Maine's Medical Assistance Programs:
Who's Covered and Who's Not
| Group |
Program |
Income
Limit
1 |
Asset
Limit |
Notes |
| Children 0- 18 |
Full-benefit
MaineCare
|
200% FPL
(federal poverty level) |
None |
Children with income up to
150% FPL are eligible for free MaineCare; infants under 1 with income up to 185%
FLP are eligible for free MaineCare. Children between 150% and 200% FPL are eligible
for low-cost MaineCare (with a premium from $8-$64 per month, per family). Children in higher-income families
who have a serious medical condition are served under the
Katie Beckett option. For the Katie Becket option, only the income and assets
of the child who has the disabling condition (not the parents' income or assets) are counted. There is an asset limit of $2,000
for the child for Katie Beckett coverage.
Full Cost Purchase Option allows families who lose coverage due to increased
income to buy into MaineCare at a cost of $100 per month per child for 18 months. More
information |
| 19- and 20-year-olds |
Full-benefit
MaineCare |
150% FPL |
$20002
(Many assets are excluded.) |
Income of parents in the household is counted in some
circumstances.
More information |
Parents with children age 18 and younger at
home3
|
Full-benefit
MaineCare |
200% FPL |
$2,0002
(Many assets are excluded.) |
Transitional coverage: If family income increases from under
150% to over 200% FPL due to earnings, an additional 6 months of coverage is available.
These
individuals are also eligible for transitional coverage for 4 months if
the reason for the increase in income is child support.
More information |
| Pregnant Women |
Full-benefit
MaineCare |
200% FPL |
None |
For the mother, coverage continues 2 months beyond pregnancy. Coverage
will continue longer if the mother meets criteria above for parents. If the mother had full-benefit MaineCare when the
baby was born, the baby is covered by MaineCare for 1 year. More
information |
| Disabled Adults and seniors age 65 and older |
Full-benefit
MaineCare |
100% FPL |
$2,000 ($3,000 for a couple)2
for working disabled: $8,000 ($12,000 for a couple)
(Many assets are excluded.)
Workers with disabilities: $8,000 ($12,000/couple)
(Many assets are excluded.) |
Full-benefit MaineCare "wraps around" Medicare.
It covers nearly all Medicare costs. Most individuals who are also enrolled in Medicare
will need to be enrolled in a Medicare Part D prescription drug plan (PDP) and will get their drugs
through Part D. Call the DHHS Pharmacy Help Desk at 1-866-796-2463 for questions on Part D.
More information on Part D (large .pdf file)
Medicare Savings Program (MSP or "Buy In"): Medicare beneficiaries who are not eligible for full-benefit MaineCare
may be eligible for the Medicare Savings Program, which pays nearly all Part D costs, the Medicare Part B premium,
and sometimes other Part A and B costs. No asset limit. More information on MSP
MaineCare Option for Workers with Disabilities: People with disabilities who work may be eligible for full-benefit
MaineCare if their unearned income is under 100% FPL and their total income, including earnings,
is under 250% of FPL. Some people may have to pay small monthly premiums. |
| "Non-Cats:" adults who do not fit into one of the "categories" for
full-benefit MaineCare |
Partial-benefit
MaineCare |
100% FPL |
$2,000 ($3,000 for couple)2
(Many assets are excluded.) |
Adults age 21 to 64 who are not disabled and do not
have minor children
living at home may be eligible for MaineCare if their income is below 100% of FLP
and they are under the asset limit. Covered services are limited. There is a waiting list
in this program. Individuals will be moved off of the waiting list and onto the program as spaces become
available.
|
| Adults medically eligible for nursing care |
Full-benefit
MaineCare |
$1,809/mo |
$2,000 ($3,000 for couple)2
(Many assets are excluded.) |
Condition must be so severe that they would be nursing home eligible, but
they are living in the community. Adults are served under the home-based care waiver program.
