What You Need to Know
A Medicare Supplement plan in Maine helps pay for expenses not covered by Original Medicare, like your deductible.
There are 10 standardized plan options.
Getting ready to turn 65 and join the federal Medicare program? You’ll first join Original Medicare, or Medicare Part A and B. This coverage won’t pay for all of your medical costs. Adding a plan from a private insurance company can help cover out-of-pocket expenses.
Medicare Supplement plans in Maine, known as Medigap policies, are medical insurance you can buy that helps pay the costs not covered by Original Medicare. For example, Original Medicare doesn’t cover deductibles or copays. Medigap policies help pay for these costs.
When Can You Enroll in Medigap?
You need to enroll in Medicare to be eligible for a Medigap policy in Maine. Once you’ve turned 65 and enrolled in Medicare Part B, you can join a Medicare Supplement plan from a private insurance provider.
- Medigap Open Enrollment Period (OEP): This six-month period after you turn 65 and join Medicare Part B is the best time to enroll in a Medicare Supplement plan. Private insurance providers can’t reject your application based on health issues. They also can’t charge you more or make you wait for coverage due to preexisting conditions like diabetes or cancer. This means you’ll likely get the most plan options and best prices during your OEP.1
- Outside Open Enrollment Period: There are no restrictions on when you can join a Medigap policy. If you wait until after your OEP to sign up, though, you’ll have to go through medical underwriting. This means that insurance companies can deny your application or charge you higher prices based on health conditions.
- Guaranteed Issue: Some situations give you a guaranteed issue right. Insurance companies can’t charge you higher rates or turn you down based on your health. For example, you’re on an employer’s plan, but that plan is ending. When it ends, you can join a Medicare Supplement plan without worrying about being rejected or charged more due to health concerns.2
- Special Enrollment Period: In some circumstances, you’ll get access to a special enrollment period where you’re guaranteed coverage. These circumstances include:
When to Enroll
The best time to sign up for Medicare Supplement Insurance is during your Medigap Open Enrollment Period.
What Are the Most Popular Medicare Supplement Plans?
Just under 70,000 Medicare beneficiaries are covered by Medigap policies in Maine. Almost 43,000 Medicare enrollees have Plan F. Medigap Plan N ranks second with just over 8,300 members.3
- Plan F: The most popular plan covers costs related to Medicare Part A hospital insurance. It helps pay for coinsurance for hospitals, hospice care or skilled nursing facility care. It also helps pay for up to three pints of blood as well as your Part A and Part B deductibles. If you become eligible for Medicare after January 1, 2020, you’re not eligible to enroll in Plan F.
- Plan G: This plan is a common alternative to Plan F. It covers the same costs, like hospital or skilled nursing coinsurance. Medigap Plan G doesn’t cover your Part B deductible.
- Plan N: This plan covers Medicare Part A coinsurance and deductibles. You’ll also get coverage for your Medicare Part B copayments. The plan doesn’t cover the Medicare Part B deductible or Medicare Part B excess charges. For example, Medicare will pay $450 for a service, but your doctor charges $500. You’ll have to cover the excess $50 out-of-pocket.
How Do You Choose a Medicare Supplement Plan?
Since Maine Medicare Supplement Insurance plans are standardized, you can easily compare coverage between plans. Remember to consider current and future health needs, including prescriptions. Medigap policies don’t include coverage for prescription drugs. You’ll have to purchase a separate prescription drug plan, or Medicare Part D, to cover medications.
How Much Do Medigap Policies Cost?
Insurance companies price Medicare Supplement Insurance plans in Maine using three ratings:4
- Community-rated: The premium is the same for everyone on the plan.
- Issue-age-rated: Your premium is based on your age when you sign up and won’t increase as you get older.
- Attained-age-rated: Premiums go up as you get older.
Plan N could cost between $155 and $296 per month in Portland. The premium for Plan G ranges from $47 to $109 with a high-deductible plan or $199 to $438 with a regular plan.5 These costs are on top of the Medicare Part B premium ($148.50 for most Medicare members in 2021).
What If You Want to Change Your Medigap Policy?
You can switch Medigap policies in Maine at any time. Simply apply for a new plan. If you’re accepted, call your old plan’s provider and request to end coverage. Remember that you could be turned down or charged more if you change plans without a guaranteed issue right outside of your OEP.
Outside Your OEP
Outside open enrollment, you can still sign up for a Medigap policy or switch to a new one, but you might get charged more or rejected over health issues.
What Are Alternatives to Medicare Supplement?
Medicare Advantage, or Part C, plans are an alternative to Original Medicare and Medigap. Medicare Advantage plans are sold by insurers and provide the same coverage as Medicare Part A and B. Most plans cover prescription drugs and use a PPO or HMO provider network.
What Are Medicare Resources in Maine?
- Maine State Health Insurance Assistance Program (SHIP): Free unbiased counseling for Medicare members to help you sign up and choose Medicare coverage.
- Maine Bureau of Insurance: The state department overseeing the insurance industry to protect consumers.
- Maine Medicaid, or MaineCare: Medicaid services include free or low-cost medical coverage to eligible low-income seniors and those with certain disabilities.
If a Medigap policy offers the right amount of supplemental insurance for you, compare plan costs from different insurance providers in Maine before you turn 65 to get the best price and most coverage options. Be sure you’re ready to enroll once you’re eligible for Original Medicare.