What Mental Health Services Does Mainecare Cover

Coverage & Benefits

MaineCare pays for medically necessary services based on your coverage group, which is adamant by your income, age, medical needs, and if y'all demand help with Activities of Daily Living (ADLs).

Photo of an older woman with a doctor

What services are covered?

Some examples of services that may exist covered include:

Doctor visits
Prescription medications
Behavioral wellness services
10-rays and labs
Emergency and infirmary visits

What services are not covered?

Some examples of services that are non covered include:

Acupuncture
Cosmetic surgery
Experimental procedures or drugs
Health club memberships, such as the YMCA
Massage therapy

How do I find out if a service is covered?

Talk with your health intendance provider or call MaineCare Fellow member Services at one-800-977-6740. TTY users, dial 711 (Maine Relay). To run across if your medication is covered, call the Chemist's shop Assistance Desk at -866-796-2463, TTY: 711.

Practise I have to pay for MaineCare coverage?

Y'all may have to pay a copayment, premium, or cost of care for MaineCare services depending on what coverage grouping you lot have.

Copayments

You may need to pay for function of the toll of some MaineCare services. What y'all pay is chosen a copayment, or copay.

Members exercise not have a copay for the following:

Services provided in Indian Health Service Centers
Family Planning services and supplies
Emergency Department services
Hospice services
All oxygen and oxygen equipment services
Tobacco cessation services and products

For details nearly services that may require a copay and members who are responsible for copays, meet the MaineCare Fellow member Handbook (PDF). To run into what you may pay for a copay for services and prescription drugs, see the MaineCare Fellow member Copayments (PDF).

Premiums

A premium is a fee that some members pay to have MaineCare coverage. For some MaineCare programs, if you are over the income level for MaineCare, y'all may have the option to pay a premium for MaineCare coverage. You will know if you must pay a premium for coverage because y'all will get a letter of the alphabet. Examples of programs with members who are responsible for premiums are the Katie Beckett program and the Children'southward Health Insurance Program (Fleck).

Cost of Intendance

If you live in a medical facility, yous may have to pay for a portion of your care. The Price of Care is the amount you pay towards your care at the medical facility. Members who pay a cost of intendance usually alive in a nursing facility, residential intendance facility, cost-reimbursed boarding habitation, or an adult family intendance domicile.

What is a Prior Authorization?

Before you can get some services or equipment, MaineCare must approve it. This approval is called Prior Authorization (PA). Your provider sends a grade to MaineCare and nosotros will transport you and your provider a letter to let you know if the service or medical equipment is canonical. If yous get the service or the medical equipment without MaineCare's approval, you may have to pay the bill.

Examples of services and medical equipment that need PA:

Some prescription drugs
Some mental health services
Some surgeries
Most medical supplies and medical equipment that cost over $699.99
Hearing aids

Most out-of-state services
Some eye care services
Some dental services, especially for adults
All services to straighten teeth
Some physical therapy, occupational therapy, and speech therapy

Inpatient treatment at an in-land psychiatric infirmary
Out-of-land and some in-state transportation services
Some dwelling care services
Some ambulance services

For questions about a PA for a prescription drug, telephone call the Pharmacy Help Desk at Pharmacy Assistance Desk-bound at 1-866-796-2463. Telephone call MaineCare Member Services at one-800-977-6740 for questions about all other services.