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Frequently Asked Questions - Medicare

I will be turning 65 in a few weeks. Can you please explain the open enrollment for Medicare supplement (Medigap) insurance policies?

If you are turning 65, your first priority is to make sure you are enrolled in Medicare Part B (contact the Social Security Administration at 1-800-772-1213 or www.ssa.gov for information on enrollment procedures). Federal law gives you a 6-month "open enrollment" period to apply for a Medicare supplement insurance policy, beginning with the first month that you enroll for benefits under Medicare Part B. For information on available Medicare supplement plans, see: Medicare supplement plans. To see exactly what Maine law says on this issue, check out: Bureau of Insurance Rule 275 Section 11. For other questions about Medicare or Medicare Supplement policies, contact the Maine State Health Insurance Assistance Program at 1-800-262-2232 (within the state) or www.maine.gov/dhhs/beas/hiap/.

Are there any alternatives to original Medicare (Parts A and B) available in Maine?

Yes, Medicare Advantage HMO, PPO, and Medicare Advantage private fee-for-service plans, with or without prescription drug coverage, are currently available in Maine. See your current edition of "Medicare and You" for a list of plans available in Maine, or call 1 -800 Medicare. For other questions about Medicare or Medicare supplement policies, contact the Maine State Health Insurance Assistance Program at 1-800-262-2232 (within the state) or www.maine.gov/dhhs/beas/hiap/.

Can I change from one Medicare supplement plan to another?

If you have had a Medicare supplement plan since you turned 65, in most cases you can change to the same or a lower plan (e.g., from plan "G" to plan "A") at another company without having to wait for open enrollment. However, you must obtain your new plan within 90 days of leaving the old plan. To see exactly what Maine law says on this issue, see: Title 24-A M.R.S.A. §5002-B. For other questions about Medicare or Medicare supplement policies, contact the Maine State Health Insurance Assistance Program at 1-877-353-3771 (within the state).

I am currently enrolled in a Medicare Advantage plan. Can I switch to original Medicare? If I switch to original Medicare, will I be able to enroll in a Medicare supplement plan?

Federal law only permits Medicare Advantage enrollees to drop their Medicare Advantage coverage at certain times. When you disenroll from Medicare Advantage, you remain enrolled in Medicare Parts A and B, so your coverage automatically reverts to original Medicare - you do not need to re-enroll. For information about how to switch to original Medicare, you can call CMS, the federal agency that runs the Medicare program, at 1-800-MEDICARE.

If you switch to original Medicare, your ability under Maine law to enroll in a Medicare supplement plan depends on how long you were enrolled in Medicare Advantage: Recent Maine legislation extended the Medicare Advantage "trial period" from one year to three years. This means:

(1) If you enroll in Medicare Advantage during your six-month open enrollment period when you are first eligible for Medicare, and then switch to original Medicare within three years, you have the right to buy the Medicare supplement plan of your choice as long as you buy it within 90 days after your Medicare Advantage coverage ends.

(2) If you have original Medicare with a Medicare supplement policy, switch to Medicare Advantage for the first time, and then return to original Medicare within three years, you have a similar 90-day guaranteed issue period, but only for policies with equivalent or lesser benefits as the policy you had immediately before enrolling in Medicare Advantage.

(3) If you are enrolled in Medicare Advantage for more than three years (or more than once) and then switch to original Medicare voluntarily, or if you wait more than 90 days to buy a Medicare supplement policy after leaving Medicare Advantage, or if you had no Medicare supplement policy when you were in original Medicare, then the insurer generally has the choice whether or not to issue a policy, which means you may need to qualify based on health status. However, each insurer offering Medicare supplement coverage must have a one-month guaranteed issue period each year during which any Medicare beneficiary may buy Medicare supplement Plan A, the basic plan.

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Last Updated: December 8, 2011