Coverage Team | MaineCare, Health Insurance Marketplace, & Other Community Resources

Who do we help?

MaineHealth’s Coverage Team aims to assist Maine’s uninsured and under-insured individuals with the process of applying for various MaineCare and Affordable Care Act programs. For assistance, call 1-833-284-8816 or email us at getcoverage@mainehealth.org.

Health Insurance Marketplace | Affordable Care Act (ACA)

Our staff are Certified Application Counselors (CACs) and offer in-person and phone counseling to help you enroll in the Health Insurance Marketplace/ACA plans. Typically, 85% of Mainers receive financial assistance to make the plans more affordable. Open Enrollment is November 1 to December 15 each year. You may be eligible for a Special Enrollment Period during the year if you have a qualifying life event (losing health coverage, moving, getting married, having a baby, or adopting a child).

For more information see the Health Insurance Marketplace, or contact the Coverage Team at 1-877-626-1684 or email us at getcoverage@mainehealth.org.

MaineCare

MaineCare rules changed in 2019. There are now free and low-cost health coverage options for more people, including childless adults. Nearly 70,000 people are newly eligible for MaineCare. You may be one of them! MaineHealth’s Coverage Team will help you apply.

How will it help me?
MaineCare is health insurance for Mainers with limited income. It pays for the care you get when you go to the doctor for a yearly well visit or when you are sick, including prescriptions. If you have kids, MaineCare will also cover their dental and vision care. MaineCare is free, and most services are covered for free or a small copayment.

How do I know if I am eligible?
If your income is at or below 138% of the Federal Poverty Level (FPL), you may be eligible for MaineCare. In 2019, you may qualify if you:

• Are a 1-person household that earns $1,437 a month or $17,236 a year or less
• Are a 2-person household that earns $1,945 a month or $23,336 a year or less
• Are a 3-person household that earns $2,453 a month or $29,435 a year or less

For each additional household member, add $508 a month or $6,100 a year.

Children, pregnant women, and adults under 21 are eligible for MaineCare at higher income levels!

MaineCare offers other Programs that you may qualify for:

MaineCare Limited Benefit

MaineCare’s Limited Benefit covers yearly physicals, birth control, and many reproductive/sexual health care services. In 2019, people with individual annual income (spousal income is not counted) under $26,729 are eligible.

Private Health Insurance Premium

To qualify for the Private Health Insurance Premium, someone in the household, usually a child, meets the eligibility requirements for MaineCare and a parent has health insurance through an employer. With the Private Health Insurance Premium, MaineCare becomes secondary insurance coverage to the employer coverage and pays the portion of health care costs that the employer coverage does not. It also pays the monthly premiums (via reimbursement) for the employer coverage.

MaineCare Deductible/SpendDown

A SpendDown is a deductible provided by MaineCare when you are in a MaineCare category (parent, pregnant, disabled) but you are over the income limit for eligibility. Once you spend a certain amount on medical expenses (the deductible), you become eligible for full MaineCare for up to a six-month period.

Medicare Savings Programs

What is the Medicare Savings Program?
The Medicare Savings Program (MSP) reduces your prescription drug out of pocket costs, pays your Medicare Part B premium (usually $134/month), and covers other Medicare deductibles and co-pays. This Program is administered by the Maine Department of Health and Human Services. There is no Estate Recovery requirements for MSP.

Who is eligible for the Medicare Savings Program?
Anybody who has Medicare and their monthly income for 2019 is under $1846/single or $2501/married couple. (Total income before any deductions.) Also assets have to be under $58,000/single and $87,000/married couple. Your home and car do not count as assets.

Coverage Team Walk-in Locations:

Walk-ins are welcome Monday-Friday. Hours vary, so please contact the local office for their walk-in hours.