Members Frequently Asked Questions
The following table contains frequently asked questions that relate to the Maine Integrated Health Management Solution (MIHMS).  Click on the topic to view the answer.

Eligibility

·                How do I apply for MaineCare?

·                How do I choose a PCP?

·                What is Creditable Coverage?

·                How do I know if I am eligible for MaineCare?

·                Who determines MaineCare eligibility?

·                What pharmacies participate in the Maine RX program?

·                Can I use a mail order company for my medication?

·                What do I do if my medication needs a Prior Authorization (PA)?

·                Does my MaineCare Card cover everyone in the Family?

·                My doctor does not accept MaineCare.  Will I have to pay this bill?

·                How do I know what services are covered?

·                Will I have a co-pay when I go to the doctor’s?

·                How often does MaineCare have Eligibility Reviews?

·                Can I schedule an Eligibility Review?

 

Benefits

·                What is PCCM?

·                What is a PCP?

·                When can I use the Emergency Room?

·                What if I am out of state and need emergency medical attention?

·                What is a PA?

·                What is a referral?

·                How do I get a replacement MaineCare ID card?

·                What is an EOB?

·                How do I find a Dentist accepting MaineCare?

Transportation

·                Can I get help with transportation to my Doctor’s appointments?

·                If I use my own vehicle to go to the doctor’s can I get reimbursed?

·                Can I bring a personal assistant with me to my doctor’s appointment?

Other Agencies

·                How can I find home care for a family member?

·                What do I do, I have just turned 65 and received a Medicare Supplemental Insurance packet from AARP?

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Eligibility

How do I apply for MaineCare?

To apply for MaineCare you must fill out an application.  You can get this application from your local DHHS office or by calling Member Services at 1-800-977-6740.  You may also download a copy of the application .  Once you have filled out the application return it to your local DHHS office

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How do I choose a PCP?

A Provider Directory of participating Primary Care Providers (PCPs) is included in your enrollment packet.  In addition, a directory is available on this web site to help you choose a PCP.  You should choose a PCP that you think will meet your medical needs and is located close to your home.  Once you have picked your PCP, complete the Provider Choice form from your enrollment packet and return it in the postage paid envelope to Member Services.  You can also choose your PCP by calling Member Services at 1-800-977-6740. 

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What is Creditable Coverage?

A Letter of Creditable Coverage will list start and end dates of when you received MaineCare coverage.  This letter is VERY important and required whenever you become eligible for private health insurance if you have a pre-existing medical condition. 

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How do I know if I am eligible for MaineCare?

Many Maine residents may be eligible for MaineCare.  There are asset and income limits that must be met.  To find out if you can join MaineCare, contact your local DHHS office.

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Who determines MaineCare eligibility?

The Office of Integrated Access and Support (OIAS) at the Department of Health and Human Services will determine if you are eligible for MaineCare coverage. 

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What pharmacies participate in the Maine RX program?

Call your pharmacy to see if they participate in Maine Rx drug discount program before using the Maine Rx card.

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Can I use a mail order company for my medication?

Yes.  MaineCare has a list of Pharmacies where you can order both generic and brand name prescriptions.  Call the Pharmacy Help Desk to get more information at 1-866-796-2463, (TTY 1-800-423-4331).

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What do I do if my medication needs a Prior Authorization (PA)?

Your pharmacists may help you by contacting your medical provider directly for the PA.  Pharmacists and doctors have a list of medications that need a PA.  If you have other questions concerning the prior authorization you can call your Doctor or the Pharmacy Help Desk at 1-866-796-2463.

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Does my MaineCare Card cover everyone in the Family?

No.  Everyone who qualifies for MaineCare has their own card and unique ID number.  Each family member must use their own card.

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My doctor does not accept MaineCare.  Will I have to pay this bill?

If you see a provider who does not accept MaineCare, you will have to pay the bill.  Before you get care, make sure the provider accepts MaineCare. 

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How do I know what services are covered?

You can call Member Services at 1-800-977-6740 and they will let you which services are covered.

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Will I have a co-pay when I go to the doctor’s?

Some individuals are exempt from co-pays (pregnant woman and children are two examples).  Call MaineCare Member Services at 1-800-977-6740 or TTY Line 1-800-977-6741 for more information.

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How often does MaineCare have Eligibility Reviews?

