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The state where you reside has a significant impact on the care you receive and how much you pay as a Medicare beneficiary. This page describes resources to help qualifying Maine residents pay for Medicare coverage and Medicaid programs to help pay for long-term care, which is not generally covered by Medicare.
Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program (MSP). In Maine, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and (in some cases) Part A premiums.
MSP asset limits: Applicants for MSPs must have liquid assets (cash and resources that can quickly be converted into cash) below $58,000 if single and $87,000 if married.
Medicare covers many services – including hospitalization, physician services, and prescription drugs – but Original Medicare doesn’t cover important services like vision and dental benefits. Beneficiaries whose incomes and assets make them eligible for Medicaid can receive coverage for certain additional services if they’re enrolled in Medicaid for the aged, blind and disabled (ABD).
In Maine, Medicaid ABD covers dental care only in emergencies. This means surgery or extractions to relieve pain or prevent infection are covered, but routine procedures like cleanings or fillings are not.
Medicaid ABD covers an eye exam every three years for most beneficiaries, but will cover one more frequently for enrollees with medical conditions affecting their eyes. Medicaid also pays for one pair of eyeglasses per lifetime, when a minimum 10 diopter correction is required.
Income eligibility: The income limit is $1,183 a month for singles and $1,637 a month for couples. (These amounts incorporate an unearned income “disregard” of $75 a month for individuals and $100 a month for spouses.)
Asset limits: The asset limit is $10,000 for singles and $15,000 for couples.
Note: Income and asset limits for Medicaid ABD and Medicaid long-term care are based on the number of household members, not applicants’ marital status. However, the income limits for QMB, SLMB and QI do vary based on marital status.
Applicants who are over-income for Medicaid ABD can qualify for Medicaid by enrolling in the Medicaid spend-down program, known as MaineCare Deductible.
Spend-down benefits are usually approved in six-month increments, with additional coverage periods requiring new medical expenses to be submitted.
The spend-down in Maine covers both regular Medicaid ABD benefits and LTSS.
Income eligibility: The income limit was $315 a month if single and $341 a month if married as of 2018.*
Asset limits: The asset limit is $2,000 if single and $3,000 if married, although many assets aren’t counted.
*This is the most up-to-date information online. You could contact a consumer organization like Consumers for Affordable Health Care at 1-800-965-7476 for more recent income level information.
Medicare beneficiaries who also have Medicaid, an MSP, or Supplemental Security Income (SSI) automatically receive Extra Help – a federal program that reduces Medicare Part D prescription drug expenses. Beneficiaries who aren’t enrolled in this program automatically can apply for it through the Social Security Administration (SSA). The income limit is $1,615 a month for singles (and $2,175 a month for couples), and the asset limit is $14,610 for individuals (and $29,160 for spouses).
The percentage of beneficiaries needing long-term care continues to grow as the American population continues to age. However, LTSS is mostly not covered by Medicare. While Medicaid can fill this coverage gap, complex eligibility rules — which vary from state to state — can make qualifying for benefits difficult.
Income limits: The applicant’s gross income must be less than the rate for a semi-private room in their nursing home (and below the private pay rate, if they reside in another type of residential care facility).
Medicaid long-term care enrollees have to pay almost all their income toward their care. They are allowed to keep a small personal needs allowance ($70 a month for nursing home enrollees and $40 a month for assisted living enrollees) and money to pay for health insurance premiums, such as Medicare Part B and Medigap.
Assets limits: The asset limit is $10,000 if single and $15,000 if married and both spouses are applying. If only one spouse needs Medicaid long-term care, the other can keep up to $128,640.
All state Medicaid programs cover community-based long-term care services. Programs that pay for this care are called Home and Community Based Services (HCBS) waivers because recipients don’t have to enter a nursing home.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married (and both spouses are applying).
Even though the income limit is $2,349 a month (if single), HCBS enrollees must pay any income above $2,128 a month toward their care.
Asset limits: The asset limit is $10,000 if single and $15,000 if married and both spouses are applying. If only one spouse needs Medicaid long-term care, the other can keep up to $128,640.
Spousal impoverishment rules allow the non-applying or “community spouse” to keep certain income and assets.
In Maine in 2020, these spousal impoverishment rules allow community spouses to keep:
Federal law requires states to limit eligibility for Medicaid nursing home and HCBS to applicants with a home equity interest below a specific dollar amount. In 2020, states set this home equity level based on a federal minimum of $595,000 and maximum of $893,000.
Maine limits home equity interest to a maximum of $595,000 for Medicaid LTSS enrollees.
Given the significant expense of long-term care, individuals sometimes contemplate transferring assets to meet eligibility requirements for Medicaid LTSS benefits. To curb asset transfers, federal law requires states to have a penalty period for Medicaid nursing home applicants who give away or transfer assets at below market value. States can choose to also have an asset transfer penalty for HCBS.
Maine has chosen to have an asset transfer penalty for both nursing home care and HCBS; Medicaid will not pay for LTSS during this penalty period.
Maine Medicaid uses a 60-month lookback period for these asset transfers and gifts. The penalty period is calculated by dividing the amount of money transferred or given away by the monthly cost of care in a nursing home; this amount was $8,476 in 2019).
State Medicaid agencies have to attempt to recover what they paid for long-term care related costs while a beneficiary was 55 or older. States can also recover the cost of all other Medicaid benefits, and recover from enrollees who didn’t receive long-term care. This process is called estate recovery.
Maine has chosen to recover the cost of all Medicaid benefits received beginning at age 55.
When Medicaid coverage was administered by a Managed Care Organization (MCO), the state will attempt to recover what it paid that MCO. This amount could differ from the actual cost of the Medicaid services received.
Many states limit estate recovery to the enrollee’s probate estate (meaning their property that is subject to a will), but Maine also pursues estate recovery for property that passes outside of a will. This means the state can attempt to recover from life estates and bank and retirement accounts that have “transfer-on-death” provisions.
Maine may decide to exempt an inheritor from estate recovery if it would leave that person without a source of income.
The state will delay its estate recovery for enrollees who are survived by a spouse or by children who are under 21, blind or disabled. Estate recovery would occur once the spouse dies, or after the child turned 21 or was no longer considered disabled.
Congress exempted Medicare premiums and cost sharing from Medicaid estate recovery starting with benefits paid after December 31, 2009, but Medicaid may try to recover the cost of MSP benefits paid through that date.
Free Medicare counseling is available by contacting the Maine State Health Insurance Assistance Program (SHIP) at 800-262-2232.
SHIP can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. SHIP may also provide information about local agencies that provide services like home care and long-term care. This website has more information about the SHIP in Maine.
You can use the National Academy of Elder Law Attorneys (NAELA) search feature to find an elder attorney for help planning for long-term care.
Consumers for Affordable Health Care (CAHC) is a non-profit organization that advocates for affordable and accessible health care for people in Maine. You can contact the program’s hotline at 800-965-7476. CAHC’s website has more information about the services the organization offers.
Medicaid is administered by the Department of Health and Human Services (DHHS) in Maine. You can apply for Medicaid ABD or an MSP using this website if you live in Maine. DHHS has also posted a printable application you can submit by fax or email.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with hospital, insurer and technology clients.