Maine Medicare Plans
Medicare Supplement (Medigap) Policies
Maine does not require insurers to offer a Medicare Supplement policy to those under sixty-five afflicted with disability nor those with ESRD.
Mini-COBRA Policies (small group)
Maine mandates small-employer coverage for twelve months following separation.
Medicare Savings Program (premium support)
Maine has three Medicare Savings Programs:
- Qualified Medicare Beneficiaries (QMBs): For individuals with a monthly income under $993 and for couples with a monthly income under $1331 (or, in both categories, an income at or below 150% of the Federal Poverty Line), the state pays all premiums for Part B and all Co-Pays and Deductibles for Parts A & B
- Specified Low-Income Medicare Beneficiaries (SLMBs): For individuals with income under $1187 or couples with income under $1593 (or, in both categories, an income at or below 175% of the Federal Poverty Line), the state pays premiums for Part B.
- Qualified Individuals (QIs): For individuals with income under $1333 or for couples with an income under $1790 (or, in both categories, an income at or below 185% of the Federal Poverty Line), the state pays premiums for Part B.
Maine's Low-Cost Drugs for the Elderly and Disabled Program provides prescription drug assistance for those with incomes under 185% of the Federal Poverty Level. The benefits are as follows:
- 80% minus $2.00 of the cost of all generic prescription drugs on the Preferred Drug List.
- 80% minus $2.00 of the cost of brand-name medications on the Preferred Drug List for the treatment of diabetes, heart disease, high blood pressure, chronic lung disease (emphysema and asthma), arthritis, anticoagulation, Hyperlipidemia (high cholesteraol), incontinence, thyroid disease, osteoporosis, (bone density loss,), Parkinson’s Disease, glaucoma, Multiple Sclerosis, and ALS (Lou Gehrig’s Disease).
The Supplemental Benefit includes other drugs not covered in he basic Benefit. The drugs must be medically necessary and supplied from participating manufacturers. Actual savings vary from drug to drug. DEL Members pay the state’s negotiated MaineCare rate minus $2.00.
Catastrophic Spending Limit:
After a Member spends $1,000 on eligible prescription drugs, the state pays 80% of the cost of all eligible prescription drugs, regardless of any disease or condition. The drugs must be medically necessary and supplied from companies with agreements with the State. The Catastrophic Spending Limit is tracked from August 1st each year to July 31st of the following year.
Mainers of all ages with income under 350% of the federal poverty level may be eligible for prescription drug discounts through the Maine Rx Plus Program. The program provides discounts of 15% - 60% off retail prices for drugs on the MaineCare Preferred Drug List.
State Health Insurance Assistance Program
The Maine SHIP is a partnership between Office of Elder Services, five area agencies on aging (AAA), Bureau of Insurance, and Legal Services for the Elderly (LSE). Counseling and outreach activities are performed primarily by staff and volunteers at the AAAs. Staff attorneys at LSE's Hotline counsel beneficiaries by phone and refer them to AAAs if face-to-face assistance is required while the Department of Insurance furnishes relevant publications and offers consultation and training support.
Maine offers a nonrefundable tax credit to employers with up to five employees who offer health insurance benefits to low-income employees and their dependents. The employees must work at least thirty hours/week or $1000 hours/year; the employer's contribution must meet minimum levels and the insurance must meet a minimum benefit standard. The credit amounts to the lesser of 20% of dependent health benefits paid or $125/year per enrolled, low-income employee with dependent coverage. Credit may not exceed 50% of the state income otherwise due.
This program is a subsidy for Part D recipients with resources under $17,505 (or $23,595 for a couple) to receive money towards a Medicare prescription drug plan. The benchmark of support is different depending on which region of the country you live in. In Maine in 2012, the low-income subsidy was $31.18 per month.
If you live in Maine, consult with one of our MedicareSolutions.com insurance specialists to get personal assistance that is specific to your area. One of our experienced specialists can compare plans in your area and help you find the Medicare insurance benefits that are right for your needs.