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MaineHealth CarePartners Program

CarePartners Info

What services are available?

  • Regular check-ups and care when you're sick
  • Prescription medications you can afford
  • Lab, X-ray and hospital services at no cost
  • Referrals to services and resources

How much will I have to pay?
If you become a member of CarePartners you'll pay no more than $10 for each office visit. Prescription co-payment varies from $10 to $25. Lab, X-ray and other hospital services are provided at no charge.

How do I know if I am eligible for CarePartners?
Eligibility guidelines

  • You're between 19 and 64 years old. You may be eligible if you're over age 65 and don't qualify for Medicare due to not working enough quarters during your lifetime.
  • You've lived, for at least six months, in one of the five cities where we have offices or a surrounding town, including Augusta, Belfast, Damariscotta, Portland and Waterville.
    • Greater Portland area includes Buxton, Cape Elizabeth, Cumberland, Falmouth, Freeport, Gorham, Gray, North Windham, North Yarmouth, Portland, Raymond, Scarborough, South Portland, South Windham, Standish, Steep Falls, Westbrook, Windham Center and Yarmouth.
  • You're not eligible for Medicaid or Medicare.
    • Applicants cannot be eligible for healthcare insurance through government-sponsored programs, which include, but are not limited to, MaineCare (formerly known as Medicaid), Cub Care, Medicare and Veterans Benefits.
  • You have countable assets less than $10,000 for a single adult or $12,000 for a couple/family. Many assets, like a car or a home, are excluded from countable assets. Applicants are required to provide a tax return to document most recent annual income, as well as show proof of current wages and any current unearned income. Click here to see the Federal Poverty Guidelines chart. The federal poverty guidelines are updated every year by the federal government, based on cost of living adjustments. 

How it works
CarePartners builds upon a long tradition of doctors and hospitals in Maine providing care for their patients regardless of healthcare coverage or ability to pay. CarePartners helps people get preventive care and primary care in a doctor's office with supportive services such as care management and affordable medications.

Intake coordinators verify eligibility for CarePartners and help applicants assess their eligibility for healthcare coverage such as MaineCare, Medicare, and Veterans Benefits. Care managers work with patients to link them to community resources, provide health education and help them better understand the healthcare system to become knowledgeable healthcare consumers. Pharmacy assistance technicians help patients access a comprehensive formulary of prescription medication, either for free or for a co-payment between $10 and $25.

CarePartners patients receive membership cards to get healthcare services from participating providers. Machigonne Benefits Administrator, a subsidiary of Anthem Blue Cross Blue Shield of Maine, donates membership cards and claims processing to give the program the look and feel of healthcare coverage. It also allows CarePartners to track the amount and value of services provided to its members.

Physicians, hospitals and other healthcare providers give comprehensive medically necessary healthcare, including primary care, specialist care, all inpatient and outpatient services, and diagnostic testing to CarePartners enrollees. Primary care physicians (PCPs) and nurse practitioners typically agree to be a PCP for 10 patients at any one time. Specialists typically provide up to 20 referral visits a year for program enrollees. The cost of an office visit for a CarePartners patient is $10, paid to the doctor. All other medical care is provided at no cost to the patient.

While the "average" CarePartners patient is a single female, age 43, with a household income of $16,000/year, enrollees are male and female, young and old, and come from all walks of life. CarePartners patients do tend to have significantly higher healthcare needs than the average population.

Upon enrollment, CarePartners patients report that:

  • 30% are in fair to poor health.
  • 41% have unmet prescription needs.
  • 35% are smokers.
  • 53% have a chronic or disabling condition.

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Covered Services
While CarePartners cannot guarantee the provision of every healthcare service to enrollees, the program works to maintain a network of providers that has sufficient capacity to serve the enrolled population.

Physician, Nurse Practitioner and Physician Assistant Services
Physician services include office visits for routine preventive, primary care and specialist care, as well as office-based and hospital-based surgeries and procedures. Both primary care and specialist services are available to CarePartners enrollees. Enrollees have a $10 co-pay due at time of service for office visits.

Hospital Services
Hospital services include all services associated with outpatient or inpatient visits, surgeries or procedures that are performed or ordered by participating physicians. All laboratory services, X-ray and other diagnostic testing will be available from participating hospitals. Emergency care will be provided by hospital emergency rooms in accordance with existing hospital regulations.

Home Care Services
Home care services are available as defined by Medicare and Medicaid eligibility criteria and authorized services. Home care services will be provided by home care agencies operated by participating hospitals.

Prescriptions
Prescriptions will be available for a co-payment of $10-$25:
$10 for generic formulary medications
$15 for brand-name formulary medications
$25 for nonformulary medications

Care Management
Every CarePartners enrollee is assigned a care manager. The role of the care manager is to assist enrollees with access to medical and nonmedical services and coordinate services as needed; to advocate for the enrollee; to provide health education for the enrollee; and to teach the enrollee to be an informed healthcare consumer. Persons who need assistance with accessing community or social services are provided with the appropriate referrals. The care manager works with enrollees to identify any special needs before they become a problem.

Services for noneligible callers
CarePartners staff provide resource and referral sources for people who call in need of services but who do not meet our guidelines for program enrollment.

Information on other programs
MedAccess: Offers help with prescription assistance MedAccess provides help, advocacy and follow-through for anyone with prescription medicines. We will show you ways ANYONE can save money on medicines. MedAccess completes patient assistance program applications for all Mainers in need of assistance. We complete applications for federal, state and local programs as well as helping you find out what pharmacy has your drugs at the best price. We work with you and your medical providers to gather all necessary information and we complete forms for you.

Referral Sources
It's often difficult for patients to understand the maze of services available to them. Many doctors do not have time to provide a comprehensive resource and referral service, but CarePartners does. We maintain a database of referral resources such as housing assistance, job training and daycare agencies. Resource and referral services are available to any person who is enrolled or who contacts our offices.

History
In 1999, MaineHealth formed a steering committee to plan and submit a grant proposal to the Robert Wood Johnson Foundation. The grant program, "Communities in Charge: Delivering and Financing Care to the Uninsured," challenged communities across the nation to develop locally based solutions to improve access to healthcare for persons without healthcare coverage. Three Maine counties were identified as sites for the demonstration project: Cumberland, Kennebec and Lincoln counties. Hospitals and providers in each county agreed to participate in the program, and Anthem Blue Cross Blue Shield of Maine agreed to donate administrative services. The result was CarePartners, a program to enhance and improve the delivery of uncompensated care. This model was chosen in response to the predominance of private-sector providers in Maine who were already providing a significant amount of uncompensated care, and because it could make an immediate difference in improving the quality and scope of services for the uninsured. 

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CarePartners is made possible by the commitment of participating providers in the communities we serve. The program is administered by Maine Medical Center in Portland, MaineGeneral Medical Center in Augusta and Waterville, Lincoln County Healthcare in Damariscotta and Waldo County Healthcare in Belfast. Additional participating hospitals include Mercy Hospital in Portland, Inland Hospital in Waterville and Spring Harbor Hospital in Portland. Financial and technical assistance is provided to all sites by MaineHealth.

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110 Free Street | Portland, Maine 04101 | (207) 661-7001