For Your Information
MaineCare Co-payments
MaineCare pays all of the cost for many services. But for some MaineCare services,
members must pay a small share of the cost, called a co-payment, or “co-pay”.
These co-pays range between 50 cents and $3.
- Some members do NOT have to make any co-pays. They are members:
- Under 21 years of age, or
- 21 years of age or older, who are:
- Native American
- On a ventilator
- In a hospital
- Pregnant
- In a nursing home
- Under State guardianship; or
- In a medical institution, intermediate care facility for the mentally
retarded (ICF-MR), or a private non-medical institution (PNMI) where DHHS sets
the cost of care.
What if I can’t afford to pay my co-pay?
If you can’t afford your co-pay when you get a MaineCare service, the
provider must still give you the service. For example, a pharmacy must still
give you your prescription even if you can’t pay your co-pay.
If you get a service but can’t pay your co-pay, you still owe that amount
to your provider. Your provider may send you a bill, but cannot deny you services
the next time you go for care because you didn’t make your co-pay. You
will not lose your MaineCare because you could not also pay your co-payments.
Who must pay their co-pay?
There are only two groups of people on MaineCare who must pay their co-pay in
order to receive the service. These are members who are in the HIV/AIDS waiver
group, and seniors and people with disabilities who only get help with prescription
drugs through the MaineCare “buy-in” program. (Seniors and people
with disabilities that need help with co-payments in this program may call the
pharmacy help desk: 1-866-796-2463).
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