Medicare Advantage Plans in Maine
Medicare Advantage Plans in Maine
To increase health care choices for seniors in Maine and most of the United States, the federal government created a private option for Medicare benefits known as Medicare Advantage. This health insurance option, also known as Part C, offers the same benefits as Original Medicare Parts A and B. It potentially covers other types of health care services, such as dental, vision and other types of specialized care. Most of Maine’s Medicare Advantage plans include prescription drug coverage. While the Centers for Medicare and Medicaid Services highly regulates Part C plans, it permits private companies to set their own premiums, deductibles and other out-of-pocket costs within reasonable price ranges.
As of 2020, Maine had 134,541 residents enrolled in Part C plans compared to 210,664 people enrolled in Parts A and B. Medicare Advantage accounted for 39% of Medicare plans, which is 3% less than the national average. The portion of Maine residents with private insurance has increased significantly between 1999 and 2020, and the Congressional Budget Office expects Medicare Advantage to account for 51% of all Medicare plans nationwide by 2030.
This guide provides detailed information about Part C policies offered to Maine seniors and other eligible individuals. It can help adults learn about the different types of policies, compare costs and benefits and find out if they are eligible for coverage.
The Top 10 Medicare Advantage Plans in Maine
Several private insurance companies sell Medicare Advantage plans in the Pine Tree State. The table below lists the most popular providers by the number of total enrollees. For providers that offer more than one plan, it lists the monthly costs in a range. Most seniors will qualify for coverage with very affordable out-of-pocket expenses. The table also shows which types of plans each company offers, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Medicare provides a rating of 0 to 5 stars for each provider to help seniors understand which companies have the highest member satisfaction levels. Beneficiaries may also determine consumer satisfaction from a variety of third-party organizations. The table below is up to date as of April 2022, and current information is available at Medicare.gov.
|
Name |
Total Enrollment |
Star Rating |
Min Cost |
Max Cost |
Plan Types |
|
Martin’s Point Generations Advantage |
57,115 |
4 |
$0 |
$99 |
HMO, PPO |
|
UnitedHealthcare |
35,318 |
4.5 |
$0 |
$72 |
PPO |
|
Aetna Medicare |
29,713 |
4.5 |
$0 |
$59 |
HMO, PPO |
|
Wellcare |
22,385 |
4 |
$0 |
$30 |
HMO, PPO, PFFS |
|
AMH Health |
17,254 |
4 |
$0 |
$79 |
HMO, PPO |
|
Humana |
12,529 |
4 |
$0 |
$40 |
HMO, PPO |
|
Anthem Blue Cross and Blue Shield |
9,333 |
0 |
$0 |
$0 |
PPO |
|
Vermont Blue Advantage |
57 |
0 |
$0 |
$0 |
PPO |
|
Blue Cross Blue Shield of Michigan |
56 |
0 |
$0 |
$0 |
PPO |
|
Blue Cross Blue Shield of Minnesota |
146,039 |
4.5 |
$0 |
$192 |
PPO |
How Medicare Advantage Plans Work in Maine
Maine seniors have a range of policy options if they choose to switch to a Medicare Advantage insurance plan. These options include many of the same policy types available to younger adults on the health care marketplace, such as HMOs and PPOs. Descriptions of these policy types are available below. These plans will have different out-of-pocket costs, covered services and networks of providers.
What Medicare Advantage Plans Cover in Maine
Medicare Advantage insurance plans include all of the benefits in Medicare Parts A and B, except for hospice care, which remains covered by Medicare Part A. The law requires this level of coverage, but companies can choose to include additional options as well. The most common is payments for prescription drugs. Other popular options include dental, vision, hearing aids and programs that promote general health and wellness.
|
|
Coverage Available With Medicare Parts A & B? |
Coverage Available With Medicare Advantage? |
|
Preventive Screenings |
Yes |
Yes |
|
Hospital Care |
Yes |
Yes |
|
Durable Medical Equipment |
Yes |
Yes |
|
Prescription Drugs |
No |
Yes** |
|
Vision Care |
No |
Yes* |
|
Dental Care |
No |
Yes* |
|
Hearing Aids |
No |
Yes* |
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Maine
Before Maine seniors can sign up for a Medicare Advantage health plan, they must already have Original Medicare Parts A and B. This requires them to be at least aged 65 or older and U.S. citizens or legal immigrants. People 65 and younger may also qualify for Medicare if they are disabled or have permanent kidney failure. Individual Medicare Advantage policies have their own eligibility requirements. Policies usually have limited service areas, so seniors must live in the locations that provide those services to qualify for coverage. There are cases where seniors can live outside the coverage area for parts of the year. Beneficiaries must enroll in Medicare Advantage during specific periods, which seniors can find below.
- Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
- Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
- Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
|
Start Date |
End Date |
|
|
Initial Coverage Election |
3 Months Before One’s |
3 Months After One’s |
|
Annual Election Period |
October 15th |
December 7th |
|
Medicare Advantage Open |
January 1st |
March 31st |
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Maine
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
State-Wide Medicare Advantage Resources
Maine Department of Health and Human Services – MaineCare
The Maine Department of Health and Human Services oversees the state Medicaid program known as MaineCare, which can offer valuable financial assistance for seniors enrolled in Medicare. Eligible seniors may qualify for the state’s Medicare Savings Program (MSP) and receive help paying their Medicare Advantage and prescription drug plan premiums. The program may also cover other out-of-pocket costs, such as coinsurance payments and deductibles. To qualify for the MSP, seniors must meet the program’s income and asset guidelines. Eligibility determinations and enrollment in the MSP are handled by the Maine DHHS Office of Family Independence.
Seniors can learn more about qualifying for the MSP and apply for the program by contacting the OFI Eligibility Office at 1-855-797-4357. Applications are also accepted at OFI district offices throughout the state, and a list of office locations is available on the department’s website.
Visit WebsiteSenior Medicare Patrol
The Senior Medicare Patrol (SMP), is a federally funded, volunteer-based organization whose goal is raising awareness of and reducing Medicare fraud and abuse, as well as billing errors. In Maine, SMP volunteers hold workshops in various locations and offer one-on-one counseling sessions to provide information, answer questions and address concerns that seniors have about health insurance services, including Medicare Advantage, other Medicare programs and MaineCare. Cases of suspected fraud or other criminal activities that are brought to the organization’s attention are referred to an appropriate local, state or federal agency.
To learn more about the assistance available through SMP and how to contact an organization volunteer for help with a concern, seniors can call the Maine Office of Elder Services at 1-800-262-2232. Alternatively, they can contact their local Area Agency on Aging.
Visit WebsiteState Health Insurance Program
The State Health Insurance Program (SHIP) offers in-depth, unbiased information about Medicare and other health insurance options to Maine residents. The program provides Medicare-eligible seniors and adults with disabilities with one-on-one counseling at no cost, either by phone or in person. Trained SHIP counselors are available to provide guidance and answer questions about Original Medicare, Medicare Advantage, Part D prescription drug coverage and MaineCare. They can also help seniors with state assistance, such as the Medicare Savings Program, which can help lower prescription drug and out-of-pocket health care costs for eligible individuals.
Seniors can learn more about the SHIP program by calling the Maine Office of Aging and Disability Services toll-free at 1-800-262-2232. To receive assistance through the SHIP program, seniors can contact their local Area Agency on Aging to schedule a counseling session, either over the phone or in-person at the agency’s location.
Visit WebsiteMaine Health Insurance Consumer Assistance Program
The Maine Health Insurance Consumer Assistance Program (MHICAP) assists seniors and other state residents with a range of health insurance coverage concerns. The program is administered by the nonprofit Maine advocacy organization, Consumers for Affordable Health Care, and is available throughout the state. Services are provided at no charge and include help learning about available coverage options, assistance applying for health insurance and handling coverage and claim denials, among others. Experienced MHICAP counselors can also help seniors apply for assistance through the state Medicaid program, MaineCare, which can reduce or cover their Medicare Advantage and prescription drug costs.
For assistance with Medicare Advantage and other health insurance issues, seniors can call the MHICAP toll-free helpline at 1-800-965-7476. For more information and answers to questions about the program, seniors can contact Consumers for Affordable Health Care’s Augusta office by phone at 1-800-838-0388, or by completing the contact form on the CAHC website.
Visit WebsiteLocal Medicare Advantage Resources
Maine Legal Services for the Elderly
Maine Legal Services for the Elderly is a not-for-profit organization that provides free legal advice to seniors aged 60 and older on a range of issues, including health insurance, public benefit programs, civil and personal legal matters and Medicare programs, such as Medicare Advantage. Seniors can access detailed information about a variety of Medicare topics on the organization’s website, or call the statewide toll-free helpline to receive personalized assistance from a Medicare Rights Advocate. One-on-one help with Medicare concerns is also available at the LSE offices located in Augusta, Bangor, Scarborough, Lewiston and Presque Isle.
For information or advice about Medicare issues, seniors can call the LSE helpline at 1-800-750-5353 and ask to speak with a Medicare Rights Advocate. Seniors can also search for the LSE location serving their county on the agency’s website, and contact the office directly for assistance.
Visit WebsiteAging and Disability Resource Centers
The five Aging & Disability Resource Centers (ADRCs) located throughout Maine connect seniors and those with disabilities to a wide range of resources, programs and services, including help understanding the different Medicare coverage choices and enrollment options. Each center can put seniors in touch with experienced Medicare consultants who can provide information about the various types of Medicare Advantage plans and their prescription drug coverage options. These trained professionals can also offer guidance to help seniors define their coverage needs and select a plan that works best for their unique situation. Assistance with completing applications is also available. These services are provided free of charge.
Maine’s Aging and Disability Resource Centers are operated by the five Area Agencies on Aging that serve specific regions of the state. Seniors can view the state map showing the service areas for each center, and find the contact details for the ADRC serving their area on the Government of Maine website.
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