Spend more time enjoying Maine‘s beautiful coastal scenery and less time stressing over healthcare coverage. Maine residents have access to terrific Medicare Advantage plans —see the highest-rated ones here!
Medicare Advantage (aka Medicare Part C) plans typically include extra benefits that Original Medicare doesn’t, like vision, dental, hearing, and prescription drug coverage. This is very appealing to many and could be why Medicare Advantage enrollment in Maine has steadily increased over the years. In 2020, 43 percent of Maine Medicare beneficiaries were enrolled in a Medicare Advantage plan —higher than the national average of 40 percent.
What can be tricky about shopping for Medicare Advantage plans is that they aren’t as straightforward as Original Medicare. This is because Medicare Advantage plans are offered by private insurance companies, so the exact coverage details and costs will vary from one plan to the next. And while having options is great, sometimes being presented with too many can get confusing.
That’s why online tools, like the Insurify Medicare comparison tool, make it easier and faster to find great options without the need to contact a licensed insurance agent. It’s your time to relax, and choosing the right health insurance plan shouldn’t be a stressful process. In this guide, we’ll review the eight highest-rated Medicare Advantage plans in Maine and a few essential tips you need to be aware of when comparison shopping. Armed with this knowledge, you’ll be well on your way to finding excellent Medicare Advantage coverage.
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Since healthcare is such a personal decision, there isn’t a universal answer for which plan is the best. The best Medicare Advantage plan for one person may not be a great plan for another. That’s why it’s important to spend some time thinking about these aspects:
Medical Needs: Do you have any health conditions that require frequent checkups? If so, you may want a plan with low co-pays. Do you take prescription medications you’ll need to be covered? In that case, you’ll want a great prescription drug plan with affordable co-pays. Does your family medical history suggest potential development of a health condition later in life? You may want to find Medicare coverage with that in mind.
Preferences: Do you have preferred physicians that you want to see? If so, remember to check if they are covered within the plan’s network. Do you prefer to go straight to specialists when you have an issue? If so, a preferred provider organization (PPO) plan will likely be best for you. Do you value the convenience of an online portal for viewing insurance information and claims, or do you prefer talking with a representative over the phone? Take note of any strong personal preferences like these when you compare insurance companies.
Budget: How much can you afford to spend on healthcare annually? Many shoppers tend to look solely at a plan’s monthly premium, but remember that healthcare costs are more than just premiums. There are also deductibles, co-pays, and coinsurance to take into account.
As we review the top eight highest-rated Medicare Advantage plans in Maine, keep these considerations in mind. Remember: star ratings are important, but a highly-rated plan that doesn’t fit your needs doesn’t do you much good. Always put your needs first.
See Also: What Age Does Medicare Start?
1. Martin's Point Generations Advantage Prime
2. Martin's Point Generations Advantage Value Plus D
3. AARP Medicare Advantage Choice Plan 1
4. AARP Medicare Advantage Choice Plan 2
5. AARP Medicare Advantage Choice Plan 3
6. Aetna Medicare Value Plan
7. Martin's Point Generations Advantage Select
8. AARP Medicare Advantage Choice
Depending on your medical needs, preferences, and budget, one of these top-rated plans may just be the perfect match for you. If these don’t quite fit your current situation, you can easily compare Medicare plans online with the Insurify Medicare comparison tool. All you need is your ZIP code to get instantly matched with plan options!
Monthly Premium:$89
Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $6,850
Counties Covered: Aroostook, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Washington, Franklin, Waldo
This five-star plan has great service area coverage and is available in 11 counties. It generally has low co-pays for doctor visits and for prescription drugs. It also has excellent benefits, including vision, dental (preventive and comprehensive), hearing, mental health services, skilled nursing facilities, rehabilitation services, podiatry services, and wellness programs.
Monthly Premium: $29
Deductible: $0
Prescription Drug Plan Deductible: $275
Out-of-Pocket Maximum: $7,550
Counties Covered: Aroostook, Franklin, Hancock, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Somerset, Waldo, Washington
Rated five stars, this plan has a low premium, low drug plan deductible, and overall low co-pays. The only downside to this plan is that it does not cover dental. But if dental coverage isn’t really on your radar, this could be a great option to consider.
