Learn About Coverage For Medicaid in Maine

Learn How To Apply For Medicaid With Our Guide

We Provide a Free Guide

Our FREE guide provides helpful information about how to apply for benefits. Learn more about us here.

Clear & Simple
Free and easy
Get the Guide

UPDATE: In 2020, the requirements and application steps for obtaining Medicaid insurance have undergone no significant changes.

If you are wondering, “What services are covered by Medicaid in Maine?” note that insured services and equipment will vary from state to state. The types of Medicaid insurance services provided by Maine Medicaid will be different from those provided in other parts of the country.

Furthermore, the question of, “How much does Medicaid cost?” varies similarly across the nation and within each state. For instance, while Medicaid coverage in ME will come with a monthly premium for some beneficiaries, others will not have to pay anything for medical services.

Medicaid cost estimates depend on the beneficiary’s financial and medical needs. Just over 250 thousand Maine residents are covered under Maine Medicaid. If you live in Maine and do not make enough money to afford health care coverage sold on the private market, you may qualify for Maine Medicaid.

For more information on Medicaid costs in Maine, and for details on what services Medicaid covers and what services it does not, review the sections provided below:

What Services are Covered by Medicaid in Maine?

The Maine Medicaid program covers all doctor visits by its beneficiaries. These include sick care visits, children’s checkups and visits for specialist care such as prenatal and surgery. While inpatient and outpatient care is covered for beneficiaries of all ages, dental services are limited to adults.

Medicaid coverage beneficiaries in assisted living centers, nursing homes, and other residential care centers also benefit fully. Download our informative guide to learn more about Medicaid coverage and costs. You will be covered under the program if you need occupational, physical and speech therapy. Here is a list of additional services:

  • Mental health services
  • Prescription drugs
  • X-rays and lab tests
  • Family planning
  • Ambulance services
  • Immunizations and other preventive services
  • Chiropractic services
  • Substance abuse services
  • Eye examinations, contact lenses, and eyeglasses
  • Hearing tests and aids

Other services may be covered as well if your physician determines that they are medically necessary. If your Medicaid denies a procedure or piece of equipment, you can always appeal the decision. A person who is eligible for Medicaid can appeal a denial based on the guidelines stated the paperwork received when enrolled. The process is pretty much the same in every state.

If you need one of the types of Medicaid insurance benefits that is not covered, you will need to file an appeal. You will need a prescription from your doctor; you may need some additional supporting documentation explaining why you need the service, how the service will benefit you, and what, if any alternative treatments are available. Depending on how busy the Medicaid department is, an appeal can take 3-6 months or more. It is always good to plan ahead for your medical whenever possible.

Children may be eligible for additional services that adults will not qualify for, such as dental services. These services may include regular exams, teeth cleaning, X-rays or even oral surgery, in extreme cases.

What Does Medicaid Not Cover in Maine?

The following services are not paid for by Medicaid coverage in Maine.

  • Missed appointments
  • Services rendered by relatives and immediate family members
  • Dietary supplements, steroids, and non-prescribed over-the-counter drugs
  • Cosmetic surgery
  • Procedures that are not medically necessary

You can still receive these services, but you will need to pay for them yourself.

Understanding Medicaid Cost Estimates in Maine

For those wondering, “How much is Medicaid in Maine?” note that many Medicaid beneficiaries pay nothing at all for their coverage due to the fact that they earn low incomes. The following Medicaid cost estimates are based on income and household size. Medicaid in Maine may cover 100% of your healthcare costs if your individual income is less than $ 1,544 per month. For a couple, this threshold is $2,082 per month.

In every case, your income has to be less than the income limits set by law in Maine. In addition, you have to possess Medicaid hospital insurance. If your income is above this threshold, you may still qualify for Medicaid, but you will have to pay a portion of the cost of your coverage.

The next logical question is, “How much does Medicaid cost?” Unfortunately, there is no absolute answer to this question. The amount you pay can change based on your income, the size of your household and the exact level of coverage you have.

If paying for your Medicaid coverage ever becomes a financial burden, be sure to let your caseworker know right away; you may qualify for additional financial assistance, especially if your income, health or living situation has changed. Even if there are no assistance programs available for you, you may be able to work out an extended payment plan.

If you need medical insurance, but you cannot afford it, Medicaid could be a good option for you. The coverage you receive may vary, depending on what state you live in, but the basic services you and your family depend on will always be included in your plan. The Medicaid cost estimates you pay for your benefits can vary as well. Many beneficiaries will pay nothing for their coverage. If you cannot pay the cost of healthcare on your own, Medicaid may be the answer you are looking for.