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Online Help Help

 Members Frequently Asked Questions

MaineCare Eligibility

񡘣                How do I apply for MaineCare?

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

񡘣                How do I report changes?

Benefits and Covered Services

񡘣                How do I know what services are covered?

񡘣                What is an Explanation of Benefits (EOB)?

MaineCare Card

񡘣                Is my MaineCare card for everyone in my family?

񡘣                How do I get a replacement MaineCare ID card?

Primary Care Provider (PCP) and Primary Care Case Management (PCCM)

񡘣                What is a Primary Care Provider (PCP)?

񡘣                How do I choose a Primary Care Provider (PCP)?

񡘣                What is Primary Care Case Management (PCCM)?

񡘣                What should I bring to my first visit with my Primary Care Provider (PCP)?

񡘣                If I get sick and it is not an emergency, what should I do?

񡘣                What is a referral?

Emergency Services

񡘣                When can I use the Emergency Department(ED)?

񡘣                When should I use urgent care instead of the Emergency Department or seeing   my Primary Care Provider (PCP)?

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

Costs to MaineCare Members

񡘣                Will I have a copayment or copay when I go to a medical appointment, fill a prescription, or receive another service covered by MaineCare?

񡘣                My provider does not accept MaineCare. If I get services from this provider, will I have to pay this bill?

Pharmacies and Medication

񡘣                Will I have a copayment or copay when I get my medication from a pharmacy?

񡘣                Which pharmacies participate in the Maine RX program?

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

Prior Authorization (PA)

񡘣                What is a Prior Authorization (PA)?

񡘣                What should I do if I need a Prior Authorization (PA) for my medication?

Dental Services

񡘣                How do I find a dental provider who accepts MaineCare?

Transportation

񡘣                Can I get help with transportation to my MaineCare-covered appointments or other services covered by MaineCare?

񡘣                If I use my own vehicle or get a ride from my friend or family member, can I get reimbursed for the cost of my gas?

񡘣                If I need help at my medical appointment, can I bring someone in the vehicle with me?

񡘣                Can I bring my child with me in the vehicle when getting a ride from a transportation broker?

Home Care

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

Medicare and Other Insurance

񡘣                What is a Letter of Creditable Coverage?

񡘣                I am getting Medicare now. Who can I call with questions?

 

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MaineCare Eligibility

How do I apply for MaineCare?

To apply for MaineCare, you can do one of the following:

·         Go to the My Maine Connection website to see if you are eligible or to apply online for MaineCare.

·         Print an application from the Office for Family Independence (OFI) webpage. Then, mail it to OFI at: 114 Corn Shop Lane, Farmington, ME 04938.

·         Call 1-855-797-4357. TTY users, dial 711.

·         Visit a local DHHS –OFI office. To see the list, go to the DHHS Locations webpage. DHHS offices are located throughout the state. Each town is assigned to a certain office. To see what office your town is assigned to, go to the Office Finder.

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How do I know if I am eligible for MaineCare?

MaineCare eligibility may depend on family situations, age, medical need, income, and assets. Once you apply, an eligibility worker at the Office for Family Independence (OFI) decides eligibility for MaineCare. You should apply to see if you are eligible for MaineCare. For ways to apply, see the How do I apply for MaineCare? question.

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How do I report changes?

Go to My Maine Connection if you have changes to your address, income, assets, or when people move in or out of your home. You can also complete your annual review by going to My Maine Connection. You can also call the eligibility office to report changes at 1-855-797-4357;TTY users, dial 711.

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Benefits and Covered Services

  

How do I know what services are covered?

You can call MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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What is an Explanation of Benefits (EOB)?

An EOB is a list of services received by a member. MaineCare sends EOBs to members randomly so members can verify the services received. You should review this letter to see if you received the services on the dates listed in the letter. If there are any services listed that you did not receive, please call the Program Integrity Unit at 1-866-796-2463; TTY users, dial 711.

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MaineCare Card

 

Is my MaineCare Card for everyone in my family?

No. Everyone in your family who has MaineCare should have their own card and unique MaineCare ID number. 

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How do I get a replacement MaineCare ID card?

If you need a new MaineCare ID card, call the eligibility office at 1-855-797-4357or MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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 Primary Care Provider (PCP)and Primary Care Case Management(PCCM)

What is a Primary Care Provider (PCP)?

A PCP can be a doctor, physician's assistant, nurse practitioner, or a health care clinic in charge of managing your medical care. 

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How do I choose a Primary Care Provider (PCP)?

