Older Adults and Adults with Disabilities

There are free and low-cost health coverage options that ensure older adults and adults with disabilities can get the important care they need to stay healthy.

Coverage

Aged, Blind, or Disabled

If you are over the age of 65, are blind or have another disability, MaineCare may be able to help you afford health coverage and services.

Home and Community-Based Waiver Recipients

If you are in an eligibility category and meet the medical and financial requirements of a Home and Community-Based Waiver program then you may qualify to receive services through one of our Home and Community Based Services waiver programs. Visit the Office of Aging and Disability Services webpage or the MaineCare Member Handbook (PDF) for more detail about waivers.

Deductibles for the Medically Needy

If you qualify for MaineCare but are over the income or asset limits, you will have a deductible. A deductible is the amount of money based on your income that you must pay for covered health services before MaineCare starts paying.To meet your deductible, your qualifying medical bills must add up to that dollar amount. If you meet your deductible, you receive full MaineCare coverage for the rest of the deductible period. MaineCare will cover qualifying medical services for whatever is left once the deductible is met. You are responsible for the medical bills you received before you met your deductible and MaineCare will not pay for them. When the deductible period ends, your MaineCare coverage will end, and you must reapply for a new deductible.

Medicare Savings Programs – Also called Buy-In

If you have Medicare, you may qualify for a Medicare Savings Plan (MSP). Depending on your income, MaineCare may pay for Part A premiums, Part B premiums, Medicare deductibles, coinsurance, and copayments.

It is important to note that this benefit is not full MaineCare coverage so check with MaineCare Member Services to see if your service is covered by MaineCare.

Medicare Savings Programs:

• Qualified Medicare Beneficiary (QMB)
• Qualifying Individual (QI)

Effective July 1, 2024, people with higher income levels now qualify for MSP! For more information on this MSP expansion, eligibility guidelines, and what is covered, please visit OFI's Health Care Assistance webpage or the Medicare Savings Programs webpage.

Long-Term Care Coverage

Covered Services & Benefits

Please visit our Covered Services & Benefits webpage for more information.

Health Homes for Chronic Conditions

If you have chronic health conditions, you may be eligible to participate in a Health Home, Behavioral Health Home, or Opioid Health Home. A Health Home partners with your Primary Care Provider to manage your chronic health conditions. See the Primary Care and Your Health webpage for more Health Home information.

Estate Recovery

Estate recovery is required by the federal government. If you are age 55 or older and MaineCare pays for your nursing facility services or home- and community-based services, the State may make a claim on the assets of your estate (upon your death) to recover the money that MaineCare has paid for these services as well as for any hospital and prescription drug services related to these nursing facility and home- and community-based services. MaineCare will not seek any recovery if a member: 

• Has not received any nursing facility services or home and community-based services 
• Only received the Medicare Savings Program (Buy-in) benefit  

Impacted members  

All the following must be true for MaineCare to seek recovery. The MaineCare member must: 

• Have received MaineCare when they were age 55 or older 
• Have received nursing facility services or home- and community-based services 
• Have no surviving spouse at the time the Department seeks recovery 
• Have no children who are under age 21 at the time the Department seeks recovery 
• Have no disabled children of any age at the time the Department seeks recovery 

See the Estate Recovery Overview (PDF) or the MaineCare Member Handbook (PDF) for additional information.  If you have questions about estate recovery, call MaineCare Member Services at 1-800-977-6740.  

MaineCare Can Help

If you have questions or to see if a service you need is covered, call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711. For prescription drug benefits, medication prior authorizations, and Medicare Part D questions, call 1-866-796-2463. TTY users dial 711.