SeniorsPlus Medicare Counseling

Call our Medicare experts to review your Medicare options. Our Medicare counseling is unbiased and free.

SeniorsPlus can help if you:

• are new to Medicare;

• need assistance understanding Medicare;

• currently have Medicare and want to review your options;

• are concerned about paying for health insurance; and/or

• need help understanding when you can change your health insurance or if changing is the best idea.

Medicare counselors at SeniorsPlus can guide you through complicated health insurance decisions. We can answer your questions on Medicare, Medicaid, supplemental insurance, prescription drug programs, and related health insurance.

Call SeniorsPlus at 1-800-427-1241 to speak to a Medicare Counselor.

Could you be eligible for help paying for Medicare?

If you have Medicare and are:

• single with gross income below $2,042 per month, and less than $58,000 (2020) in cash assets or

• married with income below $2,758 per month, and less than $87,000 (2020) in cash assets

Then you may be eligible for financial assistance that does not count your home or properties and the State of Maine will not make a claim on your estate. Call SeniorsPlus and speak to a Medicare Counselor for more information.

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Welcome to Medicare!

Becoming eligible for Medicare can be a confusing and anxious time but it doesn’t need to be that way. The Medicare counselors at SeniorsPlus are available free of charge to help Medicare beneficiaries and their families understand Medicare options.

Medicare has several parts:

Medicare Part A – Medicare Part A pays for a hospital room after you pay a deductible based on 60-day benefit periods. Call for more information.

Medicare Part B – After you pay an annual deductible, Medicare Part B pays 80% of all outpatient visits like doctor’s appointments, blood draws, and physical therapy. Part B also pays for 80% of surgeons in a hospital and outpatient treatments/medications.

• Original Medicare is not networked so a beneficiary can go to any provider that accepts Medicare nationwide.

Medicare Part D – This option is for Medicare Prescription Drug coverage. These plans can be standalone plans that go with original Medicare or are part of a Medicare Advantage Plans with Drug Coverage (MAPD) and are offered by private insurance companies for Medicare.

Medigap policies – These are companion policies to original Medicare A and B that pay for parts of the 20% a beneficiary is responsible paying for.

• There are a variety of coverage options available. These policies are not networked so a beneficiary can go to any provider that accepts Medicare nationwide.
• In Maine, a beneficiary cannot increase their coverage after making their initial choice so should choose the best policy to meet their needs now and in the future.

**Penalties – There are substantial penalties for not enrolling into Medicare B and/or a Medicare prescription drug plan. Please call SeniorsPlus for details.

Medicare Part C or Medicare Advantage Plans with Drug coverage (MAPD): These are health insurance plans with a combination of Medicare Part A, Part B, drug coverage, and extra health insurance. Plans can cover dental, vision, hearing aids, and other services. These plans are networked so you will need to make sure any medical provider or facility you wish to continue seeing accepts the MAPD you are interested in. This would include eye doctors and dentists. These plans cover urgent and emergency care outside of your local area, but may offer more coverage while traveling. Check with individual plans before purchase.

Turning 65

People turning 65 have a seven-month window around the month of their birthday during which they can make their choice of Medicare coverage and enroll. The initial enrollment period is three months prior to the month of their birthday, the month of their birthday, and three months after the month of their birthday. Medicare and all Medicare insurance options always start on the first day of a month so if a person wants their insurance to start on the first day of their birthday month they need to enroll into a plan during the first three months of their initial enrollment period. Medicare also delays the start date of Part A and Part B if a beneficiary enrolls the month of their birthday and after. Please call SeniorsPlus for details. 

To enroll into Medicare a person must call the Social Security Administration (1-800-772-1213) or enroll at www.SSA.gov.

Medicare and Disability

Individuals determined to be disabled and eligible for Medicare will automatically start Medicare after a 24-month waiting period. The exception would be for individuals diagnosed with ALS and End Stage Renal Disease. Medicare options for disabled individuals are the same as for persons 65 and older.

Deferring Medicare Enrollment

If a person is enrolled into an Employer Group Health Plan (EGHP) because they are working or enrolled into the EGHP of a spouse who is actively employed, this person does not need to take Medicare Part B — doing so is optional. The only reason a Medicare beneficiary can defer taking Medicare Part B with no penalty is because they have health insurance linked to active employment. In this instance the Medicare eligible person may want to take Medicare Part A since it covers 80% of a hospital stay and has no cost IF the beneficiary or spouse of a beneficiary worked more than 10 years in their lifetime.

Important notes:

• If someone has a MarketPlace Plan (“ObamaCare”) and is turning 65, they will need to enroll into Medicare. Most persons cannot stay with their MarketPlace plan when eligible for Medicare.

• COBRA does not stop a Medicare Part B penalty. A person on COBRA must enroll in Medicare within the first eight months of turning 65 years of age.

• Retiree health insurance does not defer a Medicare Part B penalty. If a person is turning 65 years old and is covered by retiree health insurance, they must still enroll into Medicare Parts A and B.

How do I make future changes to my insurance?

Once you are initially enrolled into Medicare you will be able to make changes to Medicare Prescription Drug plans and MAPD’s from October 15–December 7 with the change taking place on January 1. Persons enrolled into Medicare Advantage Plans can change coverage from October 15–December 7 plus have an additional window to change their coverage from January 1–March 31 of every year.

This information is generalized so please call SeniorsPlus for more information.

1-800-427-1241