Older Adults and Adults with Disabilities

Coverage

Aged, Blind, or Disabled

If you are over the age of 65, are blind or have another disability, MaineCare may be able to help you afford health coverage and services.

Home and Community-Based Waiver Recipients

If you are in an eligibility category and meet the medical and financial requirements of a Home and Community-Based Waiver program then you may qualify to receive services through one of our Home and Community Based Services (HCBS) waiver programs. Visit the Office of Aging and Disability Services webpage or the MaineCare Member Handbook (PDF) for more detail about waivers.

Deductibles for the Medically Needy

If you qualify for MaineCare but are over the income or asset limits, you will have a deductible. A deductible is a specific dollar amount that is based on your income. To meet your deductible, your qualifying medical bills must add up to that dollar amount. If you meet your deductible, you receive full MaineCare coverage for the rest of the deductible period. MaineCare will cover qualifying medical services for whatever is left once the deductible is met. You are responsible for the medical bills you received before you met your deductible and MaineCare will not pay for them. When the deductible period ends, your MaineCare coverage will end and you must reapply for a new deductible.

Medicare Savings Programs – Also called Buy-In

If you have Medicare , you may qualify for a Medicare Savings Plan. Depending on your income, MaineCare may pay for Part A premiums, Part B premiums, Medicare deductibles, coinsurance, and copayments.

It is important to note that this benefit is not full MaineCare coverage so check with MaineCare Member Services to see if your service is covered by MaineCare.

Medicare Savings Programs:

  • Qualified Medicare Beneficiary (QMB)
  • Specified Low-Income Medicare Beneficiary (SLMB)
  • Qualifying Individual (QI)
  • Qualified Disabled and Working Individuals (QDWI)

See the Medicare Savings Programs webpage for more detail about eligibility guidelines and what is covered.

Long-Term Care Coverage

Residents of Nursing Facilities

You may qualify for long-term care coverage if you live in a nursing home. MaineCare may pay for the cost of the room, food, nursing care, routine supplies, and equipment provided by your nursing home.

Residential Care Facilities

You may qualify for long-term care coverage if you live in apartment or small adult family care home and get assisted living services. MaineCare may pay for the assisted living services that you receive.

How to Apply

Learn about your options for applying for the above MaineCare benefits online, by mail, and in person. Applications for MaineCare are processed by DHHS’s Office for Family Independence.

Covered Services

For detail about general services that are covered by MaineCare, including examples of preventive and other services, see the Adults webpage. In addition to preventive and general services that MaineCare covers for all adults, you may have additional services covered, depending on your age or disability and what your health care providers determine that you need.

See the MaineCare Member Handbook (PDF) for details about services that may be covered. To see if a specific service you need is covered, call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711.

Health Homes for Chronic Conditions

If you have chronic health conditions, you may be eligible to participate in a Health Home, Behavioral Health Home, or Opioid Health Home. A Health Home partners with your Primary Care Provider (PCP) to manage your chronic health conditions. See the Primary Care and Your Health webpage for more Health Home information.

Estate Recovery

Estate recovery is required by the federal government. MaineCare seeks recovery at the time of death for the cost of all MaineCare benefits that were provided when the recipient was age 55 and older. Medicare Savings Program recipients are not subject to estate recovery. See the Estate Recovery Overview (PDF) for more detail.

Impacted Members

All of the following must be true for MaineCare to seek recovery. The MaineCare member must:

  • Have received MaineCare when they were age 55 or older
  • Have no surviving spouse
  • Have no children who are under age 21
  • Have no disabled children of any age

More Detail

For more information about estate recovery, including what types of property can be recovered and how this requirement can be waived, see the MaineCare Member Handbook (PDF).

MaineCare Can Help

If you have questions or to see if a service you need is covered, call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711. For prescription drug benefits, medication prior authorizations, and Medicare Part D questions, call 1-866-796-2463. TTY users dial 711.