Medicare

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with permanent kidney failure requiring dialysis or a kidney transplant.  Medicare covers certain medical services and items in hospitals and other settings.

  • Medicare Part A A helps to cover inpatient care in hospitals and skilled nursing facilities.  It also helps cover hospice and home health care.  Most people automatically get Part A coverage without having to pay a monthly payment.
  • Medicare Part B helps cover medical care like doctors’ services, outpatient care, some preventive services and other items and services. Part B is optional and you pay a monthly premium for this coverage. Medicare Advantage Plans are health plan options that are approved by Medicare and run by private companies. These options are Medicare Part C and they are a different way of getting Medicare coverage than traditional Medicare.
  • These plans include Part A and Part B coverage, extra benefits, and may include prescription drug coverage.
  • Medicare Prescription Drug Coverage (Part D) Medicare offers prescription drug coverage (Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. If you want Medicare drug coverage, you need to choose a plan that works with your health coverage and needs. Since plan coverage may change annually, it is very important that you review the costs and covered medications each year for any Part D Plan before you enroll.

Part D is Optional and you usually pay a monthly premium to get coverage.  Even if you don’t take a lot of prescription drugs now, you should still consider joining a Medical drug plan.  If you decide not to join a Medicare drug plan when you are first eligible, and you don’t have other creditable prescription drug coverage, you will likely pay a late enrollment penalty (higher premiums) if you choose to join later. 

If your income is low, you may be eligible for programs that pay the Part B premium, deductibles, co-insurances, and/or co-payments.  You may also be eligible for help with Part D out-of-pocket costs.  For more information, contact your local Department of Health and Human Services Office, a local Area Agency on Aging, or Legal Services for the Elderly.

Call the Social Security Administration Several months before you turn age 65 to make sure you get enrolled in the Medicare Program.  Contact information for the local Social Security offices is listed on page A36.

If you have any questions about the Medicare Program, call the Maine SHIP Program at 1-877-353-3771 or the Medicare Program directly at 1-800-MEDICARE (1-800-633-4227).

Medicare Part D Appeals Unit
Legal Services for the Elderly

The Medicare Part D Appeals Unit of Legal Services for the Elderly provides free help to low-income Mainers having trouble getting their prescription drugs covered through Medicare Part D.  Appeals Specialists provide information and assistance over the phone Monday through Friday from 9:00 to 12:00 and 1:00 to 4:00.  The Unit also helps pharmacies, medical offices and other health care providers that need information about Part D formularies or help in understanding how to get medications covered for their patients.  Information about Medicare Part D, including links to the Plan Formularies, is available at the LSE website:  www.mainelse.org

Toll Free    1-877-774-7772

Things to Consider When Choosing or Changing your Coverage

  • Coverage – When choosing between Original Medicare and a Medicare health plan, does the plan provide extra coverage you want that Original Medicare doesn’t cover?
  • Your other coverage – Do you have, or are you eligible for, other types of health or prescription drug coverage?  If so, read the materials you get from your insurer or plan, or call them to find out how the coverage works with, or are affected by, Medicare.  If you have coverage through a former or current employer or union, talk to your benefits administrator, insurer, or plan before making any changes to your coverage.
  • Cost – How much are your premiums and deductibles?  How much do you pay for services like hospital stays or doctor visits?  Your costs vary and may be different if you don’t follow the coverage rules.
  • Doctor and hospital choice – Do your doctors accept the coverage?  Are they accepting new patients?  If you are considering a Medicare health plan, do you have to choose your hospital and health care providers from a network?  Do you need a referral to see a specialist?
  • Prescription drugs – What are your drug needs?  Do you need to join a Medicare drug plan?  What will your prescription drugs cost under each plan?  Are your drugs covered under the plan’s formulary (drug list)?  Formularies can change.
  • Quality of care – The quality of care and services given by plans and other health care providers can vary.  Medicare has information to help you compare plans and providers.  See Volunteer Opportunities.
  • Convenience – Where are the doctors’ offices?  What are their hours?  Which pharmacies can you use?  Can you get your prescriptions by mail?
  • Travel – Do you spend part of each year in another state?  Will the plan cover you there?