Medicaid Costs and Coverage in Maine

If you are wondering, “How much is Medicaid in Maine?” then it is important to understand that Medicaid cost estimates will depend widely upon your income, coverage group and whether or not you stay within your Medicaid benefits coverage. MaineCare benefits packages will determine your Medicaid coverage, so it is crucial that you understand the benefits that may be available to you. In addition to understanding coverage, it is important to be aware of additional benefits that you may be entitled to receive.

The question, “How much is Medicaid in Maine?” is an important one as it can help you to become aware of potential out of pocket costs you may receive. While Medicaid provides invaluable medical insurance to low income families and individuals, it is not always entirely free. Many Medicaid beneficiaries in Maine will be expected to pay copayments at the time that they receive service. For more information on the types of Medicaid insurance and costs – review the sections provided below.

Download our helpful guide to Medicaid to gain the necessary information to apply for Medicaid.

How Much Does Medicaid Cost in Maine?

Copayment Medicaid cost estimates will not apply to individuals who are exempt from copays, such as:

  • Children who are under the age of 21
  • Pregnant women, including three months after a pregnancy ends
  • Members who are paying for part of her or his care and reside within a hospital or skilled nursing facility
  • Individuals who are either in state custody or under state guardianship
  • Native Americans who are eligible to receive services funded by Contract Health Services or Indian Health Service Tribal Union

In additional to the individuals who are exempt from these Medicaid cost estimates, there are select medical services that will never require a copayment. These services include family planning services and supplies, emergency department services, hospice services, oxygen equipment services and services that are provided in health service centers. Some Medicaid members may be able to receive service, even if they cannot pay the copayment at the time of service.

If you are asking, “How much does Medicaid cost?” it is important to also be aware of potential premiums. Monthly premiums are based upon income and, if you are required to pay a monthly premium, you will be informed of such upon your acceptance into the program. Examples of the types of Medicaid insurance that may include a premium are the Katie Beckett program and the Children’s Health Insurance Program (CHIP). Should you fail to pay your premium, you may lose your coverage.

Understanding MaineCare Benefit Packages

In order to know how much does Medicaid cost in Maine, you must first look at the benefit package that is available to you as benefit packages will determine what medical services and prescription drugs will be covered under your MaineCare plan. Benefits package eligibility is determined by your age, medical need and income. Download our comprehensive guide to affordable health insurance to learn more about coverage, costs and benefit packages available with Medicaid.

As mentioned previously, the services covered by Medicaid in Maine will be determined by the benefits package that is allotted to you. Generally, Medicaid coverage packages will cover services such as visits with a physician, immunizations, hospital care, prescription drugs, surgery, x-ray and laboratory services, therapies, ambulance services, mental health services, substance abuse treatment, prenatal care, family planning services and case management. However, some individuals, such as children who are aged 20 years old or younger, are eligible to receive additional benefits. Gathering as much information on the application as possible before you apply will help you to get the best coverage for your family. For children, Medicaid coverage also includes full coverage for dental care, vision screening, hearing tests and hearing aids/eyeglasses as necessasary. Other MaineCare beneficiaries will generally have minimal health coverage for these types of Medicaid insurance.

If you are a senior citizen considering Medicaid cost estimates, it is important to know that there are types of Medicaid insurance that are specific to your needs. Medicaid may be able to assist you with your Medicare payments, including copayments, premiums and coinsurance.

The Importance of Obtaining Prior Authorization in Maine

There are some services that, while having Maine Medicaid coverage, will still require what is called Prior Authorization (PA). If you are wondering, “What does Medicaid not cover?” your medical provider or pharmacist will ask for PA by contacting MaineCare on your behalf to request coverage. It is important that you wait to receive medical assistance for PA, because if MaineCare determine that it will not cover a service, you will be expected to pay the entirety of that medical bill. PA may be required for some surgeries, hearing aids, medical supplies and equipment, out of state services, dental services, home care services and some therapy services. Download our helpful guide to understand more about Medicaid eligibility.

Maine Medicaid Coverage for Transportation

Maine Medicaid cost estimates should also be considered when it comes to the transportation services that MaineCare has to offer. Eligible Medicaid members will be eligible to receive transportation services to and from your physicians visit, provided that you do not have reasonable and affordable transportation. In some cases, Medicaid coverage may pay for your transportation where as in other cases, they may set up a ride for you with a volunteer. In some cases, this service may be available to transport you to an out of state facility. It is important to understand the transportation that Medicaid does not cover, including emergency services. In some cases, transportation may be available for an urgent care center.

What Does Medicaid Not Cover in Maine?

Now that you understand how much is Medicaid in Maine, it is important to familiarize yourself with what medical services are not provided by any MaineCare program. Doing so can help ensure that you do not find yourself having to pay unexpected out of pocket fee. Medicaid coverage is not extended to:

  • Experimental procedures or prescription drugs
  • Surgery that is considered to be cosmetic
  • Homeopathic treatment
  • Health club memberships

Additionally, when considering what services are not covered by Medicaid, you should know that some prescription drugs may not be available. In cases such as these, it is important to discuss options with your doctor, including if another drug may work just as well or if there is an off brand, version of the prescription that Medicaid may provide coverage to.