For more information: 1-800-750-5353 |
| Women who have breast or cervical cancer
(or pre-cancerous condition) |
Full-benefit
MaineCare |
250% FPL |
None |
Women must be without insurance; age 40-64; have a
positive screening for breast or cervical cancer at an approved screener. For more information:
1-800-350-5180. |
| HIV-positive adults |
MaineCare
drug coverage and other limited benefits |
250% FPL |
None |
Individual must be HIV-positive (with or without diagnosis of AIDS); coverage
includes prescriptions and physician and hospital services; there are some limitations on services; co-pays are higher
($10 per prescription and per office visit) than for full-benefit MaineCare; there is a limit on the number of individuals
who can participate in the program. |
| "Medically Needy" or "Spend Down:" persons whose income is too high for full
benefit MaineCare
|
Full-benefit MaineCare, after a large deductible is met |
None |
$2,000 ($3,000 for some couples)2
(Many assets are excluded.) |
The Medically Needy benefit helps people with catastrophic
health care expenses; participants must be in a coverable group (65 or older, disabled, 20 or younger,
pregnant, or the parent of a minor child); the deductible amount depends on income level; medical
bills and other costs associated with medical care must have been incurred, but don’t need to have
been paid; certification is usually for 6 months. Old medical bills which you still owe
can be used towards your deductible.More
information |
| Disabled adults and seniors 62 and older |
Low Cost Drugs for the Elderly and Disabled (DEL) |
185% FPL (If spend 40%+ of gross monthly
income on Rx's, income limit is 25% higher.) |
None |
DEL covers:
- 80% of generic drugs costs (member pays 20% and $2.00 co-pay);
- 80% of drug costs for 14 specific health problems (member pays 20% and $2.00 co-pay);
- A small discount off the retail cost of many other medications;
- A catastrophic drug benefit covers 80% of the cost of most needed drugs after the person
incurs $1,000 out of
pocket using their DEL card (member pays 20% and $2.00 co-pay).
Some drugs will require prior
authorization. Most individuals who are also enrolled in Medicare will need to be enrolled
in a Medicare Part D Prescription Drug Plan (PDP) and will get their drugs through Part D.
Call the DHHS Pharmacy Help Desk at 1-866-796-2463 for questions on Part D.
|
| Persons who do not qualify for full-benefit MaineCare |
Maine Rx Plus |
350% FPL (see notes) |
None |
People over 350% of poverty will be eligible
if they have out-of-pocket prescription drug expenses exceeding 5% of the family's income, or out-of-pocket medical expenses
exceeding 15% of the family's income. Drugs listed as "preferred" on the MaineCare preferred drug list are
covered; savings will be approximately 15% on covered brand name drugs and 60% on generic drugs. |
1For most MaineCare benefits, some income does not count towards these limits.
2Asset rules now exempt $8,000 for an individual and $12,000 for a household of 2 or
more in certain savings, including retirement savings!
3DHHS Rule covers parents with an 18-year-old who will
finish high school by age 19.
Federal Poverty Levels
IMPORTANT NOTE: For most MaineCare benefits, some
income does not count toward these limits. Poverty levels are adjusted annually according to the Consumer Price Index.
Annual Income
|
Household
Size |
100% |
150% |
170% |
185% |
200% |
250% |
350% |
| 1 |
$10,400 |
$15,600 |
$17,680 |
$19,240 |
$20,800 |
$26,000 |
$36,400 |
| 2 |
$14,000 |
$21,000 |
$23,800 |
$25,900 |
$28,000 |
$35,000 |
$49,000 |
| 3 |
$17,600 |
$26,400 |
$29,920 |
$32,560 |
$35,200 |
$44,000 |
$61,600 |
| 4 |
$21,200 |
$31,800 |
$36,040 |
$39,220 |
$42,400 |
$53,000 |
$74,200 |
| 5 |
$24,800 |
$37,200 |
$42,160 |
$45,880 |
$49,600 |
$62,000 |
$86,800 |
| 6 |
$28,400 |
$42,600 |
$48,280 |
$52,540 |
$56,800 |
$71,000 |
$99,400 |
| Each additional person |
$3,600 |
$5,400 |
$6,120 |
$6,660 |
$7,200 |
$9,000 |
$12,600 |
Monthly Income
|
Household
Size |
100% |
150% |
170% |
185% |
200% |
250% |
350% |
| 1 |
$867 |
$1,300 |
$1,474 |
$1,604 |
$1,734 |
$2,167 |
$3,034 |
| 2 |
$1,167 |
$1,750 |
$1,984 |
$2,159 |
$2,334 |
$2,917 |
$4,084 |
| 3 |
$1,467 |
$2,200 |
$2,494 |
$2,714 |
$2,934 |
$3,667 |
$5,134 |
| 4 |
$1,767 |
$2,650 |
$3,004 |
$3,269 |
$3,534 |
$4,417 |
$6,184 |
| 5 |
$2,067 |
$3,100 |
$3,514 |
$3,824 |
$4,134 |
$5,167 |
$7,234 |
| 6 |
$2,367 |
$3,550 |
$4,024 |
$4,379 |
$4,734 |
$5,917 |
$8,284 |
| Each additional person |
$300 |
$450 |
$510 |
$555 |
$600 |
$750 |
$1,050 |
|
Disclaimer
Maine Equal Justice Partners
December 2007
We are providing this information as a public service. We try to make it accurate as of the date
indicated for each client education page. Sometimes the law changes. We cannot guarantee or promise that this information is
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