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

1-800-965-7476

Kids and Parents

Children 18 years old or younger

Depending on income level, kids may be able to get free MaineCare or low-cost coverage through the Children’s Health Insurance Program (CHIP), formally called CubCare. MaineCare and CHIP provide the same health coverage - the only difference is the low monthly cost for CHIP. The cost for CHIP is between $8 and $64 per month, based on income level. Use the chart below to figure out if your child could get free MaineCare or low-cost CHIP.

2014 Monthly Income Guidelines for Kids
Household SizeFree MaineCareLow-Cost CHIP
1$1,576$2,072
2$2,124$2,793
3$2,672$3,513
4$3,220$4,234
5$3,768$4,955
for each additional
household member
add...
$549$721
Last updated on 2/25/14

Parents of kids 18 and younger, living in the home

Parents of dependent children, age 18 and younger, may also be able to get MaineCare if the child lives with them. This includes both birth parents, legal parents, and relatives providing a home for dependent children. For parents to get MaineCare, income must be much lower than it has to be for children. Use the chart below to figure out if you could get MaineCare as a parent.

2014 Monthly Income Guidelines for Parents
Household SizeFree MaineCare
1$1,022
2$1,377
3$1,732
4$2,087
5$2,443
for each additional
household member
add...
$356
Last updated on 2/25/14

 

Common Questions:

What kind of income counts?

For wages, use the full amount, minus any pre-tax withholdings. For self-employed income, use net (after business expenses and taxes).  Child support will not count against you, but alimony received will be included. 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.

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 have questions or want to talk through the application.

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 have questions or want to talk through this process.

What’s covered?

Both Free MaineCare and Low-cost CHIP offer the same health benefits. They include 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! Call the HelpLine at 1-800-965-7476 if you have questions about what is covered by MaineCare and CHIP.

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?

It depends…

  • Kids on CHIP cannot have private insurance at the same time – But do not drop your child’s private insurance before they are enrolled in CHIP. In rare cases, children may have to wait to get CHIP if their private insurance coverage is dropped.
  • Kids and parents enrolled in MaineCare (not CHIP) can choose to have private insurance at the same time. Some may even qualify for help paying for private insurance through a program called the Premium Health Insurance Payment (PHIP).
  • If your private insurance is through the Health Insurance Marketplace, you should know that you cannot get Marketplace discounts if you are eligible for MaineCare or CHIP.

All this can get confusing! Call the HelpLine at 1-800-965-7476 if you want to talk through any of this information.

Can I get old medical bills paid?

Parents and kids who are eligible for free MaineCare can get medical bills paid back to 3 months before the application. Kids eligible for Low-cost CHIP can get medical bills paid back to the first day of the month of their application. To get back bills paid, you must have been eligible for MaineCare or CHIP at the time you received the services. Call the HelpLine at 1-800-965-7476 if you want to talk through getting old medical bills paid back.

What if my income is too high for MaineCare?

Even if household income is over the limit for MaineCare or CHIP, children with severe disabilities may qualify for full MaineCare coverage through the Katie Beckett Program. This option offers all standard MaineCare services including hospital, nursing or intermediate care.

MaineCare should also offer “Medically Needy” coverage to adults and children, even if they are not severely disabled. 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.

Check out the Health Insurance Marketplace and  Other Helpful Programs sections of this Guide or call the HelpLine at 1-800-965-7476 for more options.