Medicare in Maine is health insurance for Americans age 65 and older. You must be a legal U.S. citizen, or have been a legal resident for at least five years.
Original Medicare (Parts A and B) provides some hospital and medical coverage. Medicare Advantage in Maine combines the coverage you’d get from Parts A and B and bundles them with other services. This can include Part D .
The cost of Medicare in Maine starts with standard costs but is adjusted based on details like income and work history. Not enrolling on time can also cause your costs to increase.
New York-born writer E.B. White fell so in love with The Pine Tree State that he once said he’d “really rather feel bad in Maine than feel good anywhere else.”
Fortunately, with several ways to receive Medicare in Maine, you don’t have to make the same choice. Whether you’re approaching 65, or already there, Medicare provides the healthy aging resources and care you need to continue enjoying everything Maine has to offer. To help you take advantage of this program, GoHealth can answer some questions you may have. For example, do you know how much Medicare costs? What are the different options? Can you purchase Medicare Advantage in Maine?
At GoHealth, we want to make sure you feel good. To help that happen, here is GoHealth’s guide to Medicare in Maine.
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There are several ways to enroll in Medicare in Maine. Medicare is a federal program, so most people sign up through the Social Security Administration (SSA). Here’s how:
- Online at the SSA website
- In person at a nearby SSA office
- Over the phone at 1-800-772-1213
- Call a GoHealth licensed insurance agent at GoHealth. We’ll tell you what you need to enroll and show you the different Medicare plans in Maine.
If you worked for a railroad, you may need to enroll through the Railroad Retirement Board (RRB). To find out, call the RRB at 1-877-772-5772.
Who Is Eligible for Medicaid in Maine?
Medicaid and Medicare in Maine are not the same things. Medicaid is a state and federal program that offers health insurance to disabled and/or low-income residents in Maine. Eligibility is based on several factors.
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Is Medicare Required When You Turn 65?
No, you’re not required to enroll in Medicare in Maine. But not enrolling when you’re first eligible can leave you with some serious enrollment penalties when you do sign up. To avoid these penalties, you’ll want to enroll during your Initial Enrollment Period (IEP). If not, you can expect to pay extra for:
If you or your spouse work and receive health insurance through that employer’s plan when you turn 65, you may be able to delay enrollment without a penalty. If you qualify, a Special Enrollment Period will open, during which you can enroll in Parts A and B after your IEP without penalty.
Medicare in Maine enrollment periods
Your Initial Enrollment Period (IEP) is your first chance to sign up for Medicare the year you turn 65. If you want to change, add or drop your coverage in the future, there are standard annual enrollment periods during which you can do so. Here are the dates to know about:
- Initial Enrollment Period (IEP): the month you turn 65, plus three months before and after. If your birthday is in June, your IEP opens Mar. 1 and closes Sept. 30.
- Medicare Open Enrollment Period: Oct. 15 to Dec. 7
- Medicare General Enrollment Period: Jan. 1 to Mar. 31
- Medicare Advantage Open Enrollment Period: Jan. 1 to Mar. 31
What Are the Requirements for Receiving Medicare?
Medicare in Maine is available to all Americans age 65 and older who are U.S. citizens, or who have been legal residents for five or more years. You may be eligible before 65 if you’ve drawn disability-based Social Security or Railroad Retirement Board (RRB) benefits for at least 24 months.
You may also qualify for Medicare if you’re living with:
- End-stage renal disease (ESRD)
- Amyotrophic lateral sclerosis (ALS), also called Lou Gehrig’s Disease
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What Are the 4 Parts of Medicare Health Plans?
The four parts of Medicare in Maine are:
- Original Medicare (Parts A and B)
- Medicare Advantage (Part C)
- Medicare Prescription Drug Plan (Part D)
These four parts are separate, but some work together; Parts A and B combine to make up Original Medicare. Mainers with this form of Medicare also will need to enroll separately into a Part D plan for prescription drug coverage. Medicare Advantage (Part C) replaces Original Medicare (Part A & B), but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.
