Membership & Eligibility
Plan Eligibility Information
Eligibility information for Martin's Point Generations Advantage and the US Family Health Plan.
Generations Advantage Member Eligibility Requirements
Members must meet ALL of the following criteria:
- Be enrolled in Medicare Part A and Part B
- Reside in our service area, which includes all of Maine and New Hampshire
- Enroll during an eligible Medicare enrollment period
US Family Health Plan Member Eligibility Requirements
Members must meet ONE of the following criteria:
- Be an active-duty family member, including a spouse or unmarried dependent (until the 21st birthday, or, if a full-time student, the 26th birthday)
- Be a military retiree from the active/reserve component, a spouse or unmarried dependent (until the 21st birthday, or, if a full- time student, the 26th birthday)
- Military retirees who were enrolled in the plan on or before 9/30/12 are allowed to stay enrolled after their 65th birthday as long as they maintain continuous enrollment. If a member leaves the plan and returns, he or she loses "grandfathered" status.
- Military retirees who became a member of the plan on or after 10/1/2012 will be automatically dis-enrolled when they turn 65 and moved to TRICARE for Life (TFL).
- Be a family member of a deceased active-duty military member or retiree
Note: Acceptance for enrollment is dependent on confirmation of DEERS eligibility (Defense Enrollment Eligibility Reporting System) and payment of applicable enrollment fee or submission of a copy of your Medicare Part B card.
Extended Care Health Option (ECHO)
The Extended Care Health Option (ECHO) supplements the basic TRICARE program by providing financial assistance for an integrated set of services and supplies.
To use ECHO, qualified beneficiaries must be enrolled in the Exceptional Family Member Program (EFMP) as provided by the sponsor's branch of service and register through ECHO case managers in each TRICARE region.
ECHO is offered to the following beneficiaries who are diagnosed with moderate or severe mental retardation, a serious physical disability, or an extraordinary physical or psychological condition:
- Active duty family members
- Family members of activated National Guard/Reserve members
- Family members who are covered under the Transitional Assistance Management Program
- Children or spouses of former service members who are victims of abuse and qualify for the Transitional Compensation Program
- Family members of deceased active duty sponsors while they are considered "transitional survivors."
Children may remain eligible for ECHO beyond the usual age limits in certain circumstances. If you believe a qualifying condition exists, talk to a case manager or with your regional contractor to determine eligibility for ECHO benefits.
For more information, please visit: http://www.tricare.mil/echo.
Confirming Member Eligibility
Providers are encouraged to check member eligibility. Eligibility information may also be obtained from the Provider Inquiry Department at 1-888-732-7364.
Verification of eligibility is not a guarantee of claims payment.