Maine Medicare Plans

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 Maine medicare plans – known as Traditional Medicare – start 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. 

You have some cost-saving options when you first start accepting Medicare benefits. For many reasons, Medicare Part A is not optional if you decide to go the Medicare route. But you may be able to save money by rejecting Medicare Part B benefits. Medicare Part B premiums and coinsurance costs are the more expensive of the two and some seniors may have better options which cost less.

Unfortunately, rejecting Medicare Part B is not always an option. If you decide to stick with Original Medicare but also want to purchase Part D prescription-drug coverage, you are going to have to pay for Part B coverage as well. You can opt out of Original Medicare completely with a Medicare Advantage policy (Medicare Part C), but the benefits which replace Original Medicare will be at the very least equivalent to Medicare Parts A & B. There’s no getting around that no matter how desperately you need to save money on your health care costs. 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.

Maine is one of the best states in the lower 48 – but costs for medical care are some of the most expensive in the country. Retiring seniors need to be very careful when planning to manage their future health care expenses because costs aren’t going down anytime soon. It’s important to have enough saved up to care for yourself into your twilight years, but the gaps in Medicare coverage or the wrong health insurance plan could wipe out those funds very quickly.

We mention these gaps in coverage because most seniors aren’t aware that there are some very big, very expensive holes in their coverage. This is especially true for end-of-life care, serious hospital visits, and the coinsurance/co-pays which come with Medicare Part B. You could pay for these costs out of pocket, or you could find an affordable health insurance supplement to give you the fully comprehensive coverage you need. If you want to protect yourself and your savings, we suggest doing the latter.

Thankfully, it’s not hard to find a plan that fits well with your personal circumstances. But making sure you understand the plan and its benefits can be confusing at times. The two most popular supplemental options are either Medicare Advantage or Medicare Supplement policies. We’re going to explain the two of them now in order to help you get started with your search.

When it comes down to choosing between a Medicare Supplement insurance policy and a Medicare Advantage insurance policy, it’s important to understand what makes these supplements so different from one another. Medicare Advantage is also called Medicare Part C but, despite that name, it is not technically a form of government Medicare. Medicare Supplement insurance is also referred to as Medigap. Like Medicare Advantage, it is a private health insurance plan, but its smaller scope could get you some severe savings.

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:

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. 

Comparing Medicare Advantage and Medigap in Maine

The scope of Medicare Advantage can be very large depending on the type of coverage you decide to purchase. You can accept the policy that is nothing else but identical benefits compared to Medicare Parts A & B; but you won’t be doing anything about the gaps in Medicare coverage. Thankfully, you can choose to purchase more coverage which not only gives you protection against those gaps but may also provide for things like vision care and dental treatments. These will raise your premiums, but under rare circumstances you may end up saving money.

Medigap policies cover fewer options, but for many seniors, this is a good thing. These policies are specifically tailored to protect retirees from coverage gaps which could wipe out their savings. There are many different gaps that these 10 policies aim to cover, but some are more comprehensive than others. Plan F is a good option because it covers all of these gaps for an affordable monthly premium; but not all plans cover as much.

Medicare Advantage doesn’t necessarily cover the same coverage gaps that a Medigap Supplement does unless you ask for that coverage. The basic plan starts out by providing the exact same coverage you would get from Medicare Parts A & B. In certain areas, purchasing a base plan with gap coverage, and even extras like dental or prescription drug coverage, can still be relatively affordable. But seniors should do their research in order to make sure that that is the case for them.

Geography is a major player when it comes to how affordable or expensive a Medicare Supplement Plan can be. Seniors living in big cities might save some money with a Medicare Advantage plan despite their restrictive networks because the abundance of choices are such that they can still keep their costs low. Since Medigap insurance is more widely accepted than certain Medicare Advantage policies, it’s going to help seniors save money in more rural areas where options are fewer.

If you’re still trying to decide between the two, we can certainly understand why. That’s why we are here to help. Our knowledgeable, experienced staff want to walk you through the process and answer any questions you may have. We’ve even prepared an FAQ sheet below so that you get a better idea of what these two supplements can provide for you. We can also help you find affordable quotes from companies in your area.

Questions Medicare Advantage Medicare Supplement
How are expenses covered under each plan? With regard to your premiums, the government will pay some or all of your monthly premium to your health insurance provider, and your provider will charge you the rest. You pay a low monthly premium directly to your Medigap Supplement provider.
Will I still have to pay for Part B? Yes Yes
What will it cost me? Naturally, the more medical care you receive, the more expensive your costs will be regardless of how comprehensive your benefits are. Monthly premiums will be higher the more comprehensive your plan is. But in the long run, the savings are worth it for most seniors.
What will the plan cover? Medicare Advantage plans start by replicating the exact same healthcare benefits as Medicare Parts A & B. You also may add gap coverage, prescription drugs, vision, dental, or more. Medigap Supplements only cover Medicare coverage gaps. This simplicity makes it easier to manage your plan and makes the monthly premiums highly affordable.
Is it easy to budget my health care expenses? Budgeting can be harder with Medicare Advantage, especially if you aren’t in ideal health or you have a hard time anticipating your health care needs. If you order a very comprehensive plan, budgeting is practically effortless. But for plans that don’t cover expenses like co-pays or coinsurance, budgeting can get a little tricky.
Is my plan guaranteed? Or can it be cancelled? There aren’t very many guarantees with Medicare Advantage. It helps to stay in good health and good financial standing with your provider, but lapses in either of those could result in a loss of coverage. There are much stronger guarantees with a Medigap supplement. You get to keep your coverage for as long as you want, provided you pay your premiums on time and the company servicing you stays financially sound.
Do I have to clear a pre-approval or pre-certification process? Many Medicare Advantage companies will ask you to go through a pre-approval or pre-certification process; qualifying for Medicare alone doesn’t automatically qualify you for a Medicare Advantage plan. All you have to do is qualify for Original Medicare in order to be eligible for Medigap coverage.
Am I limited to specific doctors or hospitals? Medicare Advantage providers have been known to limit their networks to only the most affordable doctors and hospitals. This helps keep costs low enough for them to offer competitively-priced premiums to customers. Very rarely will a doctor or other provider reject your Medigap insurance because Medigap supplemental coverage is accepted at all of the same places which Medicare is.
What type of plan is best for me? Younger seniors, healthy seniors, retirees who live in urban areas, and anyone who wants additional coverages may see some advantages from Medicare Advantage. The more care you need, the older you are, the more rural your area, and the more concerned you are with Original Medicare coverage gaps, the more you can benefit from a Medigap supplement.

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.

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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