Medicare in Maine: Plans and Coverage (2026)

Taking Medicare in Maine runs on federal rules, but Maine sets its own Medicare Savings Program income limits far above the federal floor. It applies no asset test at all, so more residents qualify for help paying their Medicare costs here than the federal limits alone would allow. This guide covers Medicare in Maine for 2026: what it costs, the plan choices available here, and how to get help paying.1,2

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Maine (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Maine
• Help Paying for Medicare in Maine
• Medicare Enrollment Periods
• Free Medicare Help: Maine SHIP
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year; CMS announces the next year's figures each fall and publishes them at medicare.gov.3 To talk through your own coverage with a person, call 1-800-MEDICARE at 1-800-633-4227 (TTY 1-877-486-2048), staffed 24 hours a day, 7 days a week except some federal holidays.6 A free Maine SHIP counselor can also walk you through your options at 1-877-353-3771.2

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are identical in Maine and every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.7

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a nursing facility. Get readmitted after that, and the deductible applies again.3

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care.8 It doesn't cover routine dental, vision, or hearing.9

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.10

Medicare Advantage in Maine (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They must cover the medically necessary services Parts A and B cover, except hospice and a few other items, such as some clinical-trial costs, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.11

Which plans you can join depends on where you live: to enroll you need both Part A and Part B and must live in the plan's service area.12 So compare the plans actually offered where you live before you decide.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage premium for 2026 at about $14 a month, and many plans charge $0 extra. Some plans go further and may help pay part or all of your Part B premium.3,11
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.11
• Plans may require prior authorization for certain services, which Original Medicare generally does not.11
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap: CMS says there is no yearly limit on what you pay out of pocket unless you have supplemental coverage such as Medigap, Medicaid, employer, retiree, or union coverage.11

Use the Medicare Plan Finder at medicare.gov to compare the Medicare Advantage, Part D, and Medigap plans offered in your area side by side. It shows which plans offer extras like dental, but it has limited detail on those benefits, so check the specifics with the plan itself.13 If you want help weighing your plan choices, a Maine SHIP counselor will go through them with you for free.2

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026; some plans charge none, and certain insulins and vaccines are exempt from it).14
2. Initial coverage: in the standard benefit you pay 25% coinsurance on covered drugs.4
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025, and payments made for you through Extra Help count toward it too.4 The average standalone Part D premium for 2026 is about $34.50 a month, though actual plan premiums vary widely.3 Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy.4 People who qualify for Extra Help often pay much less: a $0 deductible, and for some, $0 copays.15

Medigap in Maine

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare only: a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.11

Maine offers the federally standardized plans, labeled A-D, F, G, and K-N, regulated by the Maine Bureau of Insurance.16 Plans C and F can't be sold to people new to Medicare on or after January 1, 2020, which means you turned 65 on or after that date and got Part A on or after it. If you had Medicare before 65 because of a disability or End-Stage Renal Disease (ESRD) before 2020, or were eligible before 2020 but haven't enrolled yet, you may still be able to buy Plan C or Plan F.16,5 People new to Medicare on or after January 1, 2020 have the right to buy Plan G, which covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.17,3

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer can't refuse to sell you any policy it offers or charge you more because of your health, though it can make you wait up to six months for coverage of a pre-existing condition unless you had at least six months of continuous prior creditable coverage.17 Outside it, Maine insurers may use medical underwriting for most purchases.

But Maine adds several guaranteed-issue protections that federal law does not. Every Medigap insurer must designate at least one month each year when it will sell its Plan A policy to any applicant with no health questions, though not always at the standard price; you have an ongoing right to switch to a plan with equal or lesser benefits, from any insurer, as long as you've never had a gap over 90 days in coverage that supplements Medicare since your open enrollment period; and you get a 90-day guaranteed-issue window if you lose an individual, employer, or MaineCare plan. The switching right isn't open-ended: you have to get the new plan within 90 days of leaving the old one, so don't cancel first and shop later, and a move down to a lower-benefit plan can be hard to reverse.5 For the full set of rights and how to use them, see our guide to Maine's Medigap guaranteed-issue rules.

Medigap or Medicare Advantage?