Medicare Supplement Insurance (Medigap) is another valuable resource for those with Original Medicare in Maine. While it’s not one of the four main types, Medigap is a set of policies that can be purchased by Original Medicare enrollees to help control out-of-pocket costs like premiums, copayments, coinsurance and deductibles. As with Part D, Medigap must be purchased and paid for separately from Original Medicare.
How much you’ll pay for Medicare in Maine boils down to standard costs, many of which are adjusted based on personal details like work history and income. To help you budget, here’s a run down of Medicare costs for 2022:
Medicare in ME: Part A
- $0 if you or your spouse worked 10 or more years
- $274 a month if you worked between 7.5 and 10 years
- $499 a month if you worked fewer than 7.5 years
- $1,556 for each hospital benefit period
Copayments & coinsurance:
- Hospital stays: $0 copay for Days 1-60 following deductible payment; daily charges for Days 61 and after
- Skilled Nursing Facility: $0 for Days 1-20 (each plan period); daily charges for Days 21 and after
Medicare in ME: Part B
- $170.10 monthly and up (income-based)
- $233 for each plan period
Copayments & coinsurance:
- Most preventative services: $0
- Medicare-approved services: 20% coinsurance
Medicare in ME: Part D
- Income-based; varies by plan
- No more than $480 in 2022
Copayments & coinsurance:
- Plan- and drug-specific
Can I bundle multiple benefits into one plan?See My Options
What is the Best Medicare Plan for 2022?
To find the plan that works for you, you’ll want to consider a few things before you enroll in Medicare in Maine. For example, what are your medical needs? Which medications do you take? Which doctor would you like to see?
Sifting through Medicare plans in Maine to find the best fit can be taxing. To help you prepare, here are some resources to show you which questions you should be asking, and where to find the answers.
Enrollment Checklist: Get prepped for Medicare in Maine
Pros & Cons: How to weigh Medicare plans in Maine
Pro Tips: Ways to make Medicare easier
Medicare Star Ratings: See how policyholders grade their plans
Contact GoHealth: Our licensed insurance agents are ready with impartial guidance and the answers you’re looking for
What Are the Top Rated Medicare Advantage Plans?
Selecting a Medicare Advantage plan based on what others think can be dangerous. Instead, it can be more helpful to understand what the different types of Medicare Advantage in Maine are, and how they work.
- Health Maintenance Organization (HMO) plans use primary care physicians and provider networks to administer care.
- Preferred Provider Organization (PPO) policies use primary care physicians, but allow more flexibility to see out-of-network providers.
- Private Fee-for-Service (PFFS) plans pay providers each time you receive a service.
- Special Needs Plans (SNP) are designed for enrollees with specific diseases or health conditions. D-SNP is for dual-eligible patients; C-SNPs cater to people with chronic illnesses.
What Medicare coverage is right for my specific situation?Find The Right Plan
What Are the Disadvantages of a Medicare Advantage Program?
While this really depends on your personal needs and the specific plan you’re looking at, there are some common trade-offs to know about when selecting between Original Medicare and Medicare Advantage plan in Maine.
- Medicare Advantage typically requires you to see doctors and providers within a local provider network, while Original Medicare can be used anywhere that accepts Medicare, even out of state.
- Medicare Advantage typically has lower out-of-pocket costs and includes coverages that Original Medicare doesn’t, including Medicare Part D.
- Along with Part D, Original Medicare beneficiaries often add Medicare Supplement Insurance to help cover the high costs from Parts A and B.
How Do I Speak to a Person at Medicare?
There are two ways to speak to a person at Medicare: over the phone (1-800-772-1213) or in person at a local Social Security Administration office.
Getting personal guidance and answers when you need them can be rare these days. If you’d like to speak to a real person with real knowledge about Medicare in Maine, give GoHealth a call. Our licensed insurance agents can review your needs and options to find a plan that works for you, whether you’re in Bangor or Kennebunkport.
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Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver’s Guide
For individuals with a qualifying income status