage gaps. It may also come with a prescription drug plan (a MAPD).

Medicare Advantage Enrollment In Maine

About one-fifth of seniors in Maine – around 20% – who are enrolled in Medicare are also enrolled in a Medicare Advantage policy. But unlike standardized Medicare supplement policies, Medicare Advantage plans have a great deal of variety from one to the other. Below are the most popular types, broken down by popularity:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Many different factors will come together to determine how much your Advantage plan will cost you. Age, tobacco use, Medicare enrollment status, and your zip code can alter whether your specific rates are higher or lower than average plans near you:

Most Popular Medicare Advantage Plans in Maine

Despite all of the different variables which can determine your rate, your provider network will have the biggest influence over your monthly premiums. The most popular plans, according to the chart below, are those with an HMO provider network. The less restrictive plans, such as PPOs and PFFS plans, don’t sell as much. But there’s a very good reason for that which we will get into below.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

The reason that HMO plans are more popular than plans with a larger provider network, and therefore greater access to medical care, is because they are generally less expensive than PPOs or PFFS plans. It is important to do your research once you find a plan that fits your budget in order to determine whether or not you will have to change doctors in order to be covered by that plan. Also, keep in mind that your doctor could leave the network, or be dropped from the network, at any time. You should have contingency plans in place for if you lose your preferred doctor.

Doctor/Providers List

Drug, Vision and Dental Coverage

One Advantage that Medicare Part C offers over other supplemental insurance has to do with offering seniors one simple, comprehensive, streamlined policy. With Medicare Advantage, you can bundle your Traditional Medicare benefits, prescription drug coverage (medicare part D), and any additional benefits (such as vision and/or dental) all into your Advantage plan. There’s no need to deal with separate companies and different insurance plans.

Enrollment Options & Best Time To Enroll

Like most Medicare plans, Part C has different ways to qualify and enroll. Some companies, however, may require you to give information on your current health status or undergo an exam. For most seniors, you’ll likely be accepted for coverage unless you have End Stage Renal Disease. But even those with serious conditions like ESRD can still find coverage. Your local insurance agent or your state department of insurance will have more information. You can also visit our Medicare Advantage Enrollment Options Page if you would like to learn more about the process.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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