Aged, Blind, or Disabled
If you are over the age of 65, are blind or have another disability, MaineCare may be able to help you afford health coverage and services.
Home and Community-Based Waiver Recipients
If you are in an eligibility category and meet the medical and financial requirements of a Home and Community-Based Waiver program then you may qualify to receive services through one of our Home and Community Based Services (HCBS) waiver programs. Visit the Office of Aging and Disability Services webpage or the MaineCare Member Handbook (PDF) for more detail about waivers.
Deductibles for the Medically Needy
If you qualify for MaineCare but are over the income or asset limits, you will have a deductible. A deductible is a specific dollar amount that is based on your income. To meet your deductible, your qualifying medical bills must add up to that dollar amount. If you meet your deductible, you receive full MaineCare coverage for the rest of the deductible period. MaineCare will cover qualifying medical services for whatever is left once the deductible is met. You are responsible for the medical bills you received before you met your deductible and MaineCare will not pay for them. When the deductible period ends, your MaineCare coverage will end and you must reapply for a new deductible.
Medicare Savings Programs – Also called Buy-In
If you have Medicare , you may qualify for a Medicare Savings Plan. Depending on your income, MaineCare may pay for Part A premiums, Part B premiums, Medicare deductibles, coinsurance, and copayments.
It is important to note that this benefit is not full MaineCare coverage so check with MaineCare Member Services to see if your service is covered by MaineCare.
Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualifying Individual (QI)
- Qualified Disabled and Working Individuals (QDWI)
See the Medicare Savings Programs webpage for more detail about eligibility guidelines and what is covered.
Long-Term Care Coverage
Residents of Nursing Facilities
You may qualify for long-term care coverage if you live in a nursing home. MaineCare may pay for the cost of the room, food, nursing care, routine supplies, and equipment provided by your nursing home.
Residential Care Facilities
You may qualify for long-term care coverage if you live in apartment or small adult family care home and get assisted living services. MaineCare may pay for the assisted living services that you receive.
How to Apply
Learn about your options for applying for the above MaineCare benefits online, by mail, and in person. Applications for MaineCare are processed by DHHS’s Office for Family Independence.
For detail about general services that are covered by MaineCare, including examples of preventive and other services, see the Adults webpage. In addition to preventive and general services that MaineCare covers for all adults, you may have additional services covered, depending on your age or disability and what your health care providers determine that you need.
See the MaineCare Member Handbook (PDF) for details about services that may be covered. To see if a specific service you need is covered, call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711.
Health Homes for Chronic Conditions
If you have chronic health conditions, you may be eligible to participate in a Health Home, Behavioral Health Home, or Opioid Health Home. A Health Home partners with your Primary Care Provider (PCP) to manage your chronic health conditions. See the Primary Care and Your Health webpage for more Health Home information.
Estate recovery is required by the federal government. If you are age 55 or older and MaineCare pays for your nursing facility services or home- and community-based services, the State may make a claim on the assets of your estate (upon your death) to recover the money that MaineCare has paid for these services as well as for any hospital and prescription drug services related to these nursing facility and home- and community-based services. MaineCare will not seek any recovery if a member:
- Has not received any nursing facility services or home and community-based services
- Only received the Medicare Savings Program (Buy-in) benefit
All of the following must be true for MaineCare to seek recovery. The MaineCare member must:
- Have received MaineCare when they were age 55 or older
- Have received nursing facility services or home- and community-based services
- Have no surviving spouse at the time the Department seeks recovery
- Have no children who are under age 21 at the time the Department seeks recovery
- Have no disabled children of any age at the time the Department seeks recovery
See the Estate Recovery Overview (PDF) or the MaineCare Member Handbook (PDF) for additional information. If you have questions about estate recovery, call MaineCare Member Services at 1-800-977-6740.
MaineCare Can Help
If you have questions or to see if a service you need is covered, call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711. For prescription drug benefits, medication prior authorizations, and Medicare Part D questions, call 1-866-796-2463. TTY users dial 711.