You may be wondering whether you qualify for Medicare or if it’s even the right option for you. Follow Benzinga’s guide to the best Medicare in Maine so you understand everything there is to know about your health care options in the Pine Tree State.
The Best Medicare in Maine:
- Best Overall in Maine: Humana
- Most Affordable in Maine: WellCare
- Best for Dual Eligibility: Anthem
- Best for Flexible Options: Martin's Point
- Best for Medigap Coverage: Aetna
What is Medicare?
Medicare is a federal health insurance program available to qualified individuals. You may qualify for Medicare insurance if you:
1. Are 65 or older
2. Have a disability
3. Suffer from end-stage renal disease
Medicare is broken into different parts, each of which offers coverage for a specific set of services. Here are the 4 parts of Medicare:
Part A: Hospital insurance covers inpatient hospital stays, hospice care, care in a nursing facility and some home health care.
Part B: Medical Insurance covers outpatient care, medical supplies, preventive services and other types of service.
Part C: Medicare Advantage is an alternative to Original Medicare offered by private Medicare-approved companies. Medicare Advantage plans bundle the other parts of Medicare. This Medicare option is not regulated by the federal government.
Part D: Part D, prescription drug coverage, is a Medicare supplement that adds prescription drug coverage to other Medicare plans.
Legalities of Medicare in Maine
The Medicare program is a government-controlled health plan. Medicare Advantage plans are private plans offered by Medicare-approved companies. This means that these Medicare plan options are not necessarily offered by the federal government and may not be held to the same standards.
You can generally see any doctor you’d like as long as they accept Medicare insurance plans. Medicare Advantage providers, on the other hand, can restrict the doctors and specialists that are covered with your plan. This means you may be required to receive a referral from your primary care doctor before your plan covers a visit with a specialist.
Medicare Advantage providers can also limit your prescription drug coverage. Under these plans, you may need to use generic drug treatment as opposed to brand-name treatments. In some cases, you may be eligible for coverage for brand-name treatments if generic drug treatments did not work for you.
You are prohibited from also carrying a Medicare Supplemental Insurance plan if you have a Medicare Advantage plan. Supplemental insurance is often referred to as a Medigap policy. Medigap policies are also provided by private insurance companies and are designed to fill in gaps in your Medicare coverage.
Since Medicare Advantage plans are offered by private insurance companies, these providers also reserve the right to change your insurance premiums at their will.
Types of Medicare Advantage Plans
You’ll need to decide which type of coverage fits you best. Here’s a quick overview of some of your options.
Medicare Advantage Health Maintenance Organization (HMO) Plans
This type of Medicare Advantage plan coverage includes both Part A and Part B insurance. This means that both your hospital and medical insurance needs are provided for. Medicare Advantage HMO plans often include Part D plans as well, which covers your prescription drug coverage needs. Medicare Advantage HMO plans may also include vision, hearing and dental coverage.
Medicare Advantage HMO plans do come with a couple of requirements. You must be sure that the doctors and hospitals you visit are within your plan’s network if you want the visits to be covered by your insurance plan. The only exception to this requirement is if there is an emergency and you must visit a doctor or hospital that is not within your plan’s network.
You may also need a referral from a covered primary care doctor if you wish to receive coverage for a visit with a specialist.
Medicare Advantage Preferred Provider Organization (PPO) Plan
Similar to Medicare Advantage HMO plans, this plan covers both Part A and Part B insurance. In most cases, it will also cover your prescription drug coverage. It may also cover your vision, hearing and dental coverage.
The difference with a PPO plan lies within its rules and regulations. A Medicare Advantage PPO plan means you may visit any doctor and hospital you’d like. However, if the doctor or hospital you visit is not within your plan’s network, you’ll likely pay more for your visit. One of the major benefits of this plan option is that you usually don’t need a referral to see a specialist.
This way, you can be seen in a shorter amount of time without the extra cost of a visit to a covered primary care doctor to get a specialist referral. With this plan type, you may also need to pay a copayment or insurance for your health care services. A few terms you should become familiar with are:
Deductible: Your deductible is the amount of money you pay for services before your health insurance covers services.
Coinsurance: Coinsurance is the percentage you’re responsible for after you have met your insurance plan deductible The coinsurance amount you are responsible for will be paid by you directly to your service provider, whether that be a doctor’s office or a hospital. Your insurance plan will pay the remaining percentage due to your service provider.
Copays: Copays are often required by insurance plans even after you have met your deductible. A copay is a fixed amount of money you’re responsible for paying directly to your doctor or another service provider after you have met your deductible. Your insurance plan will cover the remainder of the cost of your services.
