What if I or my spouse need nursing home care and we don’t have Long Term Care Insurance?

Neither Medicare or your retiree insurance will pay for nursing home care.  MaineCare (Medicaid) may pay for nursing home care if a person meets MaineCare’s financial eligibility requirements and other  eligibility conditions. 

For additional information on MaineCare nursing home requirements, contact:

                                    Office of Aging and Disability Services (OADS)                         

                                    Department of Health & Human Services
11 State House Station
Augusta, ME 04333
Phone: (207) 287-9200
Website: www.maine.gov/dhhs/oads/








How does Medicare coordinate with Companion Plan coverage?

According to Medicare rules, retiree insurance pays secondary to Medicare. This means that Medicare pays first for your health care, and then your retiree coverage pays for some or all of the costs that Medicare did not cover. The secondary payer only pays if there are costs the primary insurer didn’t cover.

Do I have to purchase Medicare?

Federal Medicare has four parts:

            Medicare Part A:       Hospitalization

            Medicare Part B:       Surgery, Physicians, etc.

            Medicare Part C:      Companion Plan or Advantage Plan

            Medicare Part D:      Prescription Drug Coverage

The majority of Public Service Retirees have to apply for Medicare Parts A & B at age 65.  There will be a monthly cost based on your individual circumstances.  In general, the cost for 2022 is $170.10 per month per person.

For the majority of Public Service Retirees, the State Employee Health Commission (SEHC), Maine Education Association (MEA) Benefits Trust, and the Maine Municipal Association (MMA) Employees Health Trust provide retirees with Medicare Part C.  Medicare Part C benefits includes prescription drug coverage. Therefore, there is NO need to purchase a separate Medicare Part D plan.

Specific information on the Medicare Part C plans can be provided by:

State Retirees Employee Health and Benefits https://www.maine.gov/bhr/oeh/benefits (207) 624-7380
Retired Educators Maine Education Association Benefit Trust http://meabt.org/benefits (207) 622-4418 
Participating Local District Retirees Maine Municipal Association Employees Health Trust https://memun.org/Insurance-Services/Maine-Municipal-Employees-Health-Trust (207) 623-8428