Medicare Advantage Plans in Maine

Maine’s rugged coastline is dotted with lighthouses. The oldest, Portland Head Light in Cape Elizabeth, was first lit in 1791. This dependable lighthouse kept the coastline safe for over 200 years.

Today, GoHealth is keeping you safe with reliable healthcare. For a Medicare plan you can count on, trust Medicare Advantage plans in Maine.

Medicare Advantage plans in Maine, also called Medicare Part C, give you comprehensive healthcare coverage. Medicare Advantage plans are an alternative to Medicare Part A and Part B, the federally run Original Medicare coverage. Medicare Advantage plans serve as a single, stand-alone plan that can include Part A, B and D coverage–all in one plan, with one monthly premium.

While Original Medicare provides identical coverage to adults across the United States, Medicare Advantage plans are local. These plans are offered by private insurance companies with local needs in mind. All Medicare Advantage plans available in Maine must provide at least the same coverage as Original Medicare. On top of this basic coverage, plans can offer additional benefits. Coverage can include dental, hearing and vision care, as well as extras like gym memberships and transportations services to healthcare appointments, among other benefits. Coverage can include:

• Hospital care
• Outpatient care
• Home health care
• Preventative care
• Lab tests and screenings
• Ambulance services
• Durable medical equipment like walkers
• Dental, hearing and vision care
• Prescription drug coverage
• Gym memberships
• Transportation services to healthcare appointments

Each Medicare Advantage plan has unique coverage options, so it’s a good idea to carefully review coverage before enrolling in a Medicare Advantage plan.

Original Medicare has fixed costs that apply everywhere in the country. Most older adults are eligible for premium-free Part A coverage. Part B coverage, on the other hand, comes with a monthly premium of $164.90and up in 2023.

Medicare Advantage plans in Maine set their own premiums. Some plans offer premiums as low as $0 per month, while average monthly premiums in Maine are $11.25 per month in 2023.

Coinsurance and copayments

Healthcare coverage rarely pays for 100% of healthcare services. Instead, Medicare pays for a portion of the service, and you pay the rest. This is your coinsurance or copayment amount. Medicare Part B covers 80% of approved Medicare services. You will pay for the remaining 20%.

Medicare Advantage plans set their own coinsurance and copayment terms. Some plans have copays starting at $0 for certain services.

Out-of-pocket maximum

If you’re enrolled in Original Medicare, your copayment always applies. You’ll pay 20% of services throughout the entire year, regardless of how many times you’ve accessed care.

Medicare Advantage plans have an  out-of-pocket maximum. Once you reach this limit, your plan starts paying 100% of your costs. You won’t need to worry about coinsurance or copayments, and you can still access all the healthcare services you need.

All adults enrolled in Original Medicare are eligible for Medicare Advantage plans in Maine. You can enroll in Original Medicare if:

• You’re a U.S. citizen or permanent resident of Maine.
• You’re older than 65.
• You’re younger than 65 and have a qualifying health condition such as ESRD or ALS.

After you’ve enrolled in Original Medicare Part A and Part B, you can enroll in a Medicare Advantage plan.

Enrolling in a Medicare Advantage plan

To enroll in a Medicare Advantage plan, you’ll need to:

• Have your Original Medicare number.
• Know the date your Medicare Part A and Part B coverage starts.
• Live in the Medicare Advantage plan’s coverage area.

You’ll also want to research the plans available in your area, and see which networks include your doctors and other providers. You can also verify that your medications are covered by the plans you’re considering. Another options is to call a licensed insurance agent at GoHealth. We’ll take the time to learn about your healthcare needs and help you find the plan that gets you the coverage you need. When you’re ready to enroll, we’ll help you every step of the way. You can enroll easily in a plan over the phone.

Enrollment periods

Ready to enroll in Medicare? Here are some important dates to remember.

• Initial Enrollment Period (IEP): This is your first chance to enroll in Medicare. It’s also the best time to enroll to avoid late penalties. The IEP is a seven-month period that starts a full three months before the month you turn 65, and ends three months after your birthday month. This gives you lots of time to enroll in Original Medicare, then switch to a Medicare Advantage plan.
• Medicare Open Enrollment Period: You can switch from Original Medicare to a Medicare Advantage plan from October 15 to December 7 each year. Your new coverage starts on January 1. This window is also referred to as the Annual Enrollment Period (AEP).
• Special Enrollment Period (SEP): Sometimes the unexpected takes us by surprise. That’s why Medicare offers an SEP that can be triggered by a life event. If you lose employer health insurance, move outside of your plan coverage location or your coverage is interrupted, you can enroll in another plan right away so you won’t find yourself without healthcare coverage.

Have questions about enrollment periods? Talk to a licensed insurance agent at GoHealth to find out when you can enroll in Medicare in Maine.

Most Medicare Advantage plans available in Maine include prescription drug coverage. If you want medication coverage you have two options:

• Enroll in a Part D plan on top of your Original Medicare coverage. You’ll keep paying your Part B monthly premium, as well as Part D premiums, which range from $30 to $100 per month.
• Enroll in a comprehensive Medicare Advantage plan that includes prescription drug coverage. You’ll get healthcare coverage and medication coverage all for the same monthly premium.

Each Part D and Medicare Advantage plan provides a complete list of every medication that’s covered. This formulary also gives you additional details about the coinsurance and copayments you’ll pay for each medication. Low-tier medications will have lower coinsurance rates, and high-tier medications will cost a bit more.

Before enrolling in a plan, carefully review the formulary and make sure your medications are on the list. You can also compare coinsurance rates. Finding a plan that lists your medications in a low tier to save on healthcare costs.