how to file of mainecare dual eligibility assistance when receiving medicare

Option 1: Apply online through My Maine Connection. Option 2: Download the MaineCare Application and mail it to: Office for Family Independence 114 Corn Shop Lane Farmington, ME 04938 Option 3: E-mail an application to [email protected] Option 4: Fax an application to (207) 778-8429.

Full Answer

How does dual eligibility for Medicare work?

As a result, any health care services that a dual eligible beneficiary receives are paid first by Medicare, and then by Medicaid. For full dual eligible beneficiaries, Medicaid will cover the cost of care of services that Medicare does not cover or only partially covers (as long as the service is also covered by Medicaid).

Can I apply for Medicare with my Maine connection?

My Maine Connection is for all state benefits, so you can apply for more than just Medicaid (food supplements, child care, cash assistance, etc.) You may be eligible for Medicare if you are either:

Who is responsible for processing MaineCare applications and determining eligibility?

Note: The Office for Family Independence is responsible for processing MaineCare applications and determining eligibility. Once enrolled, the Office of MaineCare Services administers the program and handles all billing and claims.

What are Medicaid managed care plans for dual eligible patients?

Others have established Medicaid managed care plans specific to the dual eligible population. Medicaid managed care is similar to Medicare Advantage, in that states contract with private insurance health plans to manage and deliver the care.

Can I have MaineCare and Medicare?

Elderly and disabled adults can have private insurance, Medicare, or Supplemental Insurance AND MaineCare.

Does Social Security count as income for MaineCare?

Income: Includes household money from sources such as Social Security, pensions, wages, alimony, self-employment, etc.

When a patient is covered through Medicare and Medicaid which coverage is primary?

Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors' visits, hospital care, home care, and skilled nursing facility care), Medicare is the primary payer. Medicaid is the payer of last resort, meaning it always pays last.

When the patient is covered by both Medicare and Medicaid what would be the order of reimbursement?

gov . Medicare pays first, and Medicaid pays second . If the employer has 20 or more employees, then the group health plan pays first, and Medicare pays second .

What is the income limit for MaineCare 2020?

You may be eligible for MaineCare if your monthly income (before you pay taxes) is up to:Your household sizeChildrenYoung Adults (19-20)1$2,413$1,8242$3,251$2,4573$4,088$3,0904$4,926$3,7241 more row

How much money can you have in the bank and still get MaineCare?

For children (18 and under) and pregnant women,MaineCare will not count assets. For parents of children (18 and under), and for 19 and 20 year olds, there is a $2,000 asset limit. For other adultcouples with no minor children at home, there is a $3,000 asset limit.

How can you have both Medicare and Medicaid?

If you are dual eligible, you are can enroll in a dual eligible special needs plan (D-SNP) that covers both Medicare and Medicaid benefits. These plans may also pay for expenses that Medicare and Medicaid don't over individually, including over-the-counter items, hearing aids, and vision or dental care.

How do I qualify for dual Medicare and Medicaid?

Persons who are eligible for both Medicare and Medicaid are called “dual eligibles”, or sometimes, Medicare-Medicaid enrollees. To be considered dually eligible, persons must be enrolled in Medicare Part A (hospital insurance), and / or Medicare Part B (medical insurance).

When a patient has Medicaid coverage in addition to other third party payer coverage Medicaid is always considered the?

For individuals who have Medicaid in addition to one or more commercial policy, Medicaid is, again, always the secondary payer.

Which insurance claim is submitted to receive reimbursement under Medicare?

Your Medicare Part A and B claims are submitted directly to Medicare by your providers (doctors, hospitals, labs, suppliers, etc.). Medicare takes approximately 30 days to process each claim.

Does Medicare cover copay as secondary?

Medicare will normally act as a primary payer and cover most of your costs once you're enrolled in benefits. Your other health insurance plan will then act as a secondary payer and cover any remaining costs, such as coinsurance or copayments.

How do you determine which insurance is primary and which is secondary?

