Medicare Advantage in Maine

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Maine Medicare Advantage enrollment by the numbers

There were more than 87,000 people in the state of Maine with a Medicare Advantage plan in 2017.¹

There are several major types of Medicare Advantage plans. In the state of Maine, there are 39 different Medicare Advantage plans available as of 2018.² Not every plan is available in each county, so it's important to find out which ones are offered where you live.

Most of Maine’s Medicare Advantage beneficiaries were enrolled in an HMO plan in 2017, 35 percent of Maine Medicare Advantage plan enrollees were enrolled in a Local PPO plan. The major types of Medicare Advantage plans include:

HMO

A Health Maintenance Organization usually requires patients to use health care providers and pharmacies that are part of the plan’s network (except in the case of emergencies) while also typically requiring a referral from a primary care doctor in order to see a specialist.

PPO

Medicare Advantage beneficiaries in a Preferred Provider Organization are able to see providers outside of their plan’s network, often at a higher cost. Beneficiaries in this type of plan typically pay less out of pocket if they choose to receive medical services from providers within their plan’s network. PPO plans typically do not require patients to acquire a referral before visiting with a specialist.

PFFS

A Private Fee-For-Service plan determines how much it will pay to health care providers and how much the patient will pay when care is received. With a PFFS plan, you can typically receive care from any doctor, hospital or health care provider that accepts your plan’s terms. Not all providers will accept these terms, however.

SNP

A Special Needs Plan is a type of Medicare Advantage plan limited to people with certain chronic conditions and  other specific characteristics. Typically, you must receive care from health care providers and hospitals within your SNP network, except for in cases when you need emergency or urgent care and when someone who has End-Stage Renal Disease (ESRD) needs out-of-area kidney dialysis.

Medicare Cost Plans, Medical Savings Accounts (MSA) and HMO Point-of-Service (HMO POS) plans are 3 additional types of Medicare Advantage plans that are less common in most states. Enrollment in these plans make up a small percentage of all Medicare Advantage plan enrollment in Maine.

Total number of Medicare Advantage enrollees in Maine: 87,548 as of 2017¹

Maine's Medicare Advantage enrollees by plan type:

Plan type Percentage of Maine enrollees (2017)
HMO 61%
Local PPO 35%
Regional PPO <1%
PPFS 4%
Cost Plans 0%
Other Plans 0%

Data reflects Medicare Advantage enrollment in the state of Maine as of 2017, as obtained from the Kaiser Family Foundation Medicare Advantage 2017 Spotlight: Enrollment Market Update¹

Maine’s State Health Insurance Assistance Program (SHIP)

The State Health Insurance Assistance Program of Maine offers free health insurance counseling and assistance to Maine residents who have Medicare. The trained staff can help answer questions about benefits in order to help people better understand and optimize their Medicare coverage. The program may be reached at 877-353-3771 (or 800-750-5353 for TTY users).     

You can also explore more information about the insurance industry in Maine by visiting the state’s Department of Insurance website.

 

¹Kaiser Family Foundation. Medicare Advantage 2017 Spotlight: Enrollment Market Update. Retrieved from https://www.kff.org/report-section/medicare-advantage-2017-spotlight-enrollment-market-update-appendices.

²Kaiser Family Foundation. State Health Facts: Medicare Advantage Plans. Retrieved from https://www.kff.org/medicare/state-indicator/plans/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC is a licensed and certified representative of A Medicare Advantage [HMO, PPO and PFFS] organization and a stand-alone prescription drug plan with a Medicare contract. Enrollment in any plan depends on contract renewal.

TZ Insurance Solutions LLC and the licensed sales agents that may call you are not connected with or endorsed by the U.S. Government or the federal Medicare program. This website does not contain a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call (877) 486-2048), 24 hours a day / 7 days a week or consult www.medicare.gov.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Medicare has neither reviewed nor endorsed this information.

Last Updated: 4/24/2018