A Provider Directory of participating PCPs is included in the packet you received when you enrolled in Primary Care Case Management (PCCM). A Provider 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 close to your home. Once you have chosen your PCP, complete the Provider Choice form from your enrollment packet. Then, return it in the postage paid envelope to MaineCare Member Services. You can also choose your PCP by calling MaineCare Member Services at 1-800-977-6740; TTY users, dial 711. 

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What is Primary Care Case Management (PCCM)?

PCCM helps members and providers work together to manage a member’s care. Most members are part of PCCM. PCCM members receive a list of Primary Care Providers(PCP)in the mail. The PCP that you pick will manage your care. For more information, please see the MaineCare Member Handbook or call MaineCare Member Services at 1-800-977-6740;TTYusers, dial 711.

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What should I bring to my first visit with my Primary Care Provider (PCP)?

Once you pick a PCP, you will get a letter with his or her name and phone number. You must take this letter and your MaineCare card with you to all your MaineCare appointments. If the PCP on your letter is not the provider you want, call MaineCare Member Services right away. We can help you change to the PCP you want.

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If I get sick and it is not an emergency, what should I do?

Call your primary care provider anytime, 7 days a week, 24 hours a day. If he or she is not there, someone else will help you or an answering machine message will tell you what to do. Do not go to the emergency department for regular medical care.

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What is a referral?

If you are a member of Primary Care Case Management (PCCM), you may sometimes need a medical service that your Primary Care Provider (PCP) does not provide. To get services from another provider or specialist, you need approval from your PCP. This approval is called a referral.

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Emergency Services

 

When can I use the Emergency Department(ED)?

If you think you have a health emergency, go to the hospital ED. If you go to the ED and it is not an emergency, you may have to wait a long time for care. If you are not sure if it is an emergency, call your Primary Care Provider (PCP).

 

Some examples of emergencies are:


·          Chest pain

·          Bad burns

·          Broken bones

·          Not able to move or speak

·          Severe bleeding

·          Deep cuts

·          Head injuries

·          Thoughts of harming yourself or others

·          Trouble breathing

·          Mental confusion

·          Poisoning

·          Severe injury to a joint

·          Rape or other attack

·          Sudden or severe pain

·          Coughing blood


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When should I use urgent care instead of the Emergency Department or seeing my Primary Care Provider (PCP)?  

Urgent care is also called walk-in care. Check with your PCP before you go to urgent care because you need a referral. If you do not get a referral and go to urgent care, MaineCare may not pay the bill.

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

In an emergency, it is okay if the provider gives you care first and then gets in touch with MaineCare. If you have a medical emergency outside of Maine and are treated at the hospital, the hospital may choose not to become a MaineCare provider. If that happens, you may have to pay the bill. You cannot get your money back from MaineCare.

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Costs to MaineCare Members

 

Will I have a copayment or copay when I go to my medical appointment, fill a prescription, or receive another service covered by MaineCare?

You may need to pay for part of the cost for some services. This is called a copayment or copay.

·          Some members, like children or pregnant women, do not have copays.

·          If you do not have money for copay, you can still get the service, but you will still owe it to the service provider.

·          There is a monthly limit on the co-pays for a certain service.

If you have questions, call MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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My provider does not accept MaineCare.  If I get services from this provider, will I have to pay the bill?

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

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Pharmacies and Medication

 

Will I have a copayment or copay when I get my medication from a pharmacy?

You may need to pay for part of the cost for some services. This is called a copayment or copay.

·          Some members, like children or pregnant women, do not have copays.

·          If you do not have money for copay, you can still get the service but you will still owe it to the service provider.

·          There is a monthly limit on the copays for a certain service.

If you have questions, call MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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Which pharmacies participate in the Maine RX program?

Pharmacies participating in the Maine RX discount drug program changes regularly. Call your pharmacy to see if they are part of the Maine Rx Plus before using your Maine Rx Plus 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 generic and brand name medications and have them delivered by mail. Call the Pharmacy Help Desk to get more information at 1-866-796-2463; TTY users, dial 711.

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Prior Authorization(PA)

 

What is a Prior Authorization (PA)?

Before you can get some services or equipment, MaineCare must give you permission. This is known as Prior Authorization (PA). Your provider asks for a PA by sending a form to MaineCare.  MaineCare will send letters to you and your provider stating if your PA is approved, denied, or if additional information is needed to complete the request. If you get the service or the medical equipment without MaineCare approval, you may have to pay the bill.

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What should I do if I need a Prior Authorization (PA) for my medication?

