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If you or your children need health insurance, MaineCare may be the answer. Apply now. Don’t wait. Some links require a Adobe PDF viewer (free).

Who is eligible for this insurance?

Note: Even if your family income is above the amount on the chart, you are encouraged to apply. Certain expenses may be taken out of your income.

How much does it cost?

• There is no cost for most families. Some families must pay a small monthly premium for their children’s coverage. Premiums are between $8 and $64.00 a month. Some parents must pay a small co-payment for services.

How do I apply?

• For children, teens or pregnant women, fill in boxes 1-10 only on the application. Sign and date (box 12).
• For parents applying for themselves along with their children and teens, fill in box 11, plus boxes 1-10 on the attached application. Sign and date (box 12).
• Mail or drop off the application to the Department of Health and Human Services Office nearest you.

How can I get more information or help filling out an application?

www.maine.gov/dhhs/DHSaddresses.htm

Information to help you fill out the application for MaineCare.

Note: If applying for children and teens age 18 and under, or if you are a pregnant woman, you need to fill in boxes 1-10 only.

1. Person Filling Out the Application

Provide information about the person filling out the application. This is usually the parent or guardian of the children listed under Household Members (#3 below). If you are applying for yourself because you are pregnant or you are under age 19 and living on your own, your name is listed here. Listing Social Security numbers will help avoid delays in processing. They are not required unless you are applying for yourself

2. Mailing Address

This is the address where you get your mail. Write the address where you live if it is different than your mailing address.

3. Household Members

List everyone who lives in the household including the children for whom you are applying. This tells us what income to count and who may be covered. If a household member is applying due to pregnancy, special rules apply which may help get coverage.

4. Household Earnings

Attach paystubs or photocopies of paystubs for the last 4 weeks. We need proof of income before we can process the application. Gross weekly wages are multiplied by 4.3 to arrive at gross monthly wages. Gross monthly wages are what determine eligibility.

5. Self-Employment

Attach a copy of your most recent tax return including all schedules. If your business is incorporated, include the corporate income tax return as well. If you have not filed a tax return, we will send you forms to complete.

6. Unearned Income

Examples are: Unemployment Compensation, Workers Compensation, Social Security, Supplemental Security Income (SSI), VA, interest income and child support received. Attach a copy of the check, check stub or award letter from the income source. You do not need to do this for Social Security or SSI.

7. Child Care Expenses

Depending on your income, these expenses are deductions from earnings when figuring eligibility. The maximum monthly deduction is $200 per child under age 2 and $175 per child age 2 and over.

8. Child Support (Paid Out)

This is the monthly amount paid to comply with a court or child support order. Depending on your income, it is used as a deduction when figuring MaineCare eligibility. Any child support received as income is not listed here. It should be listed as Unearned Income (#6 above).

9. Health Insurance

Most children with health insurance are eligible for MaineCare. Some may not be. If this applies to you, the Department of Health and Human Services will give you more information.

10. Special Conditions

Special rules may apply for children with a disabling condition. This can help them to get coverage.

There is no premium for American Indian children who are members of a Federally recognized tribe or for children who are Alaskan Natives.

In some cases medical expenses for a 3 month period prior to the month of application may be covered.

Children or pregnant woman do not need to be citizens to be covered by MaineCare. Some non-citizens who are here temporarily, for example, students or visitors, can get coverage for payment of emergency services only.

If you are a parent living with your children age 18 and under, and you want to apply for yourself along with your children, fill in box 11 also.

List any assets owned by you, your children or your spouse who lives with you. Include assets owned jointly or together with anyone else.

• Cashable Assets—This includes savings and checking accounts, certificates of deposit (CDs), credit union shares, stocks, bonds, annuities, individuals retirement accounts (IRAs), Keogh, or profit sharing.
• Real Estate—This includes any property you own.
• Vehicles—This includes any motorized vehicle such as a car, truck, boat, camper, motorcycle, snowmobile, or ATV.