Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage, also known as Medicare Part C, combines the benefits of Original Medicare, also known as Medicare Parts A and B, with additional benefits determined by approved private insurance companies. While Original Medicare, which is managed federally, offers uniform benefits nationwide, the companies offering Medicare Advantage can enrich their plans with supplementary benefits.
Medicare Advantage Plans must offer the same services as Original Medicare, except hospice care. Apart from this prerequisite, approved private insurance companies have the flexibility to devise plans within the rules and regulations set by the Centers for Medicaid & Medicare Services (CMS). As a result, each plan can have unique characteristics, such as different eligibility requirements, out-of-pocket expenses and premiums. Medicare Advantage’s appeal is its flexibility because it allows beneficiaries to choose comprehensive plans that align with their specific needs.
The number of eligible Medicare beneficiaries nationwide who have enrolled in a plan stands at 48% as of July 2023. This 3% increase in 2022 suggests Medicare Advantage is gaining popularity among eligible beneficiaries. The Congressional Budget Office (CBO) projects the number enrolled to rise to 62% by 2033 as plans become more widely available. At 55%, the adoption of Medicare Advantage among Maine’s eligible residents is outpacing the national average. Michigan and Alabama are the only states with higher enrollment. The number of seniors enrolled in Maine approached 185,000 in 2022, subsequently rising to over 204,000 the following year. This increase of 10.64% exceeds the national average of 9.75% during the same period.
Eligible seniors and persons with disabilities have 54 Medicare Advantage Plans to choose from in Maine. This guide includes a list of the state’s top plans and reveals how eligible residents can locate and select the best one for their unique requirements.
The Top Medicare Advantage Plans in Maine
Several approved providers offer Medicare Advantage Plans to eligible residents in Maine. The following table lists the most popular providers in order of the number of people enrolled as of July 2023. It includes the range of costs so seniors can better compare and contrast each plan.
Some providers offer multiple plans, and these are noted in the last column under the abbreviations HMO (Health Maintenance Organizations) and PPO (Preferred Provider Organizations). The star rating column refers to Medicare’s rating of the provider, as determined by the levels of satisfaction reported by beneficiaries.
For more up-to-date information, please visit Medicare.gov.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
UnitedHealthcare
78609
3.5
$0 – $89
PPO, HMO
Humana
48569
4
$0 – $57
PPO, HMO
Aetna Medicare
32691
3.5
$0 – $47
PPO, HMO
Wellcare
22657
2.5
$0 – $8
PPO, HMO, PFFS
Martin’s Point Generations Advantage
860
4.5
$99 – $99
PPO
How Medicare Advantage Plans Work in Maine
Maine seniors have a range of policy options if they choose to switch to a Medicare Advantage insurance plan. These options include many of the same policy types available to younger adults on the health care marketplace, such as HMOs and PPOs. Descriptions of these policy types are available below. These plans will have different out-of-pocket costs, covered services and networks of providers.
What Medicare Advantage Plans Cover in Maine
Medicare Advantage insurance plans include all of the benefits in Medicare Parts A and B, except for hospice care, which remains covered by Medicare Part A. The law requires this level of coverage, but companies can choose to include additional options as well. The most common is payments for prescription drugs. Other popular options include dental, vision, hearing aids and programs that promote general health and wellness.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Maine
Before Maine seniors can sign up for a Medicare Advantage health plan, they must already have Original Medicare Parts A and B. This requires them to be at least aged 65 or older and U.S. citizens or legal immigrants. People 65 and younger may also qualify for Medicare if they are disabled or have permanent kidney failure. Individual Medicare Advantage policies have their own eligibility requirements. Policies usually have limited service areas, so seniors must live in the locations that provide those services to qualify for coverage. There are cases where seniors can live outside the coverage area for parts of the year. Beneficiaries must enroll in Medicare Advantage during specific periods, which seniors can find below.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Maine
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Maine Department of Health and Human Services – MaineCare
The Maine Department of Health and Human Services oversees the state Medicaid program known as MaineCare, which can offer valuable financial assistance for seniors enrolled in Medicare. Eligible seniors may qualify for the state’s Medicare Savings Program (MSP) and receive help paying their Medicare Advantage and prescription drug plan premiums. The program may also cover other out-of-pocket costs, such as coinsurance payments and deductibles. To qualify for the MSP, seniors must meet the program’s income and asset guidelines. Eligibility determinations and enrollment in the MSP are handled by the Maine DHHS Office of Family Independence.
