Medicare is a federal program, so Medicare Parts A and Part B work the same way in Bangor as they do anywhere else in the country. What changes when you cross into Maine is the law written around Medicare, and Maine’s is not like most states’.

We’ll come back to that. First, the vocabulary, because nobody hands you a glossary at 65.

The four parts, simple and clear

Medicare Part A is the hospital insurance. It covers inpatient hospital stays, skilled nursing facility care after a qualifying stay, hospice and some home health care.

Medicare Part B is the medical insurance. It covers doctor visits, outpatient care, lab work, imaging, durable medical equipment and preventive services.

Together, Part A and Part B are called Original Medicare. 

Medicare Part C is the alternative to Original Medicare. Medicare Part C is better known as Medicare Advantage, which a private insurance plan you could join instead of having Original Medicare pay your bills. The plan takes over your Part A and Part B benefits and runs them through the insurance plan’s own network and its own rules.

Medicare Part D is the prescription drug coverage. It’s sold by private insurance companies, either as a standalone drug plan you add to Original Medicare or built into a Medicare Advantage plan.

The choice nobody warns you about

Here is the fork. Every person coming onto Medicare for the first time picks one of two paths, and the two paths behave very differently.

The first path is Original Medicare plus a Medicare Supplement plus a standalone Part D plan. A Medicare Supplement, also called a Medigap plan, is a private policy that pays much of what Part A and Part B leave behind, which is mostly deductibles and the 20 percent coinsurance Part B doesn’t pay. On this path you have three pieces and three premiums, you can see any provider in the country who accepts Original Medicare, and there are no referrals and no network. Get a Medicare Supplement quote. 

The second path is a single Medicare Advantage plan. One card, one plan, usually a lower premium (but a higher out of pocket maximum) than the three piece approach, often with extras that Original Medicare doesn’t cover. In return, you use the plan’s provider network, the plan decides what it will authorize, and your out of pocket costs come as copays and coinsurance as you use care rather than as a predictable monthly premium. Get a Medicare Advantage quote. 

Neither one is right in general. They’re right for different people, and the honest version of this conversation is that it depends on facts about your life, not facts about the plans.

The two questions that settle it

Almost every case comes down to two things.

Are the doctors you already use in the plan’s network? Original Medicare with a Supplement has no network, so if you see specialists in Boston, spend winters out of state, or are in the middle of treatment with a physician you’re not willing to change, that path protects those relationships. A Medicare Advantage plan is only as good as its network in the county where you live, and networks change from one plan year to the next. Before you enroll in anything, we check your actual providers against the actual plan.

Are your prescriptions on the plan’s drug list? Every Part D plan and every Medicare Advantage plan with drug coverage publishes a formulary, which is the list of medications it covers and the tier it puts each one in. Two plans with nearly identical premiums can differ by thousands of dollars a year on the same prescriptions. We run your medication list, by name and dose, against the plans available where you live before we talk about anything else.

Those two checks are most of the work, and they’re the part people skip when they enroll from a television commercial.

Where Maine is different

Maine gives Medicare Supplement policyholders switching rights that most states simply do not have, which means a decision you make at 65 here is less permanent than it would be almost anywhere else. That’s explained in full on our page about Maine’s Medicare Supplement switching rules, and it’s worth reading before you choose a path.

What happens when you call us

We start with your providers and your prescriptions, in that order. Then we show you what each path costs, what each one risks, and which carriers offer it where you live. You decide, and we handle the enrollment paperwork and stay with you afterward when a claim or a bill goes sideways.

If you’re turning 65, read Turning 65. If you’re leaving an employer plan at 65 or later, read Retiring off an employer plan.

BEST PRICE GUARANTEE As always, our services are 100% FREE and there is no extra cost or mark-up. Whether you get your Medicare coverage through us, another agent/broker or directly from the insurance carrier, you’ll pay the exact same monthly premium for the same plan, so you can rest assured that you’re getting the best available price.