medicare mainecare what if lscw is not available and the agency does not have medicare

What happens if you get a prescription without MaineCare approval?

If you 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: For questions about a PA for a prescription drug, call the Pharmacy Help Desk at Pharmacy Help Desk at 1-866-796-2463.

Can an LCSW opt out of Medicare?

LCSWs must, however, opt-out if they want to work with Medicare beneficiaries who pay the LCSW privately. This requires a signed contract with each beneficiary the LCSW treats that confirms neither the LCSW or the beneficiary will submit any claims to Medicare for the psychotherapy services that provided.

What services are covered by MaineCare?

In addition to preventive and general services that MaineCare covers for all adults, you may have additional services covered, depending on your age or disability and what your health care providers determine that you need. See the MaineCare Member Handbook (PDF) for details about services that may be covered.

Do LCSWs get paid through Medicare?

If an LCSW wishes to be paid through Medicare, the LCSW must opt-in as a Medicare provider. All LCSWs are expected to accept assignment of any Medicare beneficiary who needs mental health treatment unless there is a reason that the beneficiary needs to be referred.

Is MaineCare considered Medicare?

In Maine, Medicaid is now called “MaineCare.” The situation is particularly confusing because the two programs have almost identical names. The distinguishing features of the two programs may help you understand the difference. Medicare is an entitlement program, while Medicaid is a welfare program.

Is MaineCare the same as Medicaid?

In Maine, Medicaid is called MaineCare. Medicaid is a health insurance program that provides insurance to people who have limited income and assets. Medicaid is run by the federal and state governments. Eligibility for MaineCare is based on age and income.

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.

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

Can you have MaineCare and another insurance?

You can have both private insurance and most kinds of MaineCare if you choose. But keep in mind, If your private insurance is through the Health Insurance Marketplace, you cannot get Marketplace discounts if you are eligible for 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.

Can MaineCare take my house?

The Department of Health and Human Services (DHHS) can pursue recovery against not just the probate estate but against any legal interest the MaineCare recipient held at the time of death. Currently, the only exception is a joint tenancy interest in real estate.

Do assets count for MaineCare?

Assets: Assets are only looked at for people who are 65 and older, or who have Medicare. Many assets will not count against you. You can own a home, land that the home is on, cars and many other assets and still get MaineCare coverage. Remember: Assets do not count for most people.

At what age do you lose MaineCare?

MaineCare provides free or low-cost health insurance, other health benefits, and assistance to kids under age 21 who meet income guidelines or disability criteria.

What are the qualifications to get MaineCare?

Specifically, MaineCare can help eligible Maine resident with their health care payments....You must also be one of the following:Pregnant, or.Be responsible for a child 18 years of age or younger, or.Blind, or.Have a disability or a family member in your household with a disability, or.Be 65 years of age or older.

Who qualifies for MaineCare expansion?

Who is eligible for Expansion? People age 21 to 64, who are not eligible for Medicare, with income less than the limit shown for their family size in this chart are eligible. There are no asset limits.

Does Maine have free healthcare?

MaineCare (Medicaid) MaineCare provides free and low-cost health insurance and other help affording health care for people who meet certain requirements, such as income, age, or medical condition. Learn more about MaineCare.

What does LCSW mean in Medicare?

If an LCSW decides to opt-in, the LCSW accepts “assignment” of all Medicare cases who seek treatment. If an LCSW chooses to refer a beneficiary who seeks treatment, a referral and reason for the referral should be documented. The Medicare terminology for this category is participating (“par”). There is another category for other providers, non-participating (“non-par”) which does not apply to LCSWs.

What is a nurse practitioner in Medicare?

Nurse practitioner. Physician assistant. Medicare only covers these visits, often called counseling or therapy , when they’re provided by a health care provider who accepts ">assignment [all LCSWs.] Part B covers outpatient mental health services, including services that are usually provided outside a hospital (like in a clinic, doctor’s office, ...

Does Medicare pay for mental health services?

Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via telehealth. This includes certain mental health services (e.g., individual psychotherapy and pharmacologic management, behavior assessment and intervention, psychiatric diagnostic interview exam, annual depression screening, psychoanalysis, family psychotherapy) as well as a number of specific behavioral health and substance abuse disorder services (e.g., smoking cessation services, alcohol and/or substance abuse structured assessment and intervention services, annual alcohol misuse screening, brief face-to-face behavioral counseling for alcohol misuse)

Do LCSWs have to opt out of Medicare?

LCSWs do not need to opt-in or opt-out of Medicare. If an LCSW wishes to be paid through Medicare, the LCSW must opt-in as a Medicare provider. All LCSWs are expected to accept assignment of any Medicare beneficiary who needs mental health treatment unless there is a reason that the beneficiary needs to be referred.

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 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 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 find out if Mainecare is covered?

How do I find out if a service is covered? Talk with your health care provider or call MaineCare Member Services at 1-800-977-6740. TTY users, dial 711 (Maine Relay).

How to contact MaineCare for ambulance?

Call MaineCare Member Services at 1-800-977-6740 for questions about all other services.

What is the number to call MaineCare for PA?

Call MaineCare Member Services at 1-800-977-6740 for questions about all other services.

Do you have to pay for a portion of your care?

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

What Is MaineCare?

What Does It Cover?

Who Is Eligible?

• You may be eligible for MaineCare if your monthly income (before you pay taxes) is up to:
  *Add 1 to household size for each baby expected. You may still qualify even if you are over the income limits. Please refer to the eligibility guidelines (PDF)for detailed information about income limits for different MaineCare coverage categories. Even if you do not qualify for MaineCare, yo…

See more on maine.gov

Next Steps

MaineCare Information For Members

Paying Premiums Online