How to Sign Up for Medicare in Maine
If you are interested in signing up for Medicare Part A or Part B, you can sign up 3 different ways:
1. Enroll online.
2. Call Social Security anytime Monday through Friday from 7 a.m. to 7 p.m. at 1-800-772-1213.
3. Visit a Social Security office near you.
Here are a few steps you can take to sign up for a Medicare Advantage plan:
1. First, you should compare the Medicare health plans available to you.
2. Visit its website to see if you can enroll in the plan online. If you cannot enroll online, you should contact the company to ask for an enrollment form. Every plan is required to offer a paper enrollment form option.
3. You can also call 1-800-MEDICARE (1-800-633-4227) to enroll in a Medicare Advantage plan.
Average Cost of Medicare Advantage Plans in Maine
The costs associated with Medicare Advantage Plans can vary widely. If you’re considering a Maine Medicare option, it’s important to review the coverage and cost options available to you.
| Plan Name | Company | Plan Type | Health and Drug Costs |
|---|---|---|---|
| HumanaChoice H5216-175 | Humana | PPO | $18.12 |
| WellCare Today’s Options Advantage Plus 550B | WellCare | PPO | $18.60 |
| WellCare Value | WellCare | HMO | $0.00 |
| Anthem I MaineHealth Advantage Extra | AMH Health | HMO | $181.20 |
| Anthem MediBlue Access | Anthem Blue Cross and Blue Shield | PPO | $1,120.56 |
Best Medicare Insurance Providers in Maine
Before you decide which Medicare Insurance option is right for you, familiarize yourself with the insurance providers available to you. Whether you’re looking for a Medicare Advantage plan or Medicare Part D plans, there is an option out there for you.
- Medicare Advantage Plans
1. Best Overall in Maine: Humana
No matter what type of Medicare plan you need, Humana can probably provide it for you. Humana offers several Medicare insurance products, including Medicare Advantage, Medicare Supplemental insurance and Part D plans.
You have several HMO and PPO plans to choose from and can also add dental and vision coverage to your plan. This insurance provider also offers free fitness programs, rewards programs and partnerships with popular retailers like Walmart to give you extended prescription coverage.
- Medicare Prescription Drug Plans
2. Most Affordable in Maine: WellCare
WellCare can offer you both Medicare Advantage plans and standalone Part D plans to provide you with drug coverage. Most of WellCare’s Medicare Advantage plans are HMO plans, which are popular among individuals who only visit doctors within the WellCare network.
This insurance provider can offer Medicare Advantage plans that are among the most affordable options in Maine. Wellcare is known for its highly-rated price accuracy, its appeals process and its accessibility.
- Submiting and tracking claims
3. Best for Dual Eligibility: Anthem
Anthem is part of the Blue Cross Blue Shield health insurance network offered nationwide. Anthem offers several Medicaid health insurance plans, including drug coverage. Anthem also offers plans made for individuals who qualify for both Medicare and Medicaid.
Overall, Anthem is a quality Medicare option for many individuals, especially if you may require coverage within and outside of Maine.
4. Best for Flexible Options: Martin’s Point
Martin’s Point is exclusive to the Northeast. It offers several Medicare Advantage plans you can take advantage of when you seek Maine Medicare coverage. Some of its plans may offer monthly premiums of $0 but you’ll still need to pay the premium of the Original Medicare Part B coverage.
You may also need to pay the premium for Original Medicare Part A coverage.
- Member support
5. Best for Medigap Coverage: Aetna
Aetna may be the right option for you if you’re looking for Medigap insurance. Aetna’s Medicare Supplement program offers the freedom to see any provider you’d like. You can eliminate considerations whether your chosen provider is in-network.
You will also receive guaranteed coverage despite any potential change in your health or medical conditions. You may be able to continue your coverage with Aetna if you move. You will also benefit from guaranteed rates for 12 months of coverage.
How to Know which Medicare Plan is Right for You
Choosing the right Medicare plan for you can be a difficult and stressful process. Medicare is a federal health insurance program and there are other Medicare coverage programs that should be taken into consideration. Some of these programs are not available in each state but it’s crucial that you take the specific offers to Maine residents into consideration.
Don’t be afraid to explore your options before you make a final decision. Reach out to insurance companies in our guide to ask about each company’s process and coverage requirements. Your medical circumstances are unique to you, so it’s important to find a plan that caters to your needs.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Ashley Hart
Ashley Hart is a personal finance writer passionate about helping people feel empowered to take control of their finances. She has more than eight years of writing experience, focused on insurance.