Medicare in Maine

Maine has extensive consumer protections related to Medigap (Medicare supplement) coverage

Photo credit: Alison Chaiken | Flickr

At a glance: Medicare health insurance in Maine

Medicare enrollment in Maine

2020 Medicare enrollment dates332,242 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.

Maine has the second-highest percentage of residents age 65+ in the country, although Maine also has a higher-than-average percentage of Medicare beneficiaries who are under 65 and eligible for Medicare due to a disability (19 percent, versus 16 percent nationwide)

Medicare Advantage in Maine

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.

The availability of Medicare Advantage plans varies from one county to another. Across Maine’s 16 counties, Medicare Advantage availability ranges from six plans in Washington County, to 31 plans in Androscoggin County.

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.

Medigap in Maine

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

Medigap plans are standardized under federal rules — plans are designated by letter, from A through N; all Medigap insurers must offer at least Plan A and also offer at least Plan C or Plan F in addition to Plan A. People are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability. And after the initial six-month open enrollment period ends, federal rules do not allow enrollees guaranteed-issue access to Medigap plans (including switching from one plan to another) unless they experience one of the limited situations that trigger a guaranteed-issue right.

But Maine has much more extensive Medigap regulations, designed to protect consumers and ensure greater access to Medigap. Maine’s rules are explained in the state’s Consumer Guide to Medicare Supplement Plans, and include several provisions:

  • All Medigap insurers in Maine must designate at least one month per year when all applicants will be accepted for enrollment in Medigap Plan A, regardless of their medical history (Plan A offers the least amount of benefits).
  • People under age 65 in Maine are granted the same six-month open enrollment period for guaranteed-issue Medigap plans (starting when they’re enrolled in Medicare Part B) as people who are 65 and enrolling in Medicare due to their age. These enrollees also have access to another six-month open enrollment period — during which they can switch to any Medigap plan on a guaranteed-issue basis — when they turn 65. This is clarified in Maine Rule 275, Section 11, which clarifies that insurers cannot condition eligibility or premiums on a person’s medical history as long as they enroll during their six-month open enrollment window, or in the 60 days preceeding it (to ensure that people can have a seamless transition to Medicare, with Medigap coverage effective the same day Medicare begins).
  • After the initial six-month window ends, Medigap enrollees in Maine are allowed to switch to a different plan from their current insurer or a different insurer, as long as they pick a plan with equal or lesser benefits (this chart shows which plans are available, depending on the plan the person already has) and as long as they haven’t had a break of more than 90 days in their Medigap coverage since their initial open enrollment period.
  • Maine is one of eight states where Medigap premiums cannot vary based on age, and that provision also includes people under age 65 (some of the states that ban age-based Medigap premiums only apply that requirement to plans sold to people who are at least 65 years old). Medigap premiums in Maine only vary based on tobacco use.
  • Federal law gives people a “trial right” to try Medicare Advantage and then switch to Original Medicare instead, with guaranteed-issue access to Medigap as long as the person makes the switch to Original Medicare within a year. But Maine law extends that trial right period to three years. If a person in Maine signs up for Medicare Advantage when they’re first eligible for Medicare and then switches to Original Medicare within three years, they have a guaranteed-issue right to buy any Medigap plan available in their area, as long as they purchase it within 90 days of their Medicare Advantage plan ending.
  • Maine residents who have Medigap coverage and terminate it to switch to Medicare Advantage also have a three-year trial period, although it’s a little more restrictive. As long as they switch back to Original Medicare within three years and apply for a Medigap plan within 90 days of the Medicare Advantage plan ending, they have a guaranteed issue right to buy a Medigap plan with benefits that are equal to or less than their original Medigap plan’s benefits (again, this chart shows which plans have equal or lesser benefits).

There are 15 insurers in Maine that offer Medigap plans. The state’s consumer guide shows 2019 Medigap premiums as well as each insurer’s pre-existing condition waiting period (if applicable) for people who didn’t have continuous coverage before enrolling in the Medigap plan. Insurers cannot exclude pre-existing conditions if the applicant had a least six months of creditable coverage prior to enrolling in Medigap (if they had creditable coverage but for a period of less than six months, the insurer can implement a pre-existing condition waiting period of up to six months minus the amount of time the person had creditable coverage in the prior six months).

Medicare Part D in Maine

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D plan.

As of November 2018, there were 143,341 Medicare beneficiaries in Maine who were enrolled in stand-alone Part D prescription drug plans. 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 to those with stand-alone Part D plans, more than 97,000 Maine residents had Part D coverage integrated with the Medicare Advantage plans as of late 2018.

For 2019 coverage, there are 26 stand-alone Part D plans available in Maine, with premiums ranging from $15 to $98 per month.

Medicare spending in Maine

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. 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.

In terms of the extremes on both ends of the spectrum, average per-beneficiary Original Medicare costs in Louisiana were the highest in the nation, at $11,399, while they were lowest in the nation in Hawaii, at $6,441.

You can read more about Medicare in Maine in our state Medicare guide. You can also contact the Maine State Health Insurance Assistance Program if you have questions related to Medicare coverage in Maine.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts

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