Primary insurance: the insurance that pays first is your “primary” insurance, and this plan will pay up to coverage limits. You may owe cost sharing. Secondary insurance: once your primary insurance has paid its share, the remaining bill goes to your “secondary” insurance, if you have more than one health plan.

What happens after you submit your MaineCare application?

After you submit your application, you will be contacted if any additional documents or information is needed. You will then receive a written notice indicating whether you have been enrolled in the MaineCare program.

When will the new premium payment portal go live?

The Portal went live on Monday, August 31st, 2020. The payment portal provides an efficient and secure way for premium payments to be made online, instead of having to send payment by mail each month. This portal serves as another option to make these payments and is not mandatory; payments will still be accepted by mail.

What is dual eligible for medicaid?

Qualifications for Medicaid vary by state, but, generally, people who qualify for full dual eligible coverage are recipients of Supplemental Security Income (SSI). The SSI program provides cash assistance to people who are aged, blind, or disabled to help them meet basic food and housing needs.

What is dual eligible?

The term “full dual eligible” refers to individuals who are enrolled in Medicare and receive full Medicaid benefits. Individuals who receive assistance from Medicaid to pay for Medicare premiums or cost sharing* are known as “partial dual eligible.”.

What is Medicare Advantage?

Medicare Advantage plans are private insurance health plans that provide all Part A and Part B services. Many also offer prescription drug coverage and other supplemental benefits. Similar to how Medicaid works with Original Medicare, Medicaid wraps around the services provided by the Medicare Advantage plan andserves as a payer of last resort.

What is Medicaid managed care?

Medicaid managed care is similar to Medicare Advantage, in that states contract with private insurance health plans to manage and deliver the care. In some states, the Medicaid managed care plan is responsible for coordinating the Medicare and Medicaid services and payments.

When will Medicare become the main health insurance?

July 08, 2020. Most Americans understand that when they turn 65, Medicare will become their main health insurance plan. However, many Americans are less familiar with another health care program, Medicaid, and what it means if they are eligible for both Medicare and Medicaid. If you are dual eligible, Medicaid may pay for your Medicare ...

Does Medicare cover Part A and Part B?

Some Medicare beneficiaries may choose to receive their services through the Original Medicare Program. In this case, they receive the Part A and Part B services directly through a plan administered by the federal government, which pays providers on a fee-for-service (FFS) basis. In this case, Medicaid would “wrap around” Medicare coverage by paying for services not covered by Medicare or by covering premium and cost-sharing payments, depending on whether the beneficiary is a full or partial dual eligible.

Is Medicaid a payer of last resort?

Medicaid is known as the “payer of last resort.”. As a result, any health care services that a dual eligible beneficiary receives are paid first by Medicare, and then by Medicaid.

How much is the Medicaid exemption in Maine?

These exemptions are in addition to the Medicaid asset limit of $2,000 for a single individual and $3,000 for a married couple.

How much can a spouse retain for Medicaid?

For married couples, with one spouse as a Medicaid nursing home applicant or Medicaid waiver applicant, the community spouse (the non-applicant spouse) can retain up to a maximum of $130,380 (in 2021) of the couple’s joint assets, as the chart indicates above.

What is CSRA in Medicaid?

This, in Medicaid speak, is called the Community Spouse Resource Allowance (CSRA) and is intended to prevent spousal impoverishment of non-applicant spouses. As with the income allowance, the resource allowance does not apply to married couples with one spouse applying for regular Medicaid.

What is the medically needy pathway?

1) Medically Needy Pathway – This program allows seniors who meet all other Medicaid eligibility requirements, but have income over the limit, to still be eligible for Medicaid if they have high medical expenses.

What income is counted for Medicaid?

Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends.

How much is the MMMNA in 2021?

From July 2021 – June 2022, the MMMNA is $2,177.50. That said, the non-applicant spouse may be entitled to an even greater spousal allowance (income allowance), up to $3,259.50 / month, based on one’s mortgage / rent and utility costs. (This figure is effective January 2021 – December 2021).

