Maine Medicare Supplement

Maine Medicare Supplement plan enrollments and enrollment periods are essentially no different than any other state with regard to the Open Enrollment Period for purchase of Medicare Supplement (also known as “Medigap”).  However, if you live in the state of Maine there are some additional opportunities that may apply to you regarding Maine Medicare Supplement plan enrollments and guaranteed issue rights.

Maine Medicare Supplement plan enrollments – Open Enrollment Period

Essentially, if you apply for a Medicare Supplement plan during your Open Enrollment Period an insurance company that sells Medicare Supplement plans in your state cannot deny your application and must sell you the plan you choose.  This is known guaranteed issue rights.  During this period it does not matter what your medical condition is, an insurance company cannot deny your application for a Medicare Supplement plan.   While an insurance company may ask you medical questions during the Open Enrollment Period you cannot be refused coverage during the Open Enrollment Period based on any medical conditions or disabilities.  Medicare beneficiaries  under the age of 65 have an additional six-month Open Enrollment Period when they turn age 65.

What is the exception regarding Maine Medicare Supplement plan enrollments?

If you are buying a Medicare Supplement plan and you are not in the Open Enrollment Period that begins the month you turn 65, some Medicare Supplement plans may still be available to you as guaranteed issue.  Each insurance company that sells Medicare Supplement plans in the state of Maine must hold a one-month guaranteed issue period each year when any Medicare beneficiary will be accepted in a Medicare Supplement Plan A.  Each insurance company offering Medicare Supplement plans decides which month it will offer Plan A as guaranteed issue.  Insurance companies are not required to offer other Medicare Supplement plans other than Plan A during the Maine Medicare Supplement plan enrollment period.

Maine Medicare Supplement plan enrollments – no gap in health insurance coverage for more than 90 days.

In Maine, if you are careful never to go without a form of insurance that supplements original Medicare, such as individual health insurance coverage, group health insurance coverage, MaineCare coverage, or Medicare Supplement coverage for more than 90 days.  If you have no break in coverage then an insurance company that sells Medicare Supplement policies must offer you a Medicare Supplement policy at guaranteed issue. Note:  It is best not to leave a gap in coverage regardless of where you live because many states have time periods shorter than 90 days.  In Maine, you generally have the right to change Medicare Supplement plans as long as you change to a plan with the same benefits or a plan with lesser benefits from the same or a different insurance company if you have never had a gap in health coverage of more than 90 days. Keep in mind that if you purchase a lower benefit Medicare Supplement plan, you may not be able to enroll in the higher benefit plan you want later on without qualifying, or answering health questions, and going through the insurance company underwriting process.

Maine Medicare Supplement plan enrollments prior to 1992

If you have a Medicare Supplement policy in-force and it was issued before January 1, 1992, then you can replace that policy with any Medicare Supplement plan offered by the same insurance company at guaranteed issue.  You may also switch to another insurance company as long as you change to a Medicare Supplement plan with the same benefits or a Medicare Supplement plan with lesser benefits and you have never had a gap in coverage of more than 90 days. The insurance company cannot refuse to sell you the Medicare Supplement policy regardless of your health conditions, medical history, etc.  These Medicare Supplement plans are guarantee issue if the criteria set forth herein is met.

Maine Medicare Supplement Plan Enrollments – Medicare Advantage plan disenrollment

Federal law only allows Medicare beneficiaries who have selected a Medicare Advantage (also known as “Part C”) plan as their Medicare insurance to drop that a Medicare Advantage at certain times.  (See Medicare Pathways’ article entitled “Medicare Advantage Disenrollment Periodfor more information.)  When you disenroll from a Medicare Advantage plan you remain enrolled in original Medicare Part A and Part B, so your coverage automatically reverts back to original Medicare.   If you disenroll from a Medicare Advantage plan and return to original Medicare Part A and Part B, you may have a one-time right under Maine law to enroll in a Medicare Supplement plan with guaranteed issue rights, but only under certain circumstances.

After disenrolling from a Medicare Advantage plan, what are the circumstances for Maine Medicare Supplement plan enrollments?

  • If you enroll in a Medicare Advantage plan during your seven-month Open Enrollment Period (which coincides with your original Medicare Initial Enrollment Period), which beings three months before the month your turn 65, includes your birth month, and extends three months after your birth month, and then switch to original Medicare within three years, or disenroll from the Medicare Advantage plan during the Medicare Disenrollment Period, you have the right to purchase the Medicare Supplement plan of your choice as long as you buy it within 90 days after your Medicare Advantage coverage ends. After 36 months, the insurance company generally has the choice whether or not to sell you the Medicare Supplement policy, which means you may have to answer health questions and go through the underwriting process.
  • If you enrolled in a Medicare Advantage plan mid-year, you will need to disenroll from the Medicare Advantage plan, which automatically switches you back to original Medicare Part A and Part B as your primary coverage, sooner than three years because federal law only allows you to go back original Medicare at certain times. This is intended to provide you with a one time trial period to determine if a Medicare Advantage plan meets your needs.  This guaranteed issue right for a Medicare Supplement plan also only applies to your first enrollment in a Medicare Advantage.

The fact that the state of Maine extends the Medicare Advantage plan “trial period” (also known as “trial right”) from one year to three years so you may not have the same rights if you move to another state is very unique.  Most states only offer the “trial period” for one year after you enroll in a Medicare Advantage plan for the first time.

If you are shopping for Medicare insurance, contact Medicare Pathways and speak with a Benefit Advisor who will review your options and assist you in determining which plans you are eligible purchase or which Medicare insurance plan is available if you are just looking to change your plan.  A Benefit Advisor will also determine if you are in an enrollment period and, if so, what that enrollment period allows you to do.  If you are just shopping to find a lower monthly premium, even if you are looking to stay with the same plan, Medicare Pathways Benefit Advisors can assist with this as well.  A Medicare Pathways Benefit Advisor will not only help you make the most of your Medicare, but will also assist you in enrolling in a Medicare insurance plan.  Medicare Pathways specializes in Medicare Advantage, Medicare Supplement and Prescription Drug Plans (also known as “Part D“).  You can call 1-966-466-9118 to speak with a Benefit Advisor, or you can Request a Quote and a Medicare Pathways Benefit Advisor will contact you.

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Medicare Pathways:  1-866-466-9118