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MaineCare
is a program offered by the Department of Health
and Human Services (DHHS). Adults between the
age of 21 and 64, who are not disabled, not pregnant,
and have no minor children in their household
may be able to get free MaineCare coverage, depending
on their household income and assets.
What you'll
find on this page:
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What's covered?
MaineCare coverage is fairly comprehensive, but you
may need to follow certain rules in order to get some
services covered. MaineCare coverage can 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!
Can I get MaineCare?
If
household income is at or below the guidelines listed
below, you may be able to get MaineCare.
But, you may be placed on a waiting list for coverage.
This is because of funding limits imposed by
the Federal government. Even if you need services right
away, you should still apply for MaineCare and get on
the waiting list! Many other programs require
you to do this before you can be eligible for other
help. When looking at the income guidelines below, keep
in mind that your "household" includes only
yourself and your spouse if you are married. If you
are disabled, pregnant, or have children in your household,
you should refer to the other sections of this Guide.
Income
guidelines
For
self-employed income, use your net income (after business
expenses and taxes). For all other income types, use
the gross amount (the amount before any taxes or expenses
are taken out). Even if your income is above the
levels listed you should apply anyway! Many
other programs require you to do this before you can
be eligible for other help. If you have questions, or
are unsure whether you qualify, call our HelpLine at
1-800-965-7476.
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2009/2010*
Monthly Income Guidelines for
Free MaineCare
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Family
Size
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Income
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1
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$903
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2
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$1,215
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For
each additional family member add:
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$312
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*Income
Guidelines are based on Federal Poverty Guidelines,
which are calculated by a set formula every year.
For the first time in the history of the Federal Poverty
Guidelines, income limits for programs would have
gone down for 2010. To avoid people losing
coverage, the Obama Administration decided not to
change the Federal Poverty Guidelines at all this
year.
Asset
guidelines
Many
assets will NOT count against you. You can have savings
and retirement, a home, land that the home sits on,
cars and many other assets and still get MaineCare coverage!
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 $8,000 for a single person; $10,000
for an adult couple with no children in the
home.
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Real property that is up for sale
- Loans
that must be repaid
- The
cash value of life insurance the family has
purchased
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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
For
assets not listed above:
- Single
people are allowed to have $2,000, plus all
of the assets that do NOT count against you
(listed above). Couples are allowed to have
$3,000, plus all of the assets that do NOT count
against you (listed above). If you have questions,
or are unsure whether you qualify, call our
HelpLine at 1-800-965-7476.
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How do I apply?
There
is a simple, two-page application that is easy to fill
out and can be mailed to DHHS. You do not have to go
to a DHHS office to apply. If it takes DHHS more than
45 days to make a decision, you may be able to get temporary
coverage at no charge, until they make their decision.
To get an application or for more information, call
the HelpLine at 1-800-965-7476, or use the printable
application available on the DHHS web site.
You need to mail or drop off your completed application
at the local DHHS office. [See
complete listing of DHHS offices with addresses and
phone numbers]. When you apply, you will
need to send pay stubs or other proof to document your
last four weeks of income. If you are self-employed
you will have to send in your last year's tax return
including Schedule C - or more current records (a ledger)
if your income has changed much from the year before.
Do I have to prove
my citizenship and identity?
Yes.
The federal government has required that all states
now screen applicants for citizenship and identity.
Non-citizens will not be reported or prosecuted, but
they will only qualify for emergency services through
MaineCare. Please call the HelpLine at 1-800-965-7476
if you have questions about this process and what kinds
of documents your family will need to prove citizenship
and identity. This number is not a DHHS office, and
no information will be given out without your consent.
We can help you fill out the application.
What if my application
is denied?
Mistakes
can be made. If you feel you or other household members
are eligible but your application is denied, you have
the right to appeal the decision. Call the HelpLine
at 1-800-965-7476 if you need assistance. Or,
you can call your local DHHS office and ask for a Fair
Hearing. It is always a good idea to make your appeal
in writing as well, and send it in. [See
complete listing of DHHS offices with addresses and
phone numbers].
What happens if
my income goes up?
Your
MaineCare coverage will be given to you for 12 months.
After 12 months, your case will be reviewed to see if
you still qualify for coverage. During that 12 month
period, if you income or assets change significantly,
you are supposed to contact DHHS and let them know.
If this change means that you are no longer eligible
for MaineCare, DHHS will look to see if you qualify
for other programs. Call the HelpLine at 1-800-965-7476
for more information or if you need assistance.
What if I already
have private insurance?
Adults can have private insurance AND MaineCare. However,
most people who qualify for adult MaineCare cannot afford
private insurance. Since MaineCare is very comprehensive,
most people decide to drop their private 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?
There is no payment of old medical bills in this coverage
group. You may be able to get other programs, like Hospital
Free Care, to cover some costs. Please call
the HelpLine at 1-800-965-7476 if you have questions.
What if my income
is too high to qualify for MaineCare?
There
are other programs that can be helpful in reducing the
cost of health care services and prescriptions. Check
out the "Other
Helpful Program for Many People" section
of this Online Health Care Guide or call the HelpLine
at 1-800-965-7476 for more information.
