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Medicare in Maine

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By the numbers

Maine is not a highly populous state, but still has a substantial number of Medicare beneficiaries (333,656as of 2018). Following are some other statistics about Medicare beneficiaries in Maine*:

  • Number of Maine beneficiaries with Medicare prescription drug coverage: 241,645
  • Number of Medicare beneficiaries enrolled in Medicare Advantage plans (or other Medicare health plans): 108,308
  • Main beneficiaries enrolled in stand-alone Medicare Prescription Drug Plans: 143,386

When people think of Medicare, several different types of programs may come to mind. Original Medicare, Part A and Part B, is the federal fee-for-service program into which many eligible people are automatically enrolled at age 65 if they’re already receiving retirement benefits before 65. You can also qualify at any age through disability or having certain conditions, such as end-stage renal disease or amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease). To be eligible, you must be either a U.S. citizen or have legally and permanently resided in the country for at least five continuous years. Medicare Part C, also called Medicare Advantage, offers an alternative way to get your Original Medicare insurance. Medicare Part D is prescription drug coverage. Finally, there’s also Medicare Supplement insurance, also known as Medigap. Each of these is described below.

About Medicare in Maine

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). You’re enrolled into this program automatically at age 65 if you’re already receiving Social Security or Railroad Retirement Board retirement benefits. If you have a disability, you’re automatically enrolled into Medicare the 25th month of receiving disability benefits in most cases. If you have ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease), you’re enrolled into Original Medicare your first month of receiving disability benefits. If you have end-stage renal disease (ESRD), you may be entitled to Medicare benefits; contact Medicare to ask about your eligibility (information below).

There are other Medicare coverage options beyond Original Medicare.

  • You can get your Medicare Part A and Part B benefits through a Medicare Advantage plan offered by a private insurance company approved by Medicare. Medicare Advantage plans provide the same coverage as Medicare Part A and Part B (except hospice care, which is covered by Medicare Part A even if you have a Medicare Advantage plan). Many Medicare Advantage plans may also include more benefits, such as prescription drug coverage and routine dental services. You must still pay your Part B premium, along with any premium the Medicare Advantage plan may charge.
  • If you stay with Original Medicare, you can extend your coverage in two different ways (you can choose one or the other, both, or neither).
  • A stand-alone Medicare Part D Prescription Drug Plan can cover your medications. Available from private, Medicare-approved insurance companies, these plans each have a formulary, or list of covered drugs. You may want to make sure your prescription medications are included in a plan’s formulary before you enroll in the plan. The formulary can change at any time; your plan will notify you when necessary.
  • A Medigap (Medicare Supplement) plan can help pay your Original Medicare out-of-pocket costs, such as copayments and deductibles.

To enroll in any of these plans, you must live within the plan’s service area, and you must be enrolled in both Medicare Part A and Part B (except in the case of stand-alone Medicare Prescription Drug Plans — you need either Part A or Part B to qualify). Prices, availability, and some coverage details may vary among insurance companies and specific locations in Maine.

Medicare resources in Maine

Medicare Savings Programs: If you get your health benefits from Medicare in Maine, and have limited income and assets, you may be able to get financial help with out-of-pocket expenses from a Medicare Savings Program. To apply, contact the Maine Bureau of Insurance.

Maine State Health Insurance Counseling and Assistance Program (SHIP): People in Maine who have Medicare can get free health insurance counseling through the State Health Insurance Assistance Program (SHIP). Specially trained staff will answer your Medicare questions either on the phone or at one of their local offices.

To enroll in Medicare in Maine

Many people are automatically enrolled, as stated above. Enrollment works the same way in Maine as in the other states. If you don’t qualify for automatic enrollment, or if you want to change your coverage or get answers to questions, you can contact Medicare, or a licensed insurance agency such as eHealth Insurance Services, Inc. You’ll find contact information at the bottom of this page.

*Source: Statistical data from the Centers for Medicare & Medicaid Services (CMS), “Medicare Enrollment Dashboard,” from the CMS Office of Enterprise Data & Analytics, February 2019.

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