Written by a parent, not a doctor. Nothing here is medical advice.

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Maine program

Help with a private insurance premium (PHIP)

Maine can pay your share of a qualifying private health or dental premium when someone has full MaineCare.

What it is

Maine can pay your share of a qualifying private health or dental premium when someone has full MaineCare.

A second insurance card can help with bills while the work-plan premium still strains the budget. PHIP reviews help with that premium. It is a separate application and excludes individual CoverME.gov plans.

Eligibility rules
  • Someone in your Maine household must be eligible for full MaineCare.
  • Your family must have access to qualifying work or private insurance. Individual CoverME.gov coverage is excluded.
  • PHIP requires full MaineCare and a qualifying private plan that MaineCare finds cost-effective. A work plan or MaineCare award alone does not approve payments. You can ask about coverage offered through work before enrolling. The PHIP unit confirms the covered category, required enrollment and approved premium in writing.
What you get
  • Monthly help with your share of a qualifying health and dental premium.
  • The PHIP unit confirms payment timing and the months covered.
What the help includes
  • The PHIP unit reviews the household’s share of the premium. Approval does not itself change either plan’s treatment rules.
If you decide to apply
  1. Ask the DHHS PHIP unit for the premium application.
  2. Have the insurance card and written premium costs from your employer or insurer ready.

DHHS PHIP: 1-800-977-6740; PHIP.DHHS@maine.gov · Official page ↗

After you ask
  • The PHIP unit confirms the decision timeline, approved premium share, whose coverage it includes, first payable month and payment method. It also confirms whether earlier months can be paid. Employer contribution records and pay-stub deductions help show your share.
Good to know

PHIP does not enroll you in private insurance. Its written decision explains the approved amount and which months it will pay.

Other details
  • Your employer’s benefits office can show whether removing a child would actually reduce a family premium.

Federal background: Medicaid premium assistance.

Official sources
Ask your social worker

“Could PHIP help with our private premium if someone qualifies for full MaineCare? What are the benefits and drawbacks, and could you help with the application if it fits?”

Why I’m asking: I want to understand whether keeping private coverage could cost us less.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Discuss available private coverage with PHIP and provide premium/contribution records. The unit confirms required enrollment and the approved amount.

Your social worker

The employer's benefits office confirms what the premium costs you.

The care team

Records and letters when the application asks for them.

Who decides
The PHIP unit at the Department of Health and Human Services.
Ask HR
“What does my share of the health and dental premium cost each month, and can I have that in writing for the state?”

How to apply

First step: Email the PHIP application to PHIP.DHHS@maine.gov or call 1-800-977-6740.

  1. Send the PHIP application the week MaineCare is approved.
  2. Attach the insurance card and proof of what the premium costs you.
  3. Send a direct deposit form, or the payment arrives as a cheque.

Official application / program page ↗

Where it starts: Complete the PHIP application and email it to PHIP.DHHS@maine.gov, or call 1-800-977-6740.

What to gather

  • The insurance card
  • A pay stub or letter showing your share of the premium
  • A direct deposit form

How long: The PHIP unit confirms its decision timeline and first payable month.

What a yes looks like

A monthly cheque or deposit covering your share of the premium.

What a no looks like, and the next move

Ask whether the answer turned on the cost comparison or on who has full MaineCare.

Watch out

  • It does not enrol you. You sign up for the work plan yourself.
  • The PHIP unit confirms the first payable month and whether any earlier months qualify.
  • It will not pay for an individual CoverME.gov plan.

Dates that change this

2026-08-01: The only cost-effectiveness wording we could read sits in an August 2026 proposal built on a 2022 baseline. The current adopted text was not recovered, so the test is described rather than quoted as a rule. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Premium help after a full MaineCare and qualifying private-plan cost-effectiveness review.

Covers: Payment of the household share of a work or private health and dental premium

Legal protection: The work plan stays in place, so the oncology network stays in place

What it costs the family: None.

The eligibility facts, as published

Coverage
someone in the household is eligible for the full MaineCare benefit
Insurance status condition
the family is eligible for work-based or private insurance; an individual CoverME.gov plan is excluded
Residency
Maine
Note
The adopted rule requires cost-effectiveness. The PHIP unit confirms enrollment, covered category and any fee-for-service restriction; proposed chapter text is not adopted authority.

Decisions this site cannot make: Department cost-effectiveness decision

Expect friction on: You must enrol in the work plan yourself

The trap: PHIP does not enroll the family in private insurance. The unit checks cost-effectiveness and confirms required enrollment, approved premium, timing and any earlier months in writing.

Where I read this

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