Adults

Coverage

If one of these coverage groups describes your situation and you meet eligibility requirements, you may be covered by MaineCare’s full benefit package:

  • Parent or Caretaker Relative - You are the guardian, caretaker, or relative of a dependent child or you are related by blood or marriage or have adopted the child. The child must also be living with you and you must have primary responsibility for the child’s care.
  • Adults between age 21 and 64 who are not eligible for Medicare
  • Pregnant Women - You are pregnant, or you had a pregnancy that ended within the last 60 days.
  • Former Foster Care Children - You are under 26 years old, were in foster care in the State of Maine and were enrolled in Medicaid through the State of Maine at age 18, and are not otherwise eligible for, or enrolled in, other Medicaid coverage.

If you are an adult who is age 65 and older or eligible for Medicare, please see the Older Adults and Adults with Disabilities webpage.

MaineCare also offers more limited benefits to help Mainers cover the cost of pharmacy and dental services, as well as programs that help with the cost of drugs, private health insurance premiums, and more. Learn more about limited benefit packages.

How to Apply

Ready to apply? Learn about your options for applying online, by mail, and in person. Applications for MaineCare are processed by DHHS’s Office for Family Independence.

Preventive Services

MaineCare pays for many preventive services. These services keep you well and can find health problems before they become serious.

What are some examples of preventive services that are covered?

  • Annual physical exams
  • Immunizations, also called vaccines or shots
  • Pap smears for women
  • Mammograms
  • Prostate screenings for men
  • Eye exams

Adult Dental Coverage

MaineCare covers limited dental services for adults in order to prevent tooth decay and periodontal gum disease. See the Adult Dental Services Summary (PDF) for details about what dental services MaineCare covers for adults. See the About Dental Pain (PDF) flyer for more information about what to do if you have dental pain.

Other Covered Services

MaineCare covers only services that are medically necessary. There may be limits on how many times you can use a service.

Some examples of services that may be covered:

  • Visits to your doctor
  • Medications
  • Behavioral health services
  • Inpatient and outpatient hospital visits
  • X-rays and labs

The services covered depends on your MaineCare eligibility category. MaineCare may not cover all services listed.

What do I need to get a service?

For some services, you may need:

  • You provider to get Prior Authorization (PA) from MaineCare
  • A prescription for medication
  • To pay a copayment
  • A medical assessment of your ability to take care of yourself and do household tasks

Services Not Covered

Some examples of services that are not covered:

  • Acupuncture
  • Cosmetic surgery
  • Experimental procedures or drugs
  • Health club memberships, such as the YMCA
  • Massage therapy

MaineCare Member Services Can Help

To see if a service you need is covered, call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711. Make sure MaineCare covers the service you need before you get care. There are limits or special rules for most covered services.