You run one or the other. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who accepts Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. While you're in an Advantage plan, it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. That isn't a permanent lock-out, though: if you join an Advantage plan for the first time and aren't happy with it, a federal trial right lets you buy Medigap and a separate drug plan when you return to Original Medicare within 12 months of joining, and if you had a Medigap policy before you joined and have been in the plan under a year, you may be able to get that same policy back if the company still sells it. Outside those protections, in most cases, if you drop a Medigap policy to join an Advantage plan you may not be able to get the same policy back.11 Maine stretches the trial period from 12 months to 36. If you joined Medicare Advantage during your six-month Medigap open enrollment period and return to Original Medicare within three years, you can buy any Medicare supplement plan, as long as you buy it within 90 days after the Advantage coverage ends. If you dropped a Medigap plan to join Advantage for the first time and return within three years, you can buy an equivalent or less comprehensive plan, provided you still live in Maine and apply within 90 days. Because federal rules only let you leave Advantage at certain times, joining mid-year can mean switching back sooner than 36 months, and the right does not travel with you to other states.5 For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Maine

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

Maine runs its Medicare Savings Programs on income limits well above the federal floor. Under state law (22 M.R.S. § 3174-LLL), the department may not apply an asset test, and it was required to establish income disregards, in place no later than July 1, 2024, so that someone with income at or below 185% of the federal poverty level qualifies as a Qualified Medicare Beneficiary (QMB) and someone above 185% but no more than 250% qualifies as a Qualified Individual (QI). Maine administers the programs through MaineCare, the federal Medicaid program in Maine, run by DHHS; its Office for Family Independence decides MaineCare applications within 45 days.1

Neither tier has an asset or resource test; qualification is on income alone. QMB is the more generous of the two: MaineCare's 2026 guidelines describe it as paying your Part B monthly premium plus your Medicare coinsurance and deductibles, and it may also cover a Part A premium if you owe one. QI applicants must be entitled to Medicare Part A and Part B and cannot be enrolled in other MaineCare benefits.1 On top of what QMB pays, federal law prohibits Medicare providers and suppliers from billing a QMB enrollee for Medicare cost sharing at all: you have no legal obligation to pay Part A or Part B deductibles, coinsurance, or copayments for Medicare-covered items and services.18 Because the limits are set as percentages of the federal poverty level, DHHS republishes the dollar figures in a year-dated MaineCare eligibility guidelines chart, so check the current year's numbers before you rule yourself out.1 QI also has to be reapplied for every year; qualifying once does not carry you into the next year.18 Apply through MaineCare/DHHS, and enrolling in either program automatically qualifies you for Extra Help.18

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, helps pay Part D premiums, deductibles, and copays for people with limited income and resources. Your plan deductible drops to $0, but the premium is covered only up to a regional benchmark, so if you pick a pricier plan you pay the difference.15 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.15

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, in the 48 contiguous states and DC (Alaska and Hawaii run higher). Those are the limits for one- and two-person households; if relatives who live with you rely on you for support, or you have earnings from work, you may qualify with more, so apply rather than rule yourself out15
• Resource limits: $18,090 for an individual and $36,100 for a married couple living together. Your home, car, and personal belongings don't count. The lower $16,590 and $33,100 limits apply only if you tell Social Security that none of your resources will go toward funeral or burial expenses15
• If you qualify for QMB or QI, Maine's two Medicare Savings Program tiers, you're enrolled in Extra Help automatically18

Apply through Social Security at ssa.gov15 or call Social Security's national line, 1-800-772-1213 (TTY 1-800-325-0778).19

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Maine as everywhere else.20

The dates in the table above are federal, so they run the same in Maine as everywhere else.20 Changes you make during Annual Open Enrollment take effect the following January 1. If you start getting Social Security benefits at least four months before you turn 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through Social Security.20 If you or your spouse are still working past 65 and you have group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if the job or coverage ends during your Initial Enrollment Period, or if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).21

Free Medicare Help: Maine SHIP

You don't have to figure this out alone, and you don't have to pay a broker. Maine's SHIP Medicare Assistance program is funded by the federal Centers for Medicare and Medicaid Services and sponsored in Maine by the DHHS Office of Aging and Disability Services, the state's five Area Agencies on Aging, and Legal Services for Maine Elders. Counselors give free, confidential help on Medicare, Medicare Advantage, MaineCare, Medigap, and Part D, and they don't sell insurance or recommend policies.2

A Maine SHIP counselor can help you:

• Understand your Medicare options and what each part covers
• Weigh your plan choices, including comparison information on Medicare supplement (Medigap) policies2
• Apply for Maine's expanded Medicare Savings Programs and Extra Help2
• Sort out claims, denials, and appeals2

To reach a counselor, call the statewide Aging and Disability Resource Center line, 1-877-353-3771 (877-Elders1), and follow the instructions to select your county. That connects you to your local Area Agency on Aging.2

Key Maine Medicare Contacts

Learn More

Find personalized help with Medicare in Maine at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.