Medicare Advantage Plans
Medicare Advantage Plans (Part C) are offered by private insurance companies and include the following types:
- Health Maintenance Organization (HMO) Plans: These require you to use healthcare providers within the plan’s network, except in emergencies, and typically require a referral to see a specialist.
- Preferred Provider Organization (PPO) Plans: These offer more flexibility, allowing you to see out-of-network providers at a higher cost, and generally do not require referrals for specialists.
- Special Needs Plans (SNPs): Tailored for individuals with specific diseases or characteristics, offering specialized care management.
- Private Fee-for-Service (PFFS) Plans: These determine how much they will pay providers and how much you must pay when you receive care.
Medicare Supplement Insurance (Medigap)
Medigap policies are offered by private insurers to supplement Original Medicare (Parts A and B). They help cover out-of-pocket costs like copayments, coinsurance, and deductibles. Some popular Medigap plans include:
- Plan G: Covers most out-of-pocket costs except for the Part B deductible.
- Plan N: Similar to Plan G but requires copayments for some office visits and emergency room visits.
Medicare Part D (Prescription Drug Plans)
Medicare Part D provides coverage for prescription drugs. These plans are offered by private insurers and can be standalone plans or part of a Medicare Advantage plan that includes drug coverage.
MaineCare (Medicaid)
For those who qualify based on income and asset limits, MaineCare provides additional assistance with Medicare costs. This can include:
- Qualified Medicare Beneficiary (QMB) Program: Helps pay for Part A and B premiums, deductibles, coinsurance, and copayments.
- Specified Low-Income Medicare Beneficiary (SLMB) Program: Helps pay for Part B premiums.
- Qualifying Individual (QI) Program: Also helps pay for Part B premiums.
Enrollment Periods
Medicare enrollment periods include:
- Initial Enrollment Period: A seven-month period around your 65th birthday.
- Annual Enrollment Period: From October 15 to December 7, allowing changes in Medicare Advantage and Part D plans.
- Medicare Advantage Open Enrollment Period: From January 1 to March 31, allowing changes between Medicare Advantage plans or switching back to Original Medicare.