Seniors can learn more about qualifying for the MSP and apply for the program by contacting the OFI Eligibility Office at 1-855-797-4357. Applications are also accepted at OFI district offices throughout the state, and a list of office locations is available on the department’s website.
The Senior Medicare Patrol (SMP), is a federally funded, volunteer-based organization whose goal is raising awareness of and reducing Medicare fraud and abuse, as well as billing errors. In Maine, SMP volunteers hold workshops in various locations and offer one-on-one counseling sessions to provide information, answer questions and address concerns that seniors have about health insurance services, including Medicare Advantage, other Medicare programs and MaineCare. Cases of suspected fraud or other criminal activities that are brought to the organization’s attention are referred to an appropriate local, state or federal agency.
To learn more about the assistance available through SMP and how to contact an organization volunteer for help with a concern, seniors can call the Maine Office of Elder Services at 1-800-262-2232. Alternatively, they can contact their local Area Agency on Aging.
The State Health Insurance Program (SHIP) offers in-depth, unbiased information about Medicare and other health insurance options to Maine residents. The program provides Medicare-eligible seniors and adults with disabilities with one-on-one counseling at no cost, either by phone or in person. Trained SHIP counselors are available to provide guidance and answer questions about Original Medicare, Medicare Advantage, Part D prescription drug coverage and MaineCare. They can also help seniors with state assistance, such as the Medicare Savings Program, which can help lower prescription drug and out-of-pocket health care costs for eligible individuals.
Seniors can learn more about the SHIP program by calling the Maine Office of Aging and Disability Services toll-free at 1-800-262-2232. To receive assistance through the SHIP program, seniors can contact their local Area Agency on Aging to schedule a counseling session, either over the phone or in-person at the agency’s location.
Maine Health Insurance Consumer Assistance Program
The Maine Health Insurance Consumer Assistance Program (MHICAP) assists seniors and other state residents with a range of health insurance coverage concerns. The program is administered by the nonprofit Maine advocacy organization, Consumers for Affordable Health Care, and is available throughout the state. Services are provided at no charge and include help learning about available coverage options, assistance applying for health insurance and handling coverage and claim denials, among others. Experienced MHICAP counselors can also help seniors apply for assistance through the state Medicaid program, MaineCare, which can reduce or cover their Medicare Advantage and prescription drug costs.
For assistance with Medicare Advantage and other health insurance issues, seniors can call the MHICAP toll-free helpline at 1-800-965-7476. For more information and answers to questions about the program, seniors can contact Consumers for Affordable Health Care’s Augusta office by phone at 1-800-838-0388, or by completing the contact form on the CAHC website.
Maine Legal Services for the Elderly is a not-for-profit organization that provides free legal advice to seniors aged 60 and older on a range of issues, including health insurance, public benefit programs, civil and personal legal matters and Medicare programs, such as Medicare Advantage. Seniors can access detailed information about a variety of Medicare topics on the organization’s website, or call the statewide toll-free helpline to receive personalized assistance from a Medicare Rights Advocate. One-on-one help with Medicare concerns is also available at the LSE offices located in Augusta, Bangor, Scarborough, Lewiston and Presque Isle.
For information or advice about Medicare issues, seniors can call the LSE helpline at 1-800-750-5353 and ask to speak with a Medicare Rights Advocate. Seniors can also search for the LSE location serving their county on the agency’s website, and contact the office directly for assistance.
The five Aging & Disability Resource Centers (ADRCs) located throughout Maine connect seniors and those with disabilities to a wide range of resources, programs and services, including help understanding the different Medicare coverage choices and enrollment options. Each center can put seniors in touch with experienced Medicare consultants who can provide information about the various types of Medicare Advantage plans and their prescription drug coverage options. These trained professionals can also offer guidance to help seniors define their coverage needs and select a plan that works best for their unique situation. Assistance with completing applications is also available. These services are provided free of charge.
Contact Info
Maine’s Aging and Disability Resource Centers are operated by the five Area Agencies on Aging that serve specific regions of the state. Seniors can view the state map showing the service areas for each center, and find the contact details for the ADRC serving their area on the Government of Maine website.
