Changes to MaineCare Coverage  

1. Will I have a copay for prescriptions or services? 

Members may have a copay again for prescriptions and pharmacy services, office visits, clinical visits, hospital care, medical imaging and radiology services, labs, home health services, personal support services, behavioral health services, and medical supplies and Durable Medical Equipment (DME). 

A copay can be between $0.50 and $3.00, depending on the service. Please call MaineCare Member Services at 1-800-977-6740 to find out how much you may have for a copay for a certain service. TTY users dial 711. 

2. Will I have to pay a premium for MaineCare coverage? 

Once you have renewed your MaineCare as described in the answer to question number 10 below, you may have to pay a premium again to receive certain types of MaineCare coverage such as Katie Beckett or the Special Benefits Waiver. If you don’t pay your premium, you may lose your MaineCare coverage.  

3. Can I still get the medications I need? 

You can still get your medications, but some rules will go back to how they were before the public health emergency. You may no longer be able to request early refills of prescriptions or a 90-day prescription supply. We can no longer extend the prior authorization (PA) periods for prescriptions and certain durable medical equipment (DME) or waive initial PA requirements for some asthma and immune-related drugs. When requesting prescription refills, please plan ahead and allow enough time to ensure you receive your medication before you run out.  

4. Will MaineCare continue to cover COVID-19 testing treatment, and vaccines? 

If you have full MaineCare, COVID-19 testing, treatment, and vaccines will remain free to you. If you aren’t sure if a COVID-19 test, treatment, or vaccine is covered, talk with your doctor or call MaineCare Member Services at 1-800-977-6740. TTY users dial 711. 

5. I have COVID-19 testing, treatment, and vaccine coverage through the temporary COVID-19 program for people who were uninsured. Will my coverage end? 

If you have temporary coverage under MaineCare’s COVID-19 testing, treatment, and vaccine program, that coverage will end on May 11, 2023. If you have this temporary coverage, you will receive a letter, email, or text from the Office for Family Independence. If you didn’t create an account in My Maine Connection, you may receive a letter in the mail. If you did create a My Maine Connection account, how you get a notice depends on what you picked as your preferred contact method when you created your account. 

6, Does MaineCare cover at-home COVID-19 tests? 

MaineCare covers COVID-19 at-home tests and home collection kits at no cost. You must bring the at-home test to the pharmacy counter for MaineCare to cover the cost. MaineCare will not reimburse you for the test if you buy it at the main store register.  

You can still see your health care providers through telehealth as long as your provider agrees this is medically appropriate for you. Prior to your appointment, ask your health care provider to confirm whether your visit is through telehealth or in-person. Your providers can also continue to prescribe through telehealth as medically appropriate.  

8. Can I still get Non-Emergency Transportation (NET) services? 

Yes, NET will continue. You can continue to receive transportation to and from your pharmacy to pick up your prescriptions or to and from health appointments that are covered by MaineCare.  

If someone is sick with symptoms of COVID-19, is suspected of having COVID-19, or has tested positive for COVID-19, NET will make special transportation arrangements to reduce exposure to other MaineCare members and NET drivers. For more information about NET services and COVID-19, please see Transportation and COVID-19 Questions and Answers (PDF).  

9. What do I need to do now? 

Update your contact information. Stay connected to stay covered. Please make sure we have your current mailing address, phone number, and email address. You can visit MyMaineConnection.gov or call 1-855-797-4357, option 1 to update your information through an automated system.  

The Office for Family Independence will review your MaineCare eligibility between May 2023 and April 2024, depending on when you are scheduled for your annual review. When it is your turn to renew your information, the Office for Family Independence may send you a renewal form by mail or e-notice, depending on which you chose to receive.  

If it’s blue, it’s time to renew! If you receive your notices by mail, be on the lookout for the envelope with a blue block which will have the renewal information and instructions inside. If you signed up for e-notices, keep an eye on your email for a message you will get when it is time for your renewal.  In addition, if you have an account on MyMaineConnection.gov, the homepage will show an announcement that it is time to renew starting a month before your renewal date.  

11. What do I do if I get a renewal form or e-notice?  

If you get a renewal form, fill it out and return it right away to avoid a gap in coverage.  

It is very important that you complete your review and return it on time. If you don’t complete your renewal before the due date, your MaineCare coverage will end. The Office for Family Independence will send you a notice at least 15 days before the date coverage is set to end. 

You should complete your renewal even if you think you may no longer qualify for MaineCare. If you complete your renewal, you will keep your MaineCare until the Office for Family Independence finishes your review.  If you do not respond, you will lose your coverage immediately. 

12. How will I get health insurance if I am not longer eligible for MaineCare? 

If you are no longer eligible for MaineCare, affordable health insurance may be available through CoverME.gov, Maine’s Health Insurance Marketplace. Additional federal financial assistance for low-cost health plans has been extended through 2025, meaning most people will qualify for help paying for premiums at CoverME.gov. If the Office for Family Independence determines that you may be eligible for coverage through CoverME.gov, they will send your information to CoverME.gov and reach out to you. You will have 90 days from the date your MaineCare coverage ends to enroll in a health insurance plan at CoverME.gov. 

If you are employed, you should check with your employer to see if they offer health insurance coverage. 

If you have questions, are worried these options will not work for you, or you would like additional help, we encourage you to reach out to Consumers for Affordable Health Care (CAHC), a non-profit committed to helping all Maine people obtain quality, affordable health care. DHHS is partnering with CAHC and other community-based organizations to make sure you continue to have health insurance. You can reach CAHC at MaineCAHC.org or call the Consumers for Affordable Health Care Assistance Helpline at 1-800-965-7476. 

13. What if I have other questions? 

For more information about the end of the public health emergency, call MaineCare Member Services at 1-800-977-6740. TTY users dial 711. Check back for updates to the MaineCare COVID-19 website.