MaineCare pays for medically necessary services based on your coverage group, which is determined by your income, age, medical needs, and if you need help with Activities of Daily Living (ADLs).
Some examples of services that may be covered include:
Some examples of services that are not covered include:
Talk with your health care provider or call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711 (Maine Relay). To see if your medication is covered, call the Pharmacy Help Desk at -866-796-2463, TTY: 711.
You may have to pay a copayment, premium, or cost of care for MaineCare services depending on what coverage group you have.
You may need to pay for part of the cost of some MaineCare services. What you pay is called a copayment, or copay.
Members do not have a copay for the following:
For details about services that may require a copay and members who are responsible for copays, see the Member Copayments (PDF).
A premium is a fee that some members pay to have MaineCare coverage. For some MaineCare programs, if you are over the income level for MaineCare, you may have the option to pay a premium for MaineCare coverage. You will know if you must pay a premium for coverage because you will get a letter. An example of a program with members who are responsible for premiums is the Katie Beckett program.
Effective August 1, 2022, MaineCare extended postpartum coverage to 12 months after the pregnancy ends. This coverage is automatically applied to current MaineCare members and ensures that no one loses access to care during the postpartum period. For more detail, see the Postpartum Coverage Flyer (PDF).
If you live in a medical facility, you may have to pay for a portion of your care. The Cost of Care is the amount you pay towards your care at the medical facility. Members who pay a cost of care usually live in a nursing facility, residential care facility, cost-reimbursed boarding home, or an adult family care home.
Before you can get some services or equipment, MaineCare must approve it. This approval is called Prior Authorization (PA). Your provider sends a form to MaineCare and we will send you and your provider a letter to let you know if the service or medical equipment is approved. If you get the service or the medical equipment without MaineCare’s approval, you may have to pay the bill.
Examples of services and medical equipment that need PA:
For questions about a PA for a prescription drug, call the Pharmacy Help Desk at Pharmacy Help Desk at 1-866-796-2463. Call MaineCare Member Services at 1-800-977-6740 for questions about all other services.
See the MaineCare Options to learn more about your coverage group.
