Turning 65: You Have an Important Decision to Make.

As a member of the US Family Health Plan about to turn 65, there are some important things you need to know about your health care coverage. We are here to help you navigate them.

Can I continue as a US Family Health Plan member when I turn 65?

It depends on when you enrolled in the US Family Health Plan.

If you enrolled in the US Family Health Plan at Martin’s Point on or after October 1, 2012 (Non-Grandfathered Status), you will be disenrolled from the US Family Health Plan. Your disenrollment will be effective on the last day of the month prior to the month you turn 65. TRICARE For Life (TFL) will be your TRICARE® option. You must enroll in Medicare Part B to maintain your TRICARE eligibility. To be covered by TFL, you must enroll in Medicare Part A and Part B (Original Medicare). 

If you enrolled in the US Family Health Plan at Martin’s Point before October 1, 2012 (Grandfathered Status), you have the option of staying enrolled with the US Family Health Plan or disenrolling and using TRICARE For Life (TFL).

If you are unsure whether you are grandfathered or non-grandfathered, please contact your local Health Benefits Specialist from the list below.

 

Do I need to enroll in Medicare Part B?

If you are continuing your membership with the US Family Health Plan, you are not required to enroll in Medicare Part B. However, we strongly recommend you consider enrolling in Medicare Part B as soon as you are eligible for the following reasons:

  1. Delay in Accessing Medicare Part B and TRICARE Benefits: If you ever do disenroll from the US Family Health Plan, you will not be able to access other TRICARE benefits until you are enrolled in Medicare Part B. You will only be able to enroll in Medicare Part B during the General Enrollment Period (January through March each year), with coverage starting on July 1 of the year you sign up. You could be left without medical insurance coverage for an extended period of time should you decide to disenroll from the US Family Health Plan at a later date.

  2. Penalty in Medicare Part B Premiums: If you wait to enroll until after you’re first eligible, your Medicare Part B premium will increase by 10% for each 12-month period that you were originally eligible to enroll.

  3. Limited Coverage for Long-Term-Care Facility: Long- term-care facility residents are not eligible for the US Family Health Plan in most cases. Without Medicare Part B, your coverage will be limited to Medicare Part A and you will be responsible for the costs of medical services provided by physicians, labs, etc.

How do the US Family Health Plan and TRICARE for Life (TFL) compare?

  Martin’s Point US Family Health Plan  TRICARE For Life (TFL)
Who administers my health plan? Martin’s Point Health Care Portland, Maine

Medicare

and

Wisconsin Physician Services (WPS) Madison, Wisconsin

Who covers my medical expenses?

Martin’s Point US Family Health Plan pays 100%

*for services covered by the US Family Health Plan

Medicare pays 80%

TRICARE pays 20%

*for services covered by both Medicare and TRICARE

What are my costs for care?
  • Medicare Part B premium
  • Copayments for prescriptions (same as you currently pay)

*Martin’s Point waives your US Family Health Plan enrollment fees and copayments, other than prescription copayments

  • Medicare Part B premium
  • Copayments for prescriptions (same as you currently pay)
Where do I get my prescriptions?

Retail: US Family Health Plan network pharmacy (such as CVS, Rite Aid, Wegmans, Walgreens, Walmart, etc.)

Maintenance: Martin’s Point mail-order pharmacy

Retail: TRICARE network pharmacy
Maintenance: Express Scripts mail-order pharmacy

Have questions? Contact a Health Benefits Specialist from your area. 

Name Area Phone Address
Lori Theriault Serving: Northern and Down East Maine.

Office: 207-498-7020 
Mobile: 207-404-1000
Email: [email protected]

25 Sweden Street, Suite B
Caribou, ME 04736
Kimberly MacDonald Serving: Central, Southern, and Western Maine. Office: 207-253-6190
Email: [email protected]
891 Washington Avenue
Portland, ME 04103
Denise Luck Serving:  The Claremont and Lebanon areas of New Hampshire, Northern and Central Vermont and Northeastern New York.

Office:866-740-2623 
Mobile: 518-320-6842
Email: [email protected]

905 Roosevelt Highway,
Suite 250A
Colchester, VT 05446
John Reed Serving:  The State of New Hampshire, excluding the Claremont and Lebanon areas. Office: 603-430-5057 
Mobile: 603-651-7112
Email:  [email protected]
61 Corporate Drive
Portsmouth, NH 03801
Keith Prairie Serving: Southern Vermont and Eastern Upstate New York, including the Capital District Office: 518-588-4441 
Mobile: 518-588-4441
Email: [email protected]

800 Route 146
Bld 400 Suite 476
Clifton Park, NY 12065
Tim Dunnigan  Serving: Central New York and the Southern Tier and the Bradford and Susquehanna Counties and the Borough of Sayre in Pennsylvania. Office: 866-876-7377
Mobile: 315 263-1406
Email: [email protected]
101 Old Cove Road, Suite 112
Liverpool, NY 13090
Ralf Sosnowski  Serving:  Western New York and the Erie, PA area. Office: 716-839-0285
Mobile: 585-732-0417
Email: [email protected]
141 Sully’s Trail, Suite 4,
Pittsford, NY 14534
Melissa Strader Serving:  Fort Drum and the Watertown, NY area. Office: 315-785-5467
Mobile: 518-339-8787
Email: [email protected]
26121 US Route 11, Suite 3
Evans Mills, NY 13637