Monthly Premium: $0
Deductible: $0
Prescription Drug Plan Deductible: $250
Out-of-Pocket Maximum: $5,900
Counties Covered: Sagadahoc, Franklin, Knox, Lincoln, Waldo, York, Kennebec, Oxford, Cumberland, Androscoggin
Offered by UnitedHealthcare, this premium-free plan is rated 4.5 stars and is offered in 10 Maine counties. Although the base plan doesn’t cover dental services, you can choose to add a supplemental dental package that covers both preventive and comprehensive dental care for just $45 a month. Bear in mind, supplemental dental is a stand-alone plan—not to be confused with Medicare Supplement Insurance.
Monthly Premium: $59
Deductible: $0
Prescription Drug Plan Deductible: $150
Out-of-Pocket Maximum: $5,500
Counties Covered: Knox, Oxford, Waldo, Franklin, York, Lincoln, Sagadahoc, Kennebec, Cumberland, Androscoggin
This PPO plan has low co-pays —$0 to visit your primary care physician (PCP) and $35 for specialist visits. It covers vision, hearing, preventive dental, mental health services, skilled nursing, rehabilitation, podiatry, and wellness programs. Comprehensive dental coverage (services like extractions or restorative procedures) can be added for an additional $40 per month.
Monthly Premium: $0
Deductible: $750
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $6,700
Counties Covered: Waldo, Franklin, Cumberland, Androscoggin, Oxford, Kennebec, Knox, Lincoln, Sagadahoc, York
This PPO plan has low co-pays —$0 to visit your primary care physician and $35 for specialist visits. It covers vision, hearing, preventive dental, mental health services, skilled nursing, rehabilitation, podiatry, and wellness programs. Comprehensive dental coverage (services like extractions or restorative procedures) can be added on for an additional fee of $40 per month.
Monthly Premium: $0
Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $5,900
Counties Covered: Cumberland, Sagadahoc, York
This premium-free plan is rated 4.5 stars and offers low co-pays on doctor visits and for hearing, vision, and podiatry services. Preventive and comprehensive dental services are covered with a 50 percent coinsurance. Coinsurance means that after meeting your plan’s deductible, you pay a percentage of the healthcare bill and your provider pays for the remainder. Some people prefer co-pays because they know up front what they can expect to pay. If you don’t plan on using dental services but want some form of coverage just in case, this plan could be a good option for you.
Monthly Premium: $99
Deductible: $0
Prescription Drug Plan Deductible: $0
Out-of-Pocket Maximum: $7,300
Counties Covered: Androscoggin, Cumberland, Franklin, Knox, Lincoln, Oxford, Sagadahoc, Waldo, York
This plan is rated 4.5 stars and covers a wide range of benefits, including vision, hearing, mental health services, skilled nursing, rehabilitation, podiatry, and wellness programs. The downside is that it does not cover preventive or comprehensive dental. Generic drugs have co-payments that range from $0 to $10.
Monthly Premium: $64
Deductible: $0
Prescription Drug Plan Deductible: $295
Out-of-Pocket Maximum: $7,500
Counties Covered: Androscoggin, Aroostook, Cumberland, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, Washington, York
This plan has great service area coverage and is available in 16 Maine counties. To see your primary care physician, the co-pay is only $10; visiting a specialist is just $45. The prescription drug plan also offers affordable co-pays, with generic drugs costing $3 to $12. The plan does not include any dental services, and the vision benefit only covers routine eye exams. If you’d like to add preventive and comprehensive dental care to your plan, you can do so for an additional $45 per month.
All U.S. citizens or permanent residents are eligible for Medicare when they turn 65. You can sign up for Medicare coverage during your Initial Enrollment Period, which starts three months before your 65th birthday and ends three months after. When you sign up for Medicare, make sure to enroll in Original Medicare ( Medicare Part A and Part B ). Once you have that complete, you can later choose to switch to a Medicare Advantage plan. If you have any questions about your Medicare eligibility, you can visit www. medicare.gov or call 1 (800) 772-1213; TTY users can call 1 (800) 325-0778.
Once you’re enrolled in Original Medicare, Medicare beneficiaries can switch to a Medicare Advantage plan during the Open Enrollment Period, which occurs every year from October 15 to December 7. During this period, you can join, switch, or drop Medicare plans.
If you are already enrolled in a Medicare Advantage plan but want to switch to another MA plan or back to Original Medicare, you can do so during the Medicare Advantage Open Enrollment Period. This happens every year from January 1 to March 31.
If you choose a plan that doesn’t offer prescription drug coverage, you need to enroll in a separate Medicare Part D plan. In either case, be sure to read the plan’s formulary carefully. The formulary is the schedule of copayments associated with different tiers of prescriptions. Tier 1 is the least expensive, and Tier 4 is the most expensive. Ideally, any medications you take regularly should be covered in Tier 1 or Tier 2.
