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 that you should be made aware of. We’ll go into more details about them later.

Maine Medicare Plans

Most Medicare beneficiaries start out by paying a modest monthly premium for Part B, as well as an annual deductible. 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 that 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
  • Offered 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 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 in 2022 Medicare Part B Costs in 2022
  • Part A is premium-free for most
  • Part A deductible is $1,556 per benefit period
  • Inpatient hospital stay days 61-90 is $389
  • The standard Part B premium is $170.10
  • The annual deductible for Part B is $233
  • 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.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
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