With more plan offerings than ever before, it's no surprise that Medicare Advantage (MA) plan enrollment keeps expanding. In 2023, nearly 31 million people had an Advantage plan, accounting for 51% of eligible Medicare beneficiaries. This page explains Medicare Advantage plans in Maine, including coverage and how to compare your options.
What is Medicare Advantage in Maine?
Also known as Medicare Part C, Medicare Advantage plans must provide the same coverage as Original Medicare. This includes:
- Medicare Part A, hospital insurance
- Medicare Part B, medical insurance
Prescription drug coverage is not included with Original Medicare. You get that through Medicare Part D. Failure to maintain creditable prescription drug coverage (i.e. a plan that's comparable to Medicare), may land you with lifelong late penalties.
Medicare Advantage plans with prescription drug coverage in Maine
Medicare Advantage Prescription Drug plans (MA-PD) combine the benefits of Medicare Parts A, B, and D into a single plan.
If you choose an Advantage plan that does not provide drug coverage, you'll need to add a standalone prescription drug plan to avoid the Medicare Part D late penalty.
Who is eligible for Medicare Advantage in Maine?
You qualify for Medicare Advantage in Maine once you sign up for Medicare Parts A and B.
If you are an American citizen or permanent legal resident aged 65 or older, you are eligible for Medicare. Enrollment in Parts A and B is automatic for those who began collecting Social Security benefits at least 4 months before turning 65. Everyone else must apply for Medicare.
You may qualify for Medicare before turning 65 if you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months. Enrollment occurs automatically during month 25.
When can you sign up for a Medicare Advantage plan in Maine?
Enrollment in Medicare Part C in Maine is restricted to certain periods.
Your Initial Enrollment Period (IEP) lasts for 7 months, beginning 3 months before your Medicare eligibility month. So, if your 65th birthday or 25th month of disability occurs in February, your IEP starts on November 1 and ends on May 31.
If you didn’t sign up for Part A and/or Part B during your IEP, you may do so during the General Enrollment Period (January 1 through March 31). You may then join a Medicare Advantage plan from April 1 until June 30.
You can also join an MA plan during Medicare's Annual Enrollment Period (AEP) from October 15 through December 7.
Current Part C enrollees may take part in the Medicare Advantage Open Enrollment Period from January 1 through March 31. Your choices are joining a new MA plan or returning to Original Medicare. However, you may also enroll in a standalone Part D plan if you lose your prescription drug coverage after making that change
If you experience special circumstances, you may take advantage of a Special Enrollment Period. Medicare.gov has the full details.
Types of Medicare Advantage plans in Maine
There are four main types of Medicare Advantage plans in Maine.
- Health maintenance organizations: HMO plans control costs in three ways. First is a provider network, which may include any entity you rely on for healthcare services. Non-emergency services from an out-of-network are rarely covered by an HMO plan. The other two cost-containment measures are choosing a primary care doctor and getting a referral to see a specialist.
- Preferred provider organizations: PPO plans also have provider networks. Members can, however, see an out-of-network provider for a higher copay. PPO plan members also don't have to get a referral to see a specialist or choose a primary doctor.
- Private fee-for service: PFFS plans establish cost guidelines for covered service. They also usually have a provider network. But, as with a PPO, members can use an out-of-network provider for a higher cost.
- Special needs plans: SNPs are for Medicare beneficiaries who meet certain criteria. This means one of the following: being dual eligible (i.e. qualifying for both Medicare and Medicaid), having a chronic condition (e.g. diabetes, HIV/AIDS, ESRD), or living in an institution or requiring at-home care.
How to choose a Medicare Advantage plan in Maine
To ensure you get the best Medicare Advantage plan for your particular needs, consider following:
- Costs: May include an annual deductible, monthly premiums, and copays or coinsurance.
- Coverage: Benefit vary widely, so compare your options carefully. Also, don't forget to check the drug formulary for MA-PD plans.
- Network: May include doctors, hospitals, labs, durable medical equipment providers (DME), and more.
- Ratings: Medicare releases plan ratings every fall, just in time for AEP.
With our Find a Plan tool, it's easy to compare Medicare Advantage plans in Maine. Just enter your location information and coverage start date to review the Medicare plan options in your area.
Find a Medicare Plan in your area
It’s FREE with no obligation