Remember that, if you enroll in Medicare Advantage, you cannot also enroll in a Medicare Supplement Plan (aka Medigap). You’ll retain trial rights for 12 months after you make the switch. If you decide you’d rather use Medigap, you can switch back without going through medical underwriting. But your Medigap plan must be still available for new enrollees. If you have a grandfathered plan, you won’t be able to re-enroll.
As seen from the eight top-rated plans in Maine, Medicare Advantage costs will vary from plan to plan and person to person. The key costs you will need to review when comparing plans available in your area include:
Monthly Premium: The amount you pay each month.
Deductible: The amount of money you need to pay before insurance starts covering your costs. For example, if you have a healthcare expense of $500 and your plan has a deductible of $200, that means you have to pay $200 and then your insurance will cover the remainder. Some Medicare Advantage plans may have separate deductibles for the health plan and the prescription drug plan.
Out-of-Pocket Maximum: Some plans have an out-of-pocket maximum, which means there’s a cap on your annual out-of-pocket healthcare costs. Once you’ve reached that amount, you don’t have to pay for further services during the year.
Co-payment: This is the flat fee you pay for a doctor’s visit, service, or procedure. This is also referred to as a “ co-pay.”
Coinsurance: This is a percentage of a bill you are responsible for paying after you’ve met your plan’s deductible (if there is one). If your plan has a 20 percent coinsurance, for example, you would pay 20 percent of the healthcare bill, and your insurance provider will cover the rest.
On average, you can expect to pay $248.367 annually for your monthly premium costs.
There are four types of Medicare Advantage plans available in Maine. Two of the most common types are HMOs and PPOs. While PFFS plans and SNPs are less common, they may work best for you, depending on your unique circumstances.
Health Maintenance Organization (HMO): HMOs are among the most common and least expensive Medicare Advantage plan types in Maine. While they are the most affordable, there can be some limitations with an HMO plan. You can only use healthcare providers in the plan’s network and will need a referral from your primary care physician to visit a specialist. If you opt for an HMO-POS, you’ll have the option to receive non-emergency care outside of Maine, but you’ll pay higher premiums and copays.
Preferred Provider Organization (PPO): PPOs tend to be more expensive than HMOs but provide greater flexibility. Although PPOs also have a network of healthcare providers, you have the option to see out-of-network providers at a higher cost. You can also visit specialists without a referral from your primary care doctor.
Private Fee-for-Service (PFFS): These plans aren’t as common. They provide great flexibility with no provider networks. You can go to any provider that accepts the payment terms of your plan.
Special Needs Plan (SNP): The coverage in an SNP plan is tailored to meet the needs of a specific group of people. You are eligible for an SNP plan if you have a chronic health condition (such as end-stage renal disease ESRD ), live in an institution (such as a nursing home), or qualify for both Medicare and Medicaid services.
Medical Savings Account (MSA): The name says it all. This is a savings account that holds money to be used for medical expenses. These are typically used alongside high- deductible health plans to help save on costs.
Original Medicare is made up of Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). Original Medicare can be a great, low-cost option for Medicare beneficiaries who want the basics covered. You can add Medigap coverage or a Medicare Part D prescription drug plan to supplement your Original Medicare coverage.
On the other hand, Medicare Advantage covers everything that Original Medicare covers plus more. These additional benefits usually include a prescription drug plan, vision, hearing, and dental. Medicare beneficiaries who know they want greater comprehensive coverage may prefer a Medicare Advantage plan.
No, Medigap is Medicare Supplement Insurance that is intended to help fill the gaps of Original Medicare. It cannot be used with Medicare Advantage plans.
Most Medicare Advantage plans will include a Medicare Part D prescription drug plan. The exact details for these drug plans will vary. You will want to look at each plan's formulary to estimate how much prescription drugs will cost you annually.
There are a few special conditions where someone under the age of 65 may qualify for Medicare coverage. If you are diagnosed with end-stage renal disease (ESRD) or have been receiving Social Security disability or Railroad Retirement Board benefits for 24 consecutive months, you may be eligible for Medicare coverage.
Now that you understand eligibility requirements, enrollment processes, and what types of Medicare Advantage plans are available, you are well-equipped to start comparing plans on your own! You can bypass finding and reaching out to a licensed insurance agent and make the best decision all on your own—when you want and how you want.
Ready for a Medicare plan that works for you? Use the Insurify Medicare comparison tool to find Medicare plans near you. Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!
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