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Medicare Plans in Maine – Coverage and Benefits

Do you live in Maine? Are you approaching the age of 65? Then the good news is that you will soon be eligible for enrollment in the government-sponsored federal Medicare benefits program. This program is designed to help senior citizens manage their health care needs, as well as medical costs, during their retirement years. The base plan – known as Traditional Medicare – starts with Part A, and Part B. Both parts together are fairly comprehensive, but there are important gaps in coverage which you should be made aware of. We’ll go into more details about them later.

Most Medicare beneficiaries start out by paying a modest monthly premium for Part B, as well as an annual deductible. Those costs can be discovered here. Depending on your history of employment, Part A might actually be free. However, if you have a limited work history that is less than ten years (alternatively, 40 quarters) long, you may be required to pay some sort of premium before you will have access to your Medicare Part A benefits. The informative table below explains what each separate part of Medicare covers.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

The Variety of Medicare Insurance Programs in Maine

Maine has a pretty significant number of residents currently receiving Medicare benefits. More than a quarter million people (276,467) are currently enrolled in the program. Of those, One-fifth (20%, which is a total of 55,293 people) have chosen to purchase a Medicare Part C (a.k.a. Medicare Advantage) policy. Alternatively, 74,336 Mainers (27%) are supplementing Medicare Parts A and B with a Medigap policy, which we will also discuss in this article. The remaining 53% likely have some form of employer-sponsored supplemental benefit, or they might not have any form of supplemental coverage at all.

If you need help with Original Medicare enrollment, click that link. Once you are enrolled in Medicare and begin receiving benefits, then you can shop around for Medicare supplement insurance.

If I live in Maine, Will I Need a Medicare Supplement?

Legally, no, there is absolutely no requirement whatsoever with regard to Medicare supplement insurance. However, you are free to purchase it if you wish. And, as you can see from the chart above, many people choose to do just that. The reason is because of the potentially expensive gaps in Traditional Medicare, as outlined in the table below:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

You may feel relatively youthful and healthy now, but medical emergencies and surprises could happen at any time. For most people with supplemental insurance, the minor monthly expense and peace of mind is worth it. Below, we’ll go into detail about the most abundant and cost-effective plans out there: Medigap supplements, and Medicare Advantage.

Choosing a Medigap Supplement Policy in Maine

The federal government has collaborated with private health insurance companies to give senior citizens the ten following options with regard to Medigap supplement insurance: Plans A, B, C, D, F, G, K, L, M, and N. Each plan offers uniform benefits in every single state, meaning that Plan G in Maine is the exact same Plan G you could expect to purchase if you lived in Texas. Prices will vary by location, of course, as will available providers.

Each plan is designed specifically with the known and existing Medicare coverage gaps in mind. For more details, review the table below:

[chart category=”supplement” name=”planTypes” state=”ME” zipcode=”04401″]

Medicare Advantage Plans in Maine

Medicare Advantage is associated with the Medicare program, but in actuality is a very specific type of private health insurance policy that you purchase from a non-government provider. By law, each and every Medicare Advantage plan has to offer you identical benefits to Traditional Medicare, while leaving the option for these companies to offer you additional benefits and coverage (which many do). However, the costs will vary between Medicare Advantage and Traditional Medicare, especially if you sign up for additional benefits such as vision or dental.

It should be noted that, compared to other policies, Medicare Advantage networks tend to be slightly more restrictive, regardless of whether it’s an HMO or PPO network. If you don’t mind switching doctors, then this might not be a significant disadvantage to you. Signing up for or switching to Medicare Advantage is highly dependent on weighing the potential benefits over all of the known cons.

Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are the selective health networks through which Medicare Advantage plans provide their members with health care. 

[chart category=”advantage” name=”topHMOPlans” zipcode=”04401″ state=”ME”]

[chart category=”advantage” name=”topPPOPlans” zipcode=”04401″ state=”ME”]

Comparing Medicare Advantage and Medigap in Maine

One of the easiest ways to decide which plan is right for you is to compare them side-by-side. Below, we’ve set up a helpful chart which does exactly that. For information on estimated premium costs and cancellation policies, look below:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Helpful Medicare Resources in Maine

The best way to get all the information you need on Medigap or Medicare advantage is to ask the experts. The directory below contains contact information for several different offices in your area. Feel free to reach out and ask questions. It will help you make the educated decisions necessary to manage your health care needs.

[chart category=”general” name=”usefulContacts”]

Important Medicare-Related Healthcare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.



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