Maine Medicare Guide

Our licensed Maine Medicare Advisors are here to help! Schedule a free consultation or give us a call at (888) 604-0055 to get your Medicare questions answered.

This guide will walk you through the basics of Medicare in Maine. Learn about enrollment periods and coverage options so you can make informed decisions that get you the best value from Medicare.

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Maine
• Medicare Eligibility and Enrollment Steps
• Maine Medicare Advantage Plans
• Maine Medicare Supplement Plans
• Maine Medicare Part D Plans
• Get help paying for Medicare in Maine

A Snapshot of Medicare in Maine

Maine has 356,000 Medicare beneficiaries, making up 26% of the state’s total population. The majority of Maine beneficiaries are on Medicare due to age, but about 15% are on Medicare due to disability. 25% of Maine’s Medicare enrollees also receive Medicaid benefits. 

When it comes to Original Medicare vs. Medicare Advantage, 53% of Medicare beneficiaries choose to remain on Original Medicare and 47% choose to move to a Medicare Advantage plan.

Maine Medicare Eligibility and Enrollment Steps

Eligibility is the same for all US citizens. You’re eligible for Medicare if you’re 65 or older or have certain disabilities like ALS or End-Stage Kidney Disease.

Maine Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

Most people become eligible for Medicare when they turn 65 and can enroll as soon as their Initial Enrollment Period (IEP) begins. Your IEP is a seven-month period that starts three months before the month you turn 65 and ends three months after. Unless you’re eligible for the Part B Special Enrollment Period later on, you don’t want to miss your Initial Enrollment Period! Missing it could result in lifetime financial penalties for late enrollment. 

2. Compare additional coverage options

Once you’ve enrolled in Original Medicare, you have options. The first choice you need to make is to either stay on Original Medicare or switch to a Medicare Advantage plan. If you stay on Original Medicare, you also have the option to add a Medicare Supplement plan and/or a Part D (prescription drug) plan. If you want to enroll in a Medicare Advantage plan, there are different options with varying premiums and benefits.

The choices you make about your Medicare are critical, because the wrong plan can cost you thousands and limit your access to care. We’re happy to help you understand your options and determine which is best for your unique set of health and financial needs. Just give us a call at (888) 604-0055 or schedule a free consultation with one of our Maine Medicare Advisors.

3. Get the best value from Medicare

There are three things you need to do to get the best value from Medicare. First, pick the coverage that works best for your health and financial situation. From here, use your plan! Even if you feel well, use your preventive services, like your annual wellness visit.

The last thing you need to do is continue to review your Medicare coverage and healthcare needs each year, because both can change! A good time to do this is during Medicare’s Annual Enrollment Period, during which you can change Medicare Advantage and Part D plans without consequence. 

Maine Medicare Advantage Plans

There are 39 Medicare Advantage (MA) plans available in Maine. Plan pricing, benefits, and availability will vary from one county to the next. For example, Cumberland County has 26 Medicare Advantage plans and Waldo County has 28 (in 2023). 

Medicare Advantage plans are offered by private insurance companies as an alternative  to Original Medicare. As such, they must provide at least the same coverage as Part A and Part B. One thing that makes these plans popular is that they often provide additional coverage and benefits, which may include:

• Dental, vision, and hearing services
• Prescription coverage
• Flex spending cards
• Fitness perks
• Transportation services

MA plans often provide extra coverage benefits with no additional premium each month. Note: Medicare Advantage enrollees do still need to pay their Original Medicare premiums, so these plans are not free. 

Still, extra benefits with no (or a low) additional premium sounds nice…so, what’s the catch? Unfortunately, these plans come with big drawbacks:

• Limited provider networks
• Preauthorization requirements
• High out-of-pocket costs

Maine Medicare Supplement Plans

While Medicare Advantage plans replace Original Medicare, Medicare Supplement plans stack on top of them. Medicare Supplement (Medigap) plans help beneficiaries cover the 20% of costs that Original Medicare doesn’t. In addition to much lower out-of-pocket costs, Medigap plans don’t have network restrictions and won’t ever require prior authorization for Medicare-covered services. These advantages lead to many Medicare beneficiaries opting for coverage from Original Medicare + Medigap over Medicare Advantage. 

There are ten types of Medigap plans in Maine, labeled by letters A through N. While pricing may vary from one insurance carrier to another, all plans of the same type (e.g., all Plan Gs) are identical. 

When you enroll in a Medigap plan matters, but Maine has more flexibility than most states. The best time to enroll in a Medigap plan in Maine is during your Medigap Open Enrollment Period, which lasts for six months following your Part B effective date. Outside of this time, insurance companies are allowed to ask you questions about your health history and may deny you Medigap coverage. 

Maine has more flexibility for Medigap enrollment in the following ways:

• At any time, if you’re already on a Medigap plan, you can switch to another Medigap plan with the same or lesser coverage. See which plans you could change to in the chart on page 5 of this document.
• If you are not already on a Medigap plan, during one month out of the year, each insurance company must have a designated time during which any applicant will be accepted into a Plan A. 

Maine Part D Plans

Original Medicare does not cover prescriptions. Medicare beneficiaries can receive Part D (prescription) coverage, either through a Medicare Advantage plan that includes it or through a stand-alone Part D plan. There are 24 stand-alone Part D plans available in Maine. Plan availability and pricing varies by county. 

Even if you don’t need prescription coverage when you first enroll in Medicare, you should consider enrolling in a low-cost plan. This will help you avoid the Part D enrollment penalty later on, when you do need prescription coverage. 

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Maine Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in Maine

There are three government programs that can help Medicare beneficiaries with low incomes and resources pay for healthcare costs.

Maine Medicaid

Medicaid is a joint state and federal program that’s managed by individual states. Each Maine’s Medicaid program is called MaineCare. 

If you’re over 65, are blind, or have a disability, MaineCare may help you pay for health insurance coverage and services. Low-income Medicare beneficiaries may also be eligible for one of the four Maine Medicare Savings Programs offered by MaineCare:

• Qualified Medicare Beneficiary Program (QMB)
• Specified Low-Income Medicare Beneficiary Program (SLMB)
• Qualifying Individual (QI) Program
• Qualified Disabled and Working Individuals (QDWI) Program

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage. It’s also commonly referred to as the Part D Low-Income Subsidy (or LIS).

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Maine
• Maine pays your Part B premium
• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed Maine Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability
• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.