Reviews occur at least yearly.  Between reviews you should tell your DHHS Eligibility Specialist about changes in your household membership, assets, or income within 10 days.

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Can I schedule an Eligibility Review

Please contact your Member Services.

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Benefits

 

What is PCCM?

PCCM means Primary Care Case Management.  PCCM helps members and providers work together and manage care.  Participation in PCCM is required for most Members; please look at your Member Handbook or call Member Services at 1-800-977-6740 if you have any questions.

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What is a PCP?

PCP stands for Primary Care Provider.  This can be a doctor, physician's assistant, nurse practitioner or a health care clinic who will be in charge of managing your medical care. 

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When can I use the Emergency Room?

An emergency is any health problem (physical or mental) that could cause serious harm if not treated quickly.

Some examples of emergencies are chest pain, trouble breathing, sudden or severe bleeding or pain, bad burns, or broken bones.

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If you are not sure it is an emergency, call your provider first.  For cold and flu-like symptoms, you should call your Primary Care Provider.

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What if I am out of state and need emergency medical attention?

If you need Emergency Room medical care while out of state seek care as quickly as possible.

Some examples of emergencies are chest pain, trouble breathing, sudden or severe bleeding or pain, bad burns, or broken bones.

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The provider may give care first and then contact MaineCare to find out about becoming a MaineCare provider.  If the out of state provider chooses not to become a MaineCare provider, then you may have to pay the bill.  You cannot get your money back from MaineCare.

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What is a PA?

PA stands for Prior Authorization.  Before you can get some services or equipment, MaineCare must give its OK.  Your provider asks for a PA by sending in a form to MaineCare.  Your provider must send in the PA form before you get the service or medical equipment.  MaineCare will send your provider a letter if your PA is denied.  For some services you may get an approval letter.  If you get the service or the medical equipment without MaineCare approval, you may have to pay the bill.

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What is a referral?

If you are a Member of Primary Care Case Management (PCCM), you may sometimes need of a medical service that your Primary Care Provider (PCP) does not provide.  For certain services, your PCP may give you a referral to another MaineCare provider so that you may get the care you need. 

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How do I get a replacement MaineCare ID card?

If you need a new medical ID, card you should call your MaineCare Eligibility Case Worker at your local DHHS office.

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What is an EOB?

An EOB is an Explanation of Benefits.  MaineCare sends EOBs to members randomly so members can verify services.  You should review this letter for dates and types of services received.  If you did not receive the service on the letter call the Program Integrity Unit at 1-800-321-5557, choose option 4, and report this error.

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How do I find a Dentist accepting MaineCare?

MaineCare Member Services can give you a list of Dentists in your area.  Call 1-800-977-6740.

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Transportation

 

Can I get help with transportation to my Doctor’s appointments?

Local transportation agencies can help you with rides to your appointments, as long as the visit is covered by MaineCare.  To get help with transportation, you must get a Prior Authorization.  The transportation agency will help you with this.  You can see a list of agencies on this website, or by calling Member Services at 1-800-977-6740.

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If I use my own vehicle to go to the doctor’s can I get reimbursed?

Yes.  You must contact your local transportation provider before the service takes place to be paid for mileage.  MaineCare will pay mileage for the shortest route from the home of the person with the medical appointment.  For questions on services call your local Transportation Agency or Member Services at 1-800-977-6740.

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Can I bring a personal assistant with me to my doctor’s appointment?

Do not bring family or friends with you to your medical appointment unless you need help.  If someone is going with you, let the transportation agency know when you schedule your ride.  MaineCare will only pay for another person to go with you if you need medical help on your way to the appointment.  Prior Authorization will be required and the transportation agency will assist you with this.

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Other Agencies

 

How can I find home care for a family member?

The Office of Elder Services (OES) can help you with a list of agencies that provide in-home services such as home health, IV therapy, respiratory therapy, personal health care, end-of-life care, and services specifically designed for persons with Alzheimer's or other forms of dementia, as well as access to food assistance programs.  Call 1-800-262-2232.

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What do I do, I have just turned 65 and received a Medicare Supplemental Insurance packet from AARP?

You may now be eligible for Medicare and may be required to accept Medicare Part A, Part B, and Part D coverage to stay on MaineCare.  The Area Agencies on Aging can assist you with health needs and the best available health insurance plans.  The number is 1-877-353-3771.

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