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Medicare Part D Plans in Maine


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Medicare Part D coverage in Maine

Medicare Part D coverage in Maine is available for beneficiaries who would like help with Medicare prescription drug costs. You’ll typically have a couple ways to get this coverage, depending on whether you have Original Medicare or are enrolled in a Medicare Advantage plan.

If you are enrolled in Original Medicare, Part A and Part B, this benefit doesn’t automatically come with your Medicare coverage, and you’ll need to manually enroll in a separate Medicare Prescription Drug Plan that works alongside your Original Medicare benefits.

You can also get Medicare Part D coverage included in your Medicare Advantage plan by enrolling in a Medicare Advantage Prescription Drug plan. Medicare Advantage plans are an alternative way to get your Part A and Part B benefits. Instead of getting your Medicare benefits through the federal program, you’ll have your benefits administered through the Medicare Advantage plan, which is available through private insurance companies that contract with Medicare. Medicare Advantage plans must cover at least the same level of coverage as Original Medicare, Part A and Part B, but plans may also cover additional benefits, such as routine vision or dental, hearing, and prescription drugs.

If you enroll in a Medicare Advantage Prescription Drug plan, you shouldn’t also enroll in a Medicare Prescription Drug Plan. In fact, doing so will automatically disenroll you from your Medicare Advantage plan.

Enrolling in Medicare Part D coverage in Maine

You’re eligible for Medicare Part D coverage if:

  • You are enrolled in Medicare Part A and/or Part B, and
  • You live in the service area of a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan.

There are a number of times when beneficiaries can enroll in Medicare Part D coverage in Maine, including:

  • Initial Enrollment Period for Part D: This period often overlaps with when you first become eligible for Medicare benefits. For most people, the Initial Enrollment Period begins three months before the month they turn 65, includes their birthday month, and ends three months afterward. For those who qualify for Medicare because of disability, it starts three months before the 25th month of disability benefits from Social Security or the Railroad Retirement Board and lasts for seven months.
  • Annual Election Period: This period takes place from October 15 to December 7 of each year. During the Annual Election Period, beneficiaries can make changes to their Medicare benefits, including enrolling in or switching Medicare plans. They can also use this period to disenroll from a Medicare plan.
  • Medicare Advantage Disenrollment Period: From January 1 to February 14, you can disenroll from a Medicare Advantage plan and go back to Original Medicare. Regardless of whether your Medicare Advantage plan covered prescription drugs, you can also use this period to enroll in a stand-alone Medicare Prescription Drug Plan. These are the only changes you can make during this period.
  • Special Election Period: These periods can occur any time of the year that certain qualifying events occur in the beneficiary’s life, such as a change in address or certain coverage changes. If you’re eligible for a Special Election period, you can use this period to make changes to your Medicare Part D coverage.

Choosing Medicare Part D coverage in Maine

Both Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans are available through private insurance companies that contract with Medicare, so each plan may offer slightly different coverage and costs, and not every plan may be available in every location. Beneficiaries in Maine should carefully compare Medicare plan options when considering the coverage that may best fit their needs.

As you research Medicare Part D coverage options in Maine, here are a few tips to keep in mind:

  • Check the Medicare plan’s formulary: Every Medicare plan that covers prescription drugs has a formulary, which is a list of the medications covered by the plan. Formularies vary by plan, so it’s important to make sure that any Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan you’re considering includes your medications in its formulary. Keep in mind that formularies may change from year to year; the Medicare plan will notify you if necessary.
  • Compare your out-of-pocket costs: Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans may vary in cost-sharing expenses, even when covering the same medications. Plans may place covered medications into different cost tiers, with a certain level of cost sharing for the prescription drugs on each tier. If most of your medications fall into higher tiers, your copayments may be more expensive, which could put you at risk for entering the Medicare coverage gap.
  • Benefits and costs may change annually: Keep in mind that formularies, medication costs, and other plan benefits may change every year. It’s important to carefully review your coverage every year to ensure it’s still meeting your needs. The Annual Election Period, as mentioned, is your yearly opportunity to make coverage changes to your prescription drug coverage.

Do you have questions about how Medicare Part D coverage works in Maine? Or would you like personalized assistance finding Medicare plan options that may cover your medications? Contact eHealth today to speak with a licensed insurance agent who can address your Medicare concerns.

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