Advocating the right to quality, affordable health care for every man, woman, and child.
Consumer Assistance HelpLine

1-800-965-7476

Disabled or Elderly Adults

Based on household income and assets, people 65 years or older and people who are disabled may be able to get free MaineCare. Even if you do not receive Social Security benefits, you can still apply for MaineCare as part of this group. And, if you are working, you could make more money and still get MaineCare under the  Working Disabled Benefit. Use the income chart and asset description below to figure out if you can get MaineCare as an elderly or disabled person.

2014 Monthly Income Guidelines for Elderly or Disabled People
Family SizeElderly or DisabledWorking Disabled
1$973$2,432
2$1,311$3,278
3$1,650$4,123
4$1,988$4,969
5$2,326$5,815
6$2,655$6,661
For each additional
family member add:
$339$846
*Income can be higher if only one spouse enrolls.**More rules apply to
income in this group.

Note: Sometime certain income can be ignored or “disregarded.”  If you are close to these levels, apply!  If you have questions about what income counts, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476.

Common Questions:

 

What kind of income counts?

For Social Security, use the full amount.  For wages, use the gross amount, minus any pre-tax withholdings. For self-employed income, use net (after business expenses and taxes). There are many types of income – too many to list here! If you have questions about what income counts, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476. Even if your income is above the levels listed you should apply anyway! Sometimes deductions to income can be made.

 

Asset guidelines

Many assets will NOT count against you. You can have savings and retirement, a home, land the home sits on, cars and many other assets and still get MaineCare!

Assets that do NOT count against you:

  • The family’s home and surrounding lot
  • Basic items used in day to day living, such as furniture, tools and equipment
  • Two cars or trucks (the second vehicle must be necessary for employment, medical treatment, essential daily activities or modified for operation by a person with a disability or for the transportation of a person with a disability)
  • Property used to produce income such as boats, trucks, machinery
  • Money in a savings account, CD, pension plan, IRA – up to $10,000 for a single person; $12,000 for a family of two or more.
  • Real property that is up for sale
  • Loans that must be repaid
  • The cash value of life insurance the family has purchased
  • Up to $10,000 in a Family Development Account (FDA) that can be spent only for education, home repair, a car or truck needed for work or school, small business start up, health care, or to use for an emergency or other family need approved by DHHS
  • Other less common assets listed in DHHS rules

In addition to everything listed above:

  • Single people are allowed to have another $2,000 worth of assets.  Couples are allowed to have another $3,000 worth of assets.  If you have questions, or are unsure whether you qualify, call our HelpLine at 1-800-965-7476.

 

How do I apply?

You do not have to apply in person. There is a simple, two-page application that is easy to fill out and can be mailed to the Department of Health and Human Services (DHHS). Or, you can start your application online at My Maine Connection. Call the HelpLine at 1-800-965-7476 if you want to talk through.

When will I know if I’m eligible?

It usually takes DHHS a couple weeks to make a decision. If it takes them longer than 45 days, you may be able to get temporary coverage until they decide. Call the HelpLine at 1-800-965-7476 if you want to talk through.

 

What’s covered?

MaineCare is full coverage. It includes nearly all health services — doctor’s visits and treatment, hospital care, prescription drugs, physical therapy, mental health services, transportation to doctor’s appointments and much more!

 

What if my application is denied?

Mistakes can be made. If you feel your household is eligible but your application is denied, call the HelpLine at 1-800-965-7476. Or, you can call your local DHHS office and ask for a Fair Hearing. It is always a good idea to ask for this in writing as well, and send it in.

 

What if I already have private insurance or Medicare?

Elderly and disabled adults can have private insurance, Medicare, or Supplemental Insurance AND MaineCare. Since MaineCare is full coverage and can “wrap around” Medicare, most people decide to drop their private insurance or Supplemental Insurance once they are enrolled in MaineCare. Call the HelpLine at 1-800-965-7476 for more details.

Can I get old medical bills paid?

You can get medical bills paid back to 3 months before the application, as long as you were eligible at that time. Please call the HelpLine at 1-800-965-7476 if you have questions about this process.

 

What if my income is too high to qualify for MaineCare?

  • An elderly or disabled adult who is over income for MaineCare should be offered “Medically Needy” coverage. This is also called the “Spend Down” or “Deductible” program. Basically, if your medical bills go over a certain amount during a (usually) six month period, MaineCare will kick in and cover you for the rest of that time period. This can be an important safety net if you have high medical bills, and you may be able to get more help through other programs.
  • People eligible for Medicare may qualify for a  Medicare Savings Program to help with health care and prescriptions costs not covered by Medicare.
  • There are also other programs that can be helpful in reducing the cost of health care services and prescriptions. Check out the “Other Helpful Programs” section of this Guide or call the HelpLine at 1-800-965-7476 for more information.