Resources for Maine beneficiaries
State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.
In Maine you can reach SHIP at 1-800-606-0215 or online here.
Snapshot of Medicare in Maine
- Total Medicare enrollment in Maine
- Breakdown of eligibility: aged vs. disabled
- Medicare spending per recipient
- Medigap in Maine
- Medicare Advantage in Maine
- Stand-alone Medicare Part D coverage in Maine
- Maine health insurance for people who aren’t eligible for Medicare
Total Medicare enrollment in The Pine Tree State
332,242 Maine residents were enrolled in Medicare as of November 2018. That’s more than 24 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare. As of 2015, when Maine had 23 percent of its residents enrolled in Medicare, the state was tied with West Virginia in having the highest percentage of its residents covered by Medicare.
In terms of total enrollment, Alaska has the least recipients at 97,195 and California (which has about an eighth of the country’s population within its borders) has the most at 6.1 million (about 15 percent of its population). This doesn’t count the US Territories, which mostly have low total enrollment in Medicare (Northern Mariana Islands had just 2,075 Medicare enrollees in 2015, although Puerto Rico had nearly 757,000).
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 81 percent of Maine Medicare recipients. The balance — 19 percent — are on Medicare as the result of a disability. Kentucky, Alabama, and Mississippi, have the highest percentage of Medicare beneficiaries who are eligible due to a disability, at 23 percent (including the territories, American Samoa has the highest percentage, at 31 percent). Hawaii has the smallest percentage at 9 percent, and is tied with the Virgin Islands.
Medicare spending per recipient
In 2016, Original Medicare spent an average of $8,390 per beneficiary in Maine, based on data that were standardized to eliminate regional differences in payment rates (eg, higher labor costs or overhead expenses in higher cost-of-living areas). Costs for Medicare Advantage enrollees were not included in the analysis.
The national average that year was $9,533 per enrollee, so Medicare spending in Maine was 12 percent lower than the national average. Louisiana had the highest per-capita Medicare spending, at $11,399, while Hawaii had the lowest, at $6,441.
Medigap in Maine
Medigap is the only form of private coverage for Medicare beneficiaries that has no federally-mandated annual open enrollment period. Medigap coverage is guaranteed issue for six months when you turn 65 and are enrolled in Original Medicare. During that window, enrollees can select any Medigap plan available in their area, with no medical underwriting.
But after that six month period is over, enrollees often find themselves locked into the plan they initially purchased — regardless of how the premium changes — because in most states, switching to another plan can be impossible or unaffordable due to medical underwriting (under federal guidelines, there are seven limited circumstances when you can get a new Medigap plan without medical underwriting).
In response to the lack of a nationwide annual open enrollment period for Medigap, some states have implemented legislation that makes it easier for seniors to switch from one Medigap plan to another. The state of Maine allows seniors who already have Medigap coverage to switch to a different Medigap plan with the same or lesser benefits at any time during the year, and all Medigap carriers must designate one month each year when Medigap Plan A is available, without medical underwriting, to all enrollees.
Maine also provides a guaranteed issue six-month enrollment window during which disabled, under-65 Medicare beneficiaries can enroll in a Medigap plan when they first enroll in Original Medicare. All plans are community rated, which means that disabled enrollees don’t pay more than 65-year-old enrollees.
Maine also guarantees access to Medigap when enrollees initially pick Medicare Advantage but then switch to Original Medicare within three years (federally, it’s only one year). As long as the person enrolls in a Medigap plan within 90 days of switching to Original Medicare, the Medigap plan is guaranteed-issue.
Medicare Advantage in Maine
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). Some Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap. In short, there are pros and cons to either option (Medicare Advantage or Original Medicare), and consumers have to carefully weigh the options before deciding which coverage option will best fit their needs.
27 percent of Medicare beneficiaries in Maine were enrolled in private Medicare Advantage plans in 2017. Nationwide, the average was 33 percent, so Medicare Advantage is a little less popular in Maine than it is nationwide. The remaining 73 percent of Maine’s Medicare beneficiaries had opted instead for coverage under Original Medicare.
Minnesota is the only state where more than half (56 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. In Alaska, only 1 percent of Medicare beneficiaries have Advantage plans, and they’re employer-sponsored plans — there are no Medicare Advantage plans available for individuals to purchase in Alaska.
Medicare beneficiaries can switch from Medicare Advantage to Original Medicare or vice versa, each year during the annual election period in the fall (October 15 through December 7). And as of 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead..
Stand-alone Medicare Prescription Drug plans
Original Medicare does not cover outpatient prescription drugs, so enrollees who rely on that alone do not have prescription coverage. But Medicare beneficiaries can enroll in a Medicare Advantage plan that includes prescription coverage, or they can supplement their Original Medicare coverage with an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D plan.
For 2019 coverage, there are 26 stand-alone Part D plans available in Maine, with premiums ranging from $15 to $98 per month.
143,341 Medicare beneficiaries in Maine were enrolled in stand-alone Part D prescription drug plans as of late 2018. That’s about 43 percent of the state’s total Medicare beneficiaries, which is the same as the nationwide share of Medicare beneficiaries enrolled in stand-alone Part D plans. In addition, more than 97,000 Maine residents had Part D coverage integrated with the Medicare Advantage plans at that point.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. By the end of its first decade, Medicare Part D was providing coverage for almost three-quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan.