For more information, visit our section on Medicare Coverage.
I will be turning 65 in a few weeks. Can you please explain the open enrollment for Medicare supplement (Medigap) insurance policies?
If you are turning 65, your first priority is to make sure you are enrolled in Medicare Part B (contact the Social Security Administration at 1-800-772-1213 or www.ssa.gov/ for information on enrollment procedures). Federal law gives you a 6-month "open enrollment" period to apply for a Medicare supplement insurance policy, beginning with the first month that you enroll for benefits under Medicare Part B. For information on available Medicare supplement plans, see: A Consumer's Guide to Medicare Supplement Insurance (PDF). To see exactly what Maine law says on this issue, check out: Bureau of Insurance Rule 275 Section 11. For other questions about Medicare or Medicare Supplement policies, contact the Maine State Health Insurance Assistance Program at 1-800-262-2232 (within the state).
Yes, Medicare Advantage HMO, PPO, and Medicare Advantage private fee-for-service plans, with or without prescription drug coverage, are currently available in Maine. See your current edition of "Medicare and You" for a list of plans available in Maine, or call 1 -800 Medicare. For other questions about Medicare or Medicare supplement policies, contact the Maine State Health Insurance Assistance Program at 1-800-262-2232 (within the state)
If you have had a Medicare supplement plan since you turned 65, in most cases you can change to the same or a lower plan (e.g., from plan "G" to plan "A") at the same or another company without having to wait for open enrollment. However, you must obtain your new plan within 90 days of leaving the old plan. To see exactly what Maine law says on this issue, see: Title 24-A M.R.S.A. §5002-B. For other questions about Medicare or Medicare supplement policies, contact the Maine State Health Insurance Assistance Program at 1-800-262-2232 (within the state)
I am currently enrolled in a Medicare Advantage plan. Can I switch to original Medicare? If I switch to original Medicare, will I be able to enroll in a Medicare supplement plan?
You cannot purchase a Medicare supplement plan if you are enrolled in Medicare Advantage. If you are enrolled in a Medicare Advantage plan you may have a right under Maine law to enroll in a Medicare supplement plan if you switch back to original Medicare, but only under certain limited circumstances.
- You may be entitled to guaranteed issue of a Medicare Supplement policy if your Medicare Advantage plan is involuntarily terminated (i.e., not at your request).
- If you enroll in Medicare Advantage during your six-month open enrollment period, beginning when you first enroll in Medicare Part B, and then switch to Original Medicare Part A and Part B within 36 months:
- You have the right to buy any Medicare supplement plan as long as you buy it within 90 days after your Medicare Advantage coverage ends. This arrangement is intended to provide you with a one time trial period to determine if a Medicare Advantage plan meets your needs. NOTE: If you enrolled in a Medicare Advantage plan mid-year, you will need to switch back to original Medicare sooner than 36 months because federal law only allows you to go back to original Medicare at certain times. Also, the 36 month trial period is specific to Maine, so you may not have the same rights if you move to another state.
- If you are enrolled in a Medicare Supplement plan and you terminate that enrollment to enroll in a Medicare Advantage plan for the first time, and you then return to Original Medicare Part A and Part B within 36 months:
- You have the right to buy an equivalent or less comprehensive Medicare supplement plan as long as you are still a Maine resident and apply for the new Medicare supplement plan within 90 days. (As noted above, if you enroll in Medicare Advantage mid-year and switch back, you will need to do so sooner than 36 months.)
- For specific guidance on guaranteed issue eligibility, please see Maine Insurance Rule Chapter 275, §12 or contact the Bureau of Insurance.