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Medicare in Maine

What you need to know about Medicare in Maine, including plan options, costs and more

Reviewed by: Brett Braithwaite, Licensed Insurance Agent. Written by: Aaron Garcia.

Key Takeaways

  • Medicare in Maine is health insurance for Americans aged 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)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). provides some hospital and medical coverage. Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Maine combines the coverage you’d get from Parts A and B and bundles them with other services. This can include Part DMedicare Prescription Drug Plan (Part D) is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies..

  • 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.

How Do I Apply for Medicare in Maine?

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. [1]

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:

  • Medicare Part A
  • Medicare Part B
  • Medicare Prescription Drug Plan (Part D)

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 Part C & D 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

What Are the 4 Parts of Medicare Health Plans?

The four parts of Medicare in Maine are:

These four parts are seperate, 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 Does Medicare in Maine Cost?

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 2021:

Medicare in ME: Part A

Premium:

  • $0 if you or your spouse worked 10 or more years
  • $259 a month if you worked between 7.5 and 10 years
  • $471 a month if you worked fewer than 7.5 years

Deductible:

  • $1,484 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

Premium:

  • $148.50 monthly and up (income-based)

Deductible:

  • $203 for each plan period

Copayments & coinsurance:

  • Most preventative services: $0
  • Medicare-approved services: 20% coinsurance

Medicare in ME: Part D

Premium:

  • Income-based; varies by plan

Deductible:

  • No more than $445 in 2021

Copayments & coinsurance:

  • Plan- and drug-specific

What is the Best Medicare Plan for 2021?

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.

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.

Medicare in Maine by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 314,312 people are enrolled in Medicare in Maine. The total number of beneficiaries enrolled in Medicare Advantage in Maine is 110,391. The previous year, 95,805 enrolled in Medicare Advantage. Medicare Advantage participation in Maine went from 31.23% to 35.12% year over year. If you’d like to dive deeper into how Medicare in Maine breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Maine
314,312
Beneficiaries with Part A & Part B
110,391
Medicare Advantage Beneficiaries
35.12%
Medicare Advantage Participation Rate
54.14%
% Female
45.86%
% Male
0.93
Average HCC Score
$9,200.1
Actual Per Capita Costs
33.21%
% Eligible for Medicaid
35.15%
% of Beneficiaries with an Emergency Department Visit
16.44%
Hospital Readmission Rate
95.74%
% Non-Hispanic White
0.45%
% African American
0.57%
% Hispanic
3.25%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

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.

Maine Medicare Resources & Contacts

Beneficiaries spend an average of $9,200.10 each year on Medicare in Maine. To be certain you are not leaving anything on the table, give us a call. A GoHealth licensed insurance agent can assess your coverage or explain which Maine-based resources, like these, may be able to help:

Maine Bureau of Insurance

1-207-624-8475
1-800-300-5000

https://www.maine.gov/pfr/insurance/

What should I know about the Maine Bureau of Insurance?

Apply for the state’s Medicare Savings Programs or file an insurance complaint

Office of MaineCare Services (OMS)

1-855-797-4357
1-800-977-6740 (Member Services)

https://www.maine.gov/dhhs/oms

What should I know about MaineCare?

See if you qualify for the state’s Medicaid program for those with low incomes

Maine Department of Health and Human Services

1-207-287-3707
Maine relay 711 (TTY)

https://www.maine.gov/dhhs/

What should I know about the Maine Department of Health and Human Services?

See if you qualify for financial help from the Main State Health Insurance Assistance Program (SHIP)

Maine Bureau of Veterans’ Services

1-207-430-6035

https://www.maine.gov/veterans/

What should I know about the Maine Department of Military & Veterans Affairs?

Manage and enroll in your veterans’ benefits

Nationwide Resources

Speak with an insurance agent that is licensed in Maine about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in ME, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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