Department of Health and Human Services MaineCare Services




Дата канвертавання17.04.2016
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Department of Health and Human Services

MaineCare Services

# 11 State House Station

Augusta, Maine 04333-0011

Member Services: 1-800-977-6740

Member Services TTY: 1-800-977-6741




MaineCare Member Co-payments


Members do not have co-payments when they are:

  • Under 21 years old

  • Pregnant (including 3 months after the pregnancy ends)

  • In state custody

  • Under state guardianship

  • Services for Native American members who are eligible to receive services funded by Contract Health Services or Indian Health Services Tribal Union

  • In a

    • hospital (inpatient)

    • skilled nursing facility,

    • nursing facility,

    • Intermediate Care Facility for the Mentally Retarded (ICF-MR),

    • Private Non-Medical Institution (PNMI), Appendix C or F

    • Other medical institution

and

      • paying for part of their care as set by OMS/DHHS.


The following services do not have co-pays:

  • Services provided in Indian Health Service Centers

  • Family planning services and supplies

  • Emergency services (including if: the members’ health is in serious jeopardy, there is serious impairment(s) to bodily functions or there is serious dysfunction of any bodily organ or part).

  • Hospice services

  • All oxygen and oxygen equipment services.


Co-Payment Disputes: Providers must notify members of their right to dispute copayments. If a member believes that he or she is exempt from a copayment, disputes the amount of the copayment, or has been denied a service for failure to make a copayment, he or she may contact the Department for assistance in resolving that dispute. Complaints should be directed to the Director, Office of MaineCare Services, 11 State House Station, Augusta, Maine 04333-0011.

Co-payment Schedule

The co-payment is based upon how much MaineCare pays for the service.




When MaineCare pays . . .

the member co-payment is

$10.00 or less

$0.50

$10.01 - $25.00

$1.00

$25.01 - $50.00

$2.00

$50.01 – more

$3.00

Please Note: Once the member has paid out 5% of their monthly income in co-pays they will no longer be required to pay a co-pay for that month.
These services have a co-payment (except for the members who are under age 21, etc. – see list above.) See below for special co-payments for members enrolled in the HIV/AIDS program.
After monthly cap is reached for a service, member shall not be required to make additional co-payments for that service.


Non-Emergency Service *

Co-payments

Per day max Per month max






Ambulance

$3.00

$30.00

Chiropractor

$2.00

$20.00

Consumer Directed Attendant

$3.00

$5.00

Durable Medical Equipment

$3.00

$30.00

Federally Qualified Health Centers

$3.00

$30.00

Home Health Services

$3.00

$30.00

Hospital (inpatient and/or outpatient)

$3.00

$30.00

Laboratory

$1.00

$10.00

Occupational Therapy

$2.00

$30.00

Opticians

$2.00

$20.00

Optometrists

$3.00

$30.00

Physical Therapy

$2.00

$20.00

Podiatrist

$2.00

$20.00

Prescription Drugs ***

$3.00/

prescription



$30.00

Private Duty Nursing

$3.00

$5.00

Rural Health Center

$3.00

$30.00

Speech

$2.00

$20.00

Behavioral Health Services

$2.00

$20.00

X-rays/Medical Imaging

$1.00

$10.00

* Emergency Services have no member co-payments.



*** Members in Drugs for the Elderly and other pharmacy programs may have lower co-pays. No co-payment is charged if medications are ordered in a 90 day supply through a mail order pharmacy.
Members in the HIV/AIDS waiver have a mandatory co-payment and pay all of the regular co-payments shown above except for

  • Physician’s visit – co-pay is $10.00 (Note: there is no daily limit on member co-pays for physician visits.)

  • Prescription drugs

    • generic co-pay $10.00/30-day supply;

    • brand name co-pay $20.00/90-day supply by mail order only.





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