Medicare in Maine: Who Qualifies, Costs, and More

If you’re approaching the age of 65 in Maine or caring for someone who is, you probably have a lot of questions about Medicare, how to qualify, and how the coverage works.

Understanding eligibility requirements and how to choose the Medicare plan that’s right for you is essential so that you get the medical care you need as you grow older. This guide will help you understand Medicare in Maine and answer the most common questions we receive about the program.

Who Qualifies for Medicare in Maine?

Medicare is a federal program designed to provide health coverage for anyone 65 or older, or those with specific medical conditions. In general, these individuals are less likely to have health insurance coverage from an employer and enroll in Medicare to get the care they need. Over 1.6 million people are enrolled in a Medicare plan in Maine.

Most people are enrolled in Medicare automatically as soon as they are eligible for coverage. If you’re not, or you want to make changes to your Medicare coverage, you can contact your Social Security office or an insurer that offers Medicare plans.

To qualify for Medicare, you need to be an American citizen or permanent resident who has been living in the country for at least five years. You also need to meet at least one of the following conditions:

• You’re age 65 or older
• You’re under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
• You have end-stage renal disease (ESRD)
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

Even if you are automatically enrolled, it’s important to review your coverage to ensure that the plan you have meets your medical needs.

When Can You Get Medicare in Maine?

Most people qualify for Medicare when they are near their 65th birthday. The initial enrollment period begins three months before your 65th birthday includes your birthday month, and extends three months afterward.

If you qualify for Medicare due to a disability, you can enroll after you have received disability payments for 24 months. Some illnesses have a shorter waiting period.

If you are automatically enrolled in Medicare, you will have Medicare Part A and B. These together are known as Original Medicare. If you also want a prescription drug plan, you’ll have to choose a Medicare Part D plan and enroll yourself.

Some people prefer a Medicare Advantage plan, which is Medicare Part C. You are not automatically enrolled in an Advantage plan, you have to choose that yourself during your enrollment period. Be sure to compare plans for Medicare Advantage in Maine so that you get the coverage you need at a price that fits your budget.

After your initial enrollment period, you can make adjustments to your Medicare coverage every year during the annual enrollment period (AEP) between October 15 and December 7th. Your new coverage will begin on January 1.

How Much is Maine Medicare?

The different parts of Medicare have different costs.

Medicare Part A is inpatient hospital coverage. It doesn’t have a monthly premium for most Americans, although people who did not pay into Medicare for long enough will have to pay a monthly fee.

When you use Medicare Part A, you first have a deductible of $1,556 in 2022. Then, days 1 - 60 in each year have a $0 coinsurance. For days 61 - 90 each year, you’ll pay $389 a day in 2022. After day 90 each year, you have to use lifetime reserve days, which you only have 60 of in your lifetime, and pay $778 a day. Otherwise, you are responsible for the full cost after that point.

Medicare Part B is medical coverage for when you visit the doctor, need medical equipment, and more. This part of Medicare has a monthly premium, which is $170.10 a month in 2022. For some higher-income Maine residents, the monthly premium may be higher.

When you use Medicare Part B, you have a deductible of $233 for the year in 2022. After that, you generally pay 20% of the Medicare-approved costs, and Medicare pays the rest.

Medicare Part D is prescription drug coverage. These plans are offered by private insurance companies that are contracted with Medicare, and each plan has its own costs and a list of covered drugs. Be sure to compare plans to ensure you get the drug coverage you need at a reasonable cost.

Medicare Part C, known as Medicare Advantage, is a full replacement for Original Medicare. It replaces Medicare Parts A and B and often includes drug coverage (Part D) as well. Some Medicare Advantage plans do not cost you any more than your normal Part B premium, while others have a higher monthly cost. However, you’ll have to stay within the medical network of the Medicare Advantage plan to get coverage.

Many Medicare Advantage plans also offer additional benefits, such as vision coverage, dental coverage, and reduced costs to join fitness clubs. Learn more about the differences between Original Medicare and Medicare Advantage, and be sure to compare the costs and benefits of the plans available in your area before you make a final decision.

Learn More About Medicare in Maine

If you’re interested in comparing Medicare coverage options in Maine, talking to a licensed insurance agent can help. You deserve coverage that meets your needs. Reach out to us today for more information about Medicare in Maine and to compare the plans available to you!