Limited Benefits

MaineCare offers additional 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.

How to Apply

Applications for these benefits are processed by DHHS’s Office for Family Independence, learn about your options for applying online, by mail, and in person.

Pharmacy

When you have full MaineCare coverage, you can get prescription drugs paid for with your pharmacy benefit.

Preferred Drug List

See MaineCare's Preferred Drug List (PDL) for a list of medications your doctor can prescribe. Drugs listed as “Preferred” generally do not need a prior authorization (PA). Drugs listed as “Non-Preferred” will need a PA from your provider.

Copayments

You may need to pay for part of the cost of your prescription drug. What you pay is called a copayment, or copay.

For more information about prior authorizations, and to see what you may pay for a copay your prescription drug, visit our Coverage and Benefits webpage.

Mail Order Pharmacies

You can get brand name or generic drugs from mail order pharmacies that are approved by MaineCare. Mail order saves you time and money. You can get a 90-day supply of most generic and brand name drugs delivered to your mailbox. When you order drugs through the mail you will not be charged a copay.

If you have prescription drug questions, please contact the Pharmacy Help Desk: 1-866-796-2463. TTY users dial 711.

Discount Drug Programs

Drugs for the Elderly and Disabled (DEL)

This discount drug program is for individuals who are age 62 and older or have a disability and are over the income level for MaineCare. You may get up to 80% off the cost of your prescription drugs. You may also have to pay a $2.00 copayment.

Maine Rx Plus

If you are over the income level for MaineCare, you may get a discount on some prescription drugs. If you are eligible, you may save up to 60% on generic drugs and 15% on name brands.

Private Health Insurance Premium (PHIP)

The PHIP program can help you pay your share of the cost for your work-based health insurance. You must fill out a PHIP application. If you have private insurance available through work, please call Member Services at (800) 977-6740 to learn more about this program.

Limited Benefit Packages

Special Benefit Waiver (HIV Waiver)

The Special Benefit Waiver is a limited MaineCare benefit for individuals living with HIV or AIDS who do not qualify for full MaineCare benefits due to income. If eligible, members may be charged copayments, and/or a monthly premium based on their income. See the HIV Waiver Pamphlet (PDF) for more information about who qualifies and what this program covers.

Pregnant Women Who Are Presumptively Eligible

Pregnant woman can have prenatal care for up to 60 days, beginning the date her health care provider finds her eligible. To get care for the rest of the pregnancy, the woman must apply for MaineCare and be found eligible by the DHHS eligibility office before the 60 days pass.

Limited Family Planning Benefit

This benefit covers services for members wishing to prevent or delay pregnancy or regulate the number of children and timing of pregnancies. To qualify, you must not be pregnant. To see more detail about who qualifies, including income guidelines, see the MaineCare Member Handbook (PDF).

Emergency Services (also called Emergency MaineCare)

This limited benefit package is for people who:

  • Are not citizens and have no documents from Homeland Security
  • Are non-citizens

The only covered service is emergency medical services to stabilize the emergency condition. Any further treatment after the emergency is stabilized, is not covered. Labor and delivery is also covered.

Prison Coverage

Only inpatient services are covered by MaineCare for inmates involuntarily confined in a public institution, state or federal prison, jail, detention facility, or penal facility. 

This package covers only inpatient services in:

  • Hospitals
  • Intermediate Care Facilities for individuals with intellectual disabilities
  • Nursing facilities
  • Juvenile psychiatric facilities

Contact Us

Pharmacy Help Desk: 1-866-796-2463. TTY users dial 711.

Call MaineCare Member Services at 1-800-977-6740. TTY users dial 711. You can also email.