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 The Pine Tree State
In 2015 there were 306,420 Medicare beneficiaries in Maine, which is 23 percent of its total population. That compares with 17 percent of the United States population enrolled in Medicare. Maine is tied with West Virginia in having the highest percentage of its residents covered by Medicare.
The states with the lowest percentage of residents enrolled in Medicare are Alaska (11 percent) and Utah (12 percent). In raw numbers, Alaska has the least recipients at 83,863 and California (which has about an eighth of the country’s population within its borders) has the most at 5.6 million (14 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).
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 80 percent of Maine Medicare recipients. The balance — 20 percent — are on Medicare as the result of a disability. Kentucky has the highest percent of Medicare recipients listed as disabled (25 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 10 percent, followed by New Jersey, and North and South Dakota at 13 percent each.
Medicare spending per recipient
As of 2014, Medicare paid about $7,678 annually per enrollee in Maine. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.
Medicare spending overall
In total spending on Medicare, Maine ranked #38 in 2009, with $2.3 billion per year. With the largest and smallest numbers of recipients, itʼs no surprise that California accounted for $50.6 billion of overall Medicare spending while Medicare spending in Alaska was only $553 million. Total Medicare spending for all states and the District of Columbia was $471 billion in 2009 (latest available data).
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.
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). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on Original Medicare. 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 2015 in Maine, 22 percent of all Medicare recipients chose a Medicare Advantage plan. Nationwide, 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage program.
Minnesota is the only state where more than half (53 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska, with only 56 Advantage enrollees, is the only state to have zero percent enrolled in Medicare Advantage. Five more states have Medicare Advantage enrollment (as a percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire and Vermont with 7 percent, and Delaware and Maryland with 8 percent.
Stand-alone Medicare Prescription Drug plans
Maine had 151,414 Medicare beneficiaries – about 47 percent of the state’s total – enrolled in stand-alone prescription drug plans in 2015. The state has 27 plans with premiums ranging from about $18 to $119 per month.
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. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers. But 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).