MaineCare gives health coverage to people with low income

MaineCare’s income eligibility limits are different for different types of households. Families with minor children have one of the highest eligibility limits. For example, if you have a family of three with a minor child, you can get MaineCare if your income, after some deductions, is below about $34,340 per year. If you have four family members, including a child, the limit is about $41,300. People over 65, people with disabilities, and other adults without children may also get MaineCare, although at lower income levels. Other smaller groups, such as women with breast cancer, people with HIV or AIDS, and pregnant women can get MaineCare, too.

For more information go to a two page summary of MaineCare called, Maine's Medical Assistance Programs: Who’s Covered and Who’s Not provided by Maine Equal Justice Partners where you can also find a very detailed guide to MaineCare. An easy to read Guide to Health Care in Maine is provided by Consumers for Affordable Health Care Foundation who also has a Health Care Helpline at 1-800-965-7476. You can also print out the MaineCare application and send it in. (After you file this short form with your local DHHS office, you should get a phone call from them to help you complete the application process. The form allows you to apply for other assistance as well.) [NOTE:If your income has recently changed – for example, if you just lost wages or lost your job – then attach a note to the application saying your income has gone down. DHHS will ask for income information for the last four weeks, but will look at your income 30 days forward if it has changed.]

DirigoChoice provides health coverage on a sliding scale

Depending on your income and family size, your monthly cost could be discounted by as much as 80%. The amount of your deductible will also be reduced depending on your income. For example, a person with an 80% discount would see their $1,750 deductible reduced to $500. DirigoChoice covers preventative care at 100% (no co-pay or deductible applies), doctor's visits, routine lab work done as part of your routine physical exam and prescription drugs without requiring you to meet your deductible first. The program also does not exclude anyone based upon a pre-existing condition. To learn more, go to the DirigoChoice web site or call 1-877-893-8391.

Federally Qualified Health Centers

These health centers provide primary care for all who walk in the door, rich or poor, insured or uninsured. They provide care for the uninsured on a sliding scale. These Health Centers operate throughout Maine. To find one in your area, click here or call 207-621-0677.

Health Care for Veterans

If you served in the military, you are almost certainly eligible for Health Services through the Veterans Administration -- even if you do not have a service-connected health problem. Standard benefits include prescription drugs, preventative care, outpatient services, inpatient services, long term care, mental health and substance abuse treatment and other services. Every CareerCenter has a Veterans’ Representative who would be happy to point you in the right direction. A list of CareerCenter sites is online. Click here to find the CareerCenter nearest you. You can also find out more at the VA Health Administration Center’s web site.

Free Hospital Care

Maine hospitals provide free hospital care to people with low income.Many hospitals also have programs to help with doctor’s visits, prescription drugs, and other services. Call your local hospital to find out if they have a program and whether you would be eligible. To find a hospital near you, go to the Maine Hospital Association’s web site.

Health Coverage Tax Credit (HCTC)

The HCTC is a federal program for workers who were laid-off because their former employer lost business due to foreign competition. The HCTC pays 65% of your monthly health insurance premium. It is a tax credit, but you can get it monthly in time to pay your bill. After you are laid-off you should receive in the mail the form to apply for the HCTC. (If you don’t get it, call 866 628-4282 and request it.)

To be eligible for the HCTC, you must be receiving Unemployment Insurance benefits, Trade Readjustment Allowance (TRA) benefits or Additional Trade Readjustment Allowance (ATRA) benefits. ALSO you must be enrolled in training under the Trade Adjustment Act or have a training waiver. The deadline to enroll in training (or to get a training waiver) is 16 weeks after your separation from employment or 8 weeks after your former employer was TAA certified.

• To apply for unemployment, TRA or ATRA, call 1-800-593-7660.
• For more information about the HCTC, click here for the Maine Department of Labor’s HCTC description. You can go to the IRS’s HCTC site.
• For help with 65% of your health insurance payments while you wait for the federal HCTC, call Debra Reitchel in the Maine Department of Labor at (207) 287-6494 or toll free 1 877 457-8883.

NOTE: If you enroll in DirigoChoice and get a discount, the HCTC can still pay 65% of your costs. This “double discount” makes health coverage much more affordable.

Prescription Drug Help

The Low Cost Drugs for the Elderly and Disabled program (often called “ DEL”) is for people who are disabled or elderly (62 and over) and whoare over the income limit for MaineCare. DEL pays 80% of the cost of prescription drugs for many common illnesses. If you are not eligible for DEL, you still may qualify for Maine Rx Plus. This program provides, on average, 60% off on generic drugs and 15% off on brand named drugs. Both programs also help to fill in the gaps left by Medicare Part D coverage. For the eligibility guidelines, an application and a brochure, click on the Maine RX Plus site from DHHS or call them at 1-800-423-4331. Drug manufacturers also provide free prescriptions to those in need. For more information, a directory of these programs is provided at https://www.pparx.org.

COBRA

COBRA is the law that requires employers with 20 or more employees to continue to provide health coverage – at the employee’s expense -- after an employee has left his job, unless the employer has terminated the health or gone out of business. This coverage must be available for 18 months and, for dependents, under some circumstances, 36 months. For qualified trade-affected workers, COBRA can be combined with the HCTC (below) to obtain 65% off the cost (This is probably more expensive than DirigoChoice). For more about your rights when you lose group health insurance, including COBRA, the Maine Bureau of Insurance has a good brochure, What Can I Do When I Lose My Group Health Insurance.

What about pre-existing conditions?

Sometimes, if you have had a certain amount of time without health coverage (a gap in coverage) before you start with a new health insurance plan, the health insurance company can refuse you coverage for a pre-existing health condition for 12 months. However, state and federal laws protect you from having your pre-existing health condition excluded from coverage depending on how long your gap in coverage was. Wehighly recommend that you get advice if you think this may apply to you. Free advice is available at the Consumers for Affordable Health Care Helpline, 1-800-965-7476 or from the Maine Bureau if Insurance, 1-800-300-5000 or 207-624-8475 – ask for the Consumer Division. Generally, if when you lost your coverage you became eligible to join your spouse’s plan, you should do that within 30 days. If your former employer was “self-insured,” then your gap in coverage must be less than 63 days. (Most self-insured employers -- usually large employers -- use an insurance company to run their program, so it could be self-insured even though it looks to you like ordinary group coverage. You need to ask to find out if they were self-insured.) If your prior coverage was MaineCare or ordinary group coverage from your former employer, your gap in coverage must be less than 90 days (If your gap in coverage may be over 63 days but less than 90 days, ask to be sure that your former employer was not self-insured.) For more details, see the pamphlet What Can I Do When I Lose My Group Health Insurance by the Maine Bureau of Insurance. DirigoChoice does not exclude pre-existing conditions no matter how long you were uninsured; nor does MaineCare.