MaineCare and MaineCare Managed Care and Medicaid
We bill MaineCare for inpatient and outpatient services, if you provide proof of coverage (i.e. a MaineCare card) at the time of service.
MaineCare may require prior approval for services by patients and/or their primary care providers (PCP's) before services can be covered. This is called pre-authorization. If you have MaineCare Managed Care, you need to contact your PCP for pre-authorization.
MaineCare may have a "spend down," or "co-pay."
- A spend down is a semi-annual expense that you must pay before your MaineCare benefits can begin. This amount can vary depending on income, assets, or where the service is delivered (i.e. your doctor’s office vs. a large hospital).
- A co-pay is a set amount paid each visit based on the service or a dollar amount.