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Bureau of Insurance
OTHER PFR AGENCIES
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 http://www.maine.gov/dhhs/oads/aging/community/ship.shtml
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/.
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).
Federal law only allows Medicare Advantage enrollees to drop that 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 enroll in Medicare Advantage during your seven-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. After 36 months, the insurer generally has the choice whether or not to issue a policy, which means you may need to qualify based on health status. If you enrolled in a Medicare Advantage plan mid-year, you will need to switch back to original Medicare 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 and it only applies to your first enrollment in Medicare Advantage. Maine law extends the Medicare Advantage "trial period" from one year to three years so you may not have the same rights if you move to another state. You may also be entitled to guaranteed issue of a Medicare supplement policy if your Medicare Advantage plan is involuntarily terminated (i.e., not at the enrollee’s request). For specific guidance on guaranteed issue eligibility, please see Maine Insurance Rule Chapter 275, §12 or contact the Bureau of Insurance.
Last Updated: February 11, 2014
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