Medicaid Costs and Coverage in Maine

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There are different types of Medicaid insurance in Maine offered to eligible applicants seeking affordable healthcare. It is important for all petitioners to understand the Medicaid coverage options available, as well as determining the Medicaid cost estimates for health insurance in Maine. Each state has its own set of Medicaid coverage and costs, which can vary depending on different factors. Since Medicaid is a federal- and state-funded program, the bulk of cost for medical services is covered through government aid. However, this does not necessarily negate the fact that costs for Medicaid may still be assessed. Copays, deductibles and premiums are still a possibility, as well as out-of-pocket costs. Applicants should take the time to learn what services are covered by Medicaid, as well as asking, “What does Medicaid not cover?” in terms of medical services and treatments. Preparation is key for potential applicants who wish to learn more about affordable healthcare options in Maine. Since each state differs in regard to optional benefits covered by Medicaid, it is important to learn as much as possible before starting the application process. In order to learn more about Medicaid cost estimates, or what types of Medicaid insurance are available to Maine residents, continue reading the information outlined below.

What services are covered by Medicaid in Maine?

There are different types of Medicaid insurance options available to residents who seek affordable healthcare. Medicaid insurance types can vary depending on applicant information, such as age and income level, but coverage is also impacted by the services covered by Medicaid. There are always the most basic Medicaid coverages in each state, required by federal law. However, besides the mandated coverage for Medicaid, there are also optional benefits that the state of Maine elects to cover. Since funding for Medicaid is also on a state level, Maine officials can determine the benefits for Medicaid they wishes to cover. Some of the coverage options that are overseen by Medicaid in Maine include, but are not limited to the following:

  • Doctor’s office visits
  • Family care services for adults
  • Dialysis services
  • Ambulance services
  • Inpatient hospital services
  • Outpatient hospital services
  • Dental services
  • Chiropractic services
  • Behavioral health services
  • Home health services
  • Emergency transportation services

Download our free guide to review the full list of Medicaid-covered services.

Many applicants may have medical issues that arise, and thus, are unsure of whether or not they will be covered under Medicaid. If ever an approved applicant questions Medicaid coverage options, he or she can contact a local Medicaid provider or a primary care physician. There are even circumstances in which a doctor can contact Medicaid on behalf of the patient for prior authorization of Medicaid coverage that would not normally be covered.

What services are not covered by Medicaid in Maine?

It is equally important to understand what services Medicaid does not cover when considering how to apply for Medicaid. Applicants should be prepared for any unnecessary issues that may arise after they are approved for Medicaid coverage. Emergency services can be debilitating financially, especially when applicants are not sure if their needed services are covered by Medicaid. A simple way to rule out Medicaid services not covered is by determining if the doctor is a Medicaid provider. If not, then the services offered will not be covered. Another way to see which services will be covered by Medicaid is to determine if they are medically imperative for an applicant. Medicaid coverage is geared toward medically necessary services and treatments, only. Other services that are not covered by Medicaid include, but are not limited to:

  • Cosmetic surgeries and services.
  • Experimental treatments and services.
  • Health services provided by relatives or friends.
  • Private nursing duties.
  • Medical equipment not prescribed.

Medicaid services that are not covered usually can have exceptions, depending on authorization and necessity. If Medicaid does not cover specific services or treatments and a doctor finds it to be medically important, then there may be exceptions to the rule. While it is not the norm, Medicaid coverage exceptions can be made, depending on circumstance.

How much does Medicaid cost in Maine?

Those that meet Medicaid eligibility often wonder, “How much does Medicaid cost in Maine?” While Medicaid cost estimates are not as exact as an applicant can hope for, they can still provide a general idea of what to expect. Costs for Medicaid differ depending on a variety of factors, including an applicant’s age or income earned. Age plays a huge role in Medicaid coverage, as Medicaid is intended to cover children in entirety. While there may be different types of Medicaid insurance options, like CHIP, each will cover children for essential medical services. In addition to children finding Medicaid coverage, seniors too, have a better chance of receiving services entirely covered by Medicaid.

While there are various Medicaid coverage options that are without charge or cost, there will be fees attached to certain medical services. Copayments, for example, are one of the most common out-of-pocket expenses that an approved Medicaid applicant will endure. While copayments can differ depending on the services needed, they are still minimal in terms of expense. Once an applicant is approved for Medicaid services, he or she will receive a comprehensive guide to the services covered by Medicaid, as well as the copayments that may be necessary. It is worth noting that if an applicant cannot pay the copayment or difference of the medical bill that Medicaid will not cover, then service may be denied by the medical provider. There may be circumstances where out-of-pocket expenses can be billed to the applicant, which is up to the discretion of the medical provider. For more exact Medicaid cost estimates, applicants can contact their local Medicaid providers. Learn more about Medicaid costs and coverage by downloading our complimentary guide.