Medicare Advantage Plans in Maine

Written by:

Vanessa Jerusalimiec

Reviewed by:

Cassandra Parker

Key Takeaways

All adults enrolled in Original MedicareOriginal 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). are eligible for Medicare Advantage plans in Maine.
Medicare Advantage (Part C) plansMedicare 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). may have lower monthly premiumsA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. and copaymentsA copayment is the fixed amount you pay directly to your provider for medical services or prescription drugs covered in your plan. For example: If your plan includes a copayment of $20 for office visits, you’ll pay $20 to your doctor whenever you have an appointment. than Original Medicare.
Medicare Advantage plans can offer additional benefits such as dental and vision coverage.
The best time to enroll in a Medicare Advantage plan is during your seven-month Initial Enrollment Period, which starts three months before you turn 65.
A licensed insurance agent at GoHealth can help you compare Medicare Advantage plans available in Maine and find the option that’s right for you.

Maine residents who enroll in Medicare can choose from a range of Medicare Advantage plans that offer a variety of coverage and benefits. The specific plans that are available to you depend on the ZIP code you live in, so it’s important to understand your options. Read on to learn more about Medicare Advantage coverage in Maine.

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Maine Medicare Advantage Plan Coverage

Medicare Advantage plans, also called Medicare Part C, are an alternative to the federally run Original Medicare, which consists of Medicare Parts A and B. Medicare Advantage plans serve as a single, stand-alone plan that can include Part A, B, and Part D prescription drug coverage.

While Original Medicare provides identical coverage to adults across the United States, Medicare Advantage plans are offered by private insurance companies and specific to certain locations. All Medicare Advantage plans must provide at least the same coverage as Original Medicare. On top of this basic coverage, plans can offer additional benefits like dental, hearing and vision care, as well as extras like gym memberships and transportation services to healthcare appointments.

Medicare Advantage coverage can include:

Hospital care
Outpatient care
Home health care
Preventative care
Lab tests and screenings
Ambulance services
Durable medical equipment like walkers
Dental, hearing and vision care
Prescription drug coverage
Gym memberships
Transportation services to healthcare appointments

Each Medicare Advantage plan has unique coverage options, so it’s a good idea to carefully review your choices.

ME Medicare Advantage Plan Costs

Original Medicare has fixed costs that apply everywhere in the country. Most older adults are eligible for premium-free Part A coverage. Part B coverage, on the other hand, comes with a monthly premium of $174.70 and up in 2024.

For Medicare Advantage, the average monthly premium in Maine was $13.90 per month in 2024. All Maine residents have access to a Medicare Advantage plan with a $0 premium.

Coinsurance and Copayments

Healthcare coverage rarely pays for 100% of healthcare services. Instead, Medicare pays for a portion of the service, and you pay the rest. This is your coinsurance or copayment amount. Medicare Part B covers 80% of approved Medicare services. You will pay for the remaining 20%.

Medicare Advantage plans set their own coinsurance and copayment terms. Some plans have copays starting at $0 for certain services.

Out-of-Pocket Maximum

If you’re enrolled in Original Medicare, your copayment always applies. You’ll pay 20% of services throughout the entire year, regardless of how many times you’ve accessed care.

Medicare Advantage plans have an out-of-pocket maximum. Once you reach this limit, your plan starts paying 100% of your costs. You won’t need to worry about coinsurance or copayments, and you can still access all the healthcare services you need.

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Medicare Advantage Plan Eligibility and Enrollment in Maine

All adults enrolled in Original Medicare are eligible for Medicare Advantage plans in Maine. You can enroll in Original Medicare if:

You’re a U.S. citizen or permanent resident of Maine.
You’re older than 65.
You’re younger than 65 and have a qualifying health condition such as ESRD or ALS.

After you’ve enrolled in Original Medicare Part A and Part B, you can enroll in a Medicare Advantage plan.

Enrolling in a Medicare Advantage Plan

To enroll in a Medicare Advantage plan, you’ll need to:

Have your Original Medicare number.
Know the date your Medicare Part A and Part B coverage starts.
Live in the Medicare Advantage plan’s coverage area.

You’ll also want to research the plans available in your area, and see which networks include your doctors and other providers. You can also verify that your medications are covered by the plans you’re considering. Another options is to call a licensed insurance agent at GoHealth. We’ll take the time to learn about your healthcare needs and help you find the plan that gets you the coverage you need. When you’re ready to enroll, we’ll help you every step of the way. You can enroll easily in a plan over the phone.

Enrollment periods

Ready to enroll in Medicare? Here are some important dates to remember.

Initial Enrollment Period (IEP): This is your first chance to enroll in Medicare. It’s also the best time to enroll to avoid late penalties. The IEP is a seven-month period that starts a full three months before the month you turn 65, and ends three months after your birthday month. This gives you lots of time to enroll in Original Medicare, then switch to a Medicare Advantage plan.
Medicare Open Enrollment Period: You can switch from Original Medicare to a Medicare Advantage plan from October 15 to December 7 each year. Your new coverage starts on January 1. This window is also referred to as the Annual Enrollment Period (AEP).
Special Enrollment Period (SEP): Sometimes the unexpected takes us by surprise. That’s why Medicare offers an SEP that can be triggered by a life event. If you lose employer health insurance, move outside of your plan coverage location or your coverage is interrupted, you can enroll in another plan right away so you won’t find yourself without healthcare coverage.

Have questions about enrollment periods? Talk to a licensed insurance agent at GoHealth to find out when you can enroll in Medicare in Maine.

Are There Maine Medicare Advantage Plans With Prescription Drug Coverage?

Most Medicare Advantage plans available in Maine include prescription drug coverage. If you want your prescriptions covered, you have two options:

Enroll in a Part D plan on top of Original Medicare. You’ll keep paying your Part B monthly premium, as well as Part D premiums, which range from $30 to $100 per month.
Enroll in a comprehensive Medicare Advantage plan that includes prescription drug coverage.

Each Part D and Medicare Advantage plan provides a complete list of every medication that’s covered. This formulary also gives you additional details about the coinsurance and copayments you’ll pay for each medication. Low-tier medications will have lower coinsurance rates, and high-tier medications will cost a bit more.

Before enrolling in a plan, carefully review the formulary and make sure your medications are on the list. You can also compare coinsurance rates. Finding a plan that lists your medications in a low tier to save on healthcare costs.

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Sources

Part B costs. Medicare.gov.
FACT SHEET. CMS.gov.

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

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