What are some examples of Medicaid?

Examples include paying for home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expense s, and paying off debt. 2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care.

How to apply for medicaid in Maine?

Ready to apply for MaineCare? To apply for Medicaid in Maine, you should start by gathering your legal documents. For your application, you will need proof of citizenship and identity, income documentation, proof of property ownership, health insurance cards, proof of liquid assets, and other relevant documents.

What age is Mainecare eligible?

MaineCare eligible groups include: Low-income people between the ages of 21 and 64 who are not eligible for Medicare. Low-income parents or caretakers with a child under 18 in the household. Low-income kids under 21. Low-income people under 26 who aged out of the foster care system.

What is Maine Medicaid?

MaineCare (Maine Medicaid Program) MaineCare is the name for the state of Maine Medicaid program. MaineCare provides no and low-cost health insurance to low-income Maine residents.

How does MaineCare work?

Your MaineCare benefit package will depend on your age, income, and medical needs. You will automatically be assigned a benefits package based on your eligibility and your application; it can change if your income and needs change. The packages are separated into three categories:

How much does Medicare cost per month?

Most families will not have to pay anything for this coverage, but some families with higher incomes will be asked to pay anywhere from $8 to $62 per month.

Can I get Medicare if I have ALS?

You may be eligible for Medicare if you are either: Over 65, Diagnosed with ALS, Diagnosed with ESRD, or. Receiving SSDI (for at least 24 months) If you qualify for both Medicare and Medicaid, you may qualify for a Dual-Eligible Special Needs Plan (DSNP).

Apply for MaineCare

Ready to apply? Applications for MaineCare are processed by the Office for Family Independence. Learn how to apply today.

Contact MaineCare

If you have questions or need help, the Contact Us page can help you find the right person at MaineCare.

What age can you get MaineCare?

If you are over the age of 65, are blind or have another disability, MaineCare may be able to help you afford health coverage and services.

Does MaineCare pay for Medicare?

If you have Medicare , you may qualify for a Medicare Savings Plan. Depending on your income, MaineCare may pay for Part A premiums, Part B premiums, Medicare deductibles, coinsurance, and copayments.

How to check if MaineCare is covered?

To see if a service you need is covered, call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711. Make sure MaineCare covers the service you need before you get care. There are limits or special rules for most covered services.

What are some examples of services that may be covered by MaineCare?

Some examples of services that may be covered: Visits to your doctor. Medications. Behavioral health services. Inpatient and outpatient hospital visits. X-rays and labs. The services covered depends on your MaineCare eligibility category. MaineCare may not cover all services listed.

How old do you have to be to be in foster care in Maine?

Former Foster Care Children - You are under 26 years old, were in foster care in the State of Maine and were enrolled in Medicaid through the State of Maine at age 18, and are not otherwise eligible for, or enrolled in, other Medicaid coverage. If you are an adult who is age 65 and older or eligible for Medicare, ...

How to get help with quit smoking in Maine?

If your ready to quit, you can call: The Maine Tobacco Helpline at 1-800-207-1230 to get free help with your quit plan. Your doctor for help finding services and determining which products might be best for you. See the Tobacco Cessation (PDF) for more information about how we can help.

What Is MaineCare?

What Does It Cover?

Who Is Eligible?

Next Steps

• After you submit your application, you will be contacted if any additional documents or information is needed. You will then receive a written notice indicating whether you have been enrolled in the MaineCare program. Note: The Office for Family Independence is responsible for processing MaineCare applications and determining eligibility. Once enro...

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MaineCare Information For Members

Paying Premiums Online

Summary

• Medicaid in Maine is called MaineCare. Medicaid is a wide-ranging, jointly funded federal and state health care program for low-income individuals of any age. However, this page is focused on Medicaid eligibility for elderly Maine residents who are a minimum of 65 years old who require long-term care, whether that is at home, in a nursing home or i...

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