Your medical provider will need to get permission for MaineCare to pay for your medication if you need a PA. Your pharmacists may help you by contacting your medical provider directly for the PA. If you have questions about your PA, you can call your medical provider or the Pharmacy Help Desk at 1-866-796-2463; TTY users, dial 711.

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Dental Services

 

How do I find a dental provider who accepts MaineCare?

Call MaineCare Member Services for a list of dental providers in your area at 1-800-977-6740; TTY users, dial 711. You can also go to the Insure Kids Now website for a listing of dental providers who accept MaineCare.

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Transportation

 

Can I get help with transportation to my MaineCare-covered appointments or to pick up my prescriptions at the pharmacy?

Yes. A transportation broker can help you with rides to your MaineCare covered appointments or to pick up your prescriptions at the pharmacy. You need to tell the broker 48 hours or two business days before you need the ride unless you need urgent care. To get help with out of state transportation, you must get Prior Authorization (PA). The broker will request the PA. See the list of transportation brokers or call MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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If I use my own vehicle or get a ride from my friend or family member, can I get reimbursed for the cost of my gas?

You must contact your transportation broker48 hours before you go to your MaineCare-covered service or to pick up your prescription to be sure your gas mileage can be reimbursed. MaineCare will pay mileage for the shortest route from your home. For questions, see the list of transportation brokers or call MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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If I need help at my medical appointment, can I bring someone in the vehicle with me?

MaineCare will allow another person to go with you if you need medical help on your way to the appointment or at the appointment. You may need to get a Letter of Medical Necessity. Call the transportation broker and they will tell you if a letter is needed when you schedule your ride. See the list of transportation brokers or call MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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Can I bring my child with me in the vehicle when getting a ride from a transportation broker?

The transportation broker can see if there is room in the vehicle for your child. Talk to your transportation broker when you schedule your ride. See the list of transportation brokers or call MaineCare Member Services at 1-800-977-6740; TTY users, dial 711.

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Home Care

 

How can I find home care for a family member?

The Department of Health and Human Services (DHHS) Office of Aging and Disability Services (OADS) can tell you which agencies provide in-home services such as:

 

·          Home health

·          IV therapy

·          Respiratory therapy

·          Personal health care

·          End-of-life care

·          Services specifically designed for persons with Alzheimer's or other forms of dementia 

 

For more information, call OADS at 1-800-262-2232, TTY users, dial 711.

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Medicare and Other Insurance

 

What is a Letter of Creditable Coverage?

A Letter of Creditable Coverage lists the start and end dates of your MaineCare coverage. This letter is needed when you become eligible for private health insurance.

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I am getting Medicare now. Who can I call with questions?

Call one of the Area Agencies on Aging listed below to discuss this and other Medicare questions.

 

Maine Area Agency on Aging 

The five Area Agencies on Aging in Maine are the central resource for elder services. They can help you either directly or by referring you to the appropriate agency in your area.

Call 1-877-353-3771 from anywhere in Maine to contact the Area Agency on Aging that serves the town you live in.

Aroostook Area Agency on Aging

Aroostook County
One Edgemont Drive, Suite B, PO Box 1288
Presque Isle, Maine  04769
Phone 207-764-3396/1-800-439-1789
TTY 207-992-0150

www.aroostookaging.org
Office Hours:8am – 4:30pm, Monday – Friday

 

Eastern Area Agency on Aging

Hancock, Penobscot, Piscataquis and Washington Counties
450 Essex Street
Bangor, Maine  04401-3937
Phone 207-941-2865/1-800-432-7812
TTY 207-992-0150
Office Hours: 8am – 4:30pm, Monday – Friday

 

Seniors Plus

Androscoggin, Franklin and Oxford Counties
8 Falcon Road
Lewiston, Maine  04240
Phone 207-795-4010/1-800-427-1241
TTY 207-795-7232
Office Hours: 8am – 5pm, Monday – Friday

 

Southern Maine Area Agency on Aging

Cumberland, except Brunswick and Harpswell, and York Counties
136 U.S. Route 1
Scarborough, ME  04074
Phone 207-396-6500/1-800-427-7411
TTY 207-883-0532
Office Hours: 8am – 4:30pm, Monday – Friday

 

Spectrum Generations (formerly Senior Spectrum)

Kennebec, Knox, Lincoln, Sagadahoc, Somerset and Waldo Counties, Brunswick and Harpswell

One Weston Court, PO Box 2589
Augusta, Maine  04338-2589
Phone1-800-639-1553
TTY 1-800-464-8703
Office Hours: 8am – 4:30pm, Monday – Friday

 

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