Turning Age 65? 
Frequently Asked Questions Regarding Your Health Insurance
For State of Maine Retirees and Their Dependents

Who do I contact to find out if I qualify for Medicare?
Your local Social Security Administration office. Click here to search for the Social Security Office Locator.

How do I qualify for Medicare benefits?
When you work and pay Social Security taxes, you earn "credits" toward Social Security benefits.  To qualify for Medicare at age 65, you need 40 credits or 10 years of work.  You may qualify for Medicare through your own earnings history, your current spouse, former spouse or deceased spouse.  (Note: State of Maine employees hired or rehired after March 31, 1986 are subject to the mandatory Medicare payroll tax of 1.45%.  This also qualifies you for Medicare benefits.)  You may also qualify for Medicare if you receive Social Security disability benefits.

How will my health insurance change if I qualify for Original Medicare (Parts A and B)?
You will be transferred from the State of Maine's Point of Service health insurance plan to our Medicare Advantage Plan. The transfer will be effective the same date your Original Medicare (Parts A and B) becomes effective provided we have received your Medicare Advantage application at the Division of Employee Health & Benefits office.  (Receipt of a late application could result in a later effective date of transfer.)

Am I required to transfer health insurance plans if I qualify for Medicare?
Yes (if you wish to keep your insurance policy provided by the State of Maine).

What steps should I take if I qualify for Medicare?
Step 1:  Apply for Medicare Parts A and B at your local Social Security office. (Social Security Office Locator).
Step 2: Complete and return the application to enroll in the State of Maine's Medicare Advantage Plan.

Do I need to enroll in both Medicare Parts A and B?
Yes (if you wish to keep your insurance policy provided by the State of Maine).  Part A (hospital insurance) is at no cost to you.  Part B (medical insurance) is at your own expense.

Will the State of Maine pay my Medicare Part B premium expense?
No. The Medicare Part B premium is at your own expense.  Social Security will withhold the premium directly from your Social Security check.  If your check is not large enough, Medicare will bill you quarterly for your premium.  For the current Medicare Part B premium amount click this link.  If you need help paying for your Part B premium, you may qualify for a Medicare Savings Program by meeting certain conditions.  You may also find additional assistance from your local Department of Health and Human Services office.

Do I need to maintain Medicare B coverage to keep my State of Maine health insurance policy?
Yes.  If Medicare cancels your Medicare B coverage due to non-payment of premiums, you will automatically lose health insurance coverage with the State of Maine.  You would not be eligible to re-enroll after cancellation unless you satisfy your Medicare B premiums and Medicare reinstates your Medicare B coverage without a break in coverage.  If you are dis-enrolled due to non-payment of Medicare B premiums on four (4) separate occasions, you will permanently lose your eligiblity and cannot re-enroll in the State of Maine health plan.

Do I need to enroll in Medicare Part D (prescription drug coverage)?
No. The State of Maine's Medicare Advantage Plan provides your prescription drug coverage.  This type of coverage is considered a Part D prescription plan and you cannot have more than one Part D policy.  If you enroll in a separate Medicare Part D plan, you will not be eligible for the State of Maine's Medicare Advantage Plan.

What will happen to my health insurance if I do not qualify for Medicare?
If you do not qualify for Medicare or are not eligible for Medicare Part A at no cost you will remain on the Point of Service plan you have now. Please forward a copy of your letter from the Social Security Administration stating you do not qualify for Medicare benefits.  (Please note:  If you qualify for Medicare at a later date you must contact Employee Health and Benefits to transfer your coverage.)


Governing State of Maine Statutes: Title 5 § 285, §285-A and § 286