Health Care Plans and Programs
TRICARE: Transitioning From TRICARE
Eligible separating military members and their family may participate in the premium-free TRICARE Transition Assistance Management Program (TAMP) for the first 180 days after discharge.
After the Tricare TAMP transition health care benefit expires, eligible individuals may apply for extended temporary, transitional medical coverage under the Continued Health Care Benefit Program (CHCBP) offered through Humana Military. CHCBP, available for 18 to 36 months depending on the circumstances, serves as a bridge between military health benefits and civilian health plans.
These coverage plans require premium payments, deductibles, co-pays, and possibly other out-of-pocket cost shares.
TRICARE: Continuing With TRICARE Before 65
The following information is a very brief, not all-inclusive, overview of TRICARE and the US Family Health Plan. Because health care insurance coverages are detailed and impacted by individual circumstances, it is very important to research plans and communicate with health insurance and health care program customer service representatives to ensure you clearly understand their current coverages and your possible out-of-pocket cost shares. Contact and resource links are posted at the end of this section.
TRICARE offers different health plans, dental plans, and special programs to meet unique health care needs. Plan availability depends on who you are and where you live.
In general but not exclusively, TRICARE-eligible beneficiaries may include active duty military, retired military, Reserve, Guard and their families, survivors, former spouses, Medal of Honor recipients, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS).
TRICARE offers several different health plans.
All plans meet or exceed the requirements for minimum essential coverage required by The Affordable Care Act. If you don't have minimum essential coverage, you may have to pay a fee for each month you aren't covered.
Plan availability depends on your circumstances (veteran, spouse, duty status, etc.) and where you live. Relocating to another state may also mean changing TRICARE plans, which means you may or may not have the same care options and cost shares.
The US Family Health Plan (TRICARE Prime) is available throughout the state of Maine.
Martin's Point Health Care Centers in Maine are open to US Familty Health Plan members as well as members of other insurance plans.
Martin's Point-contracted Primary Care Providers (PCPs) belong to their statewide network of participating doctors. If you cannot find a particular physician, you can call Member Services noted below.
Martin's Point Member Services: 888-674-8734
External Website: TRICARE
Women Veteran Health Care Program (Maine Department of Veterans Affairs)
The Maine Department of Veterans Affairs ( Maine VA) women veterans' health care and benefits contacts will help you navigate the VA health care enrollment application and disabilities compensation and benefits claim processes.
If you file a disabilities compensation and benefits claim, there are also other VA-accredited Veteran Service Organization (VSO) and state representatives, attorneys, and claims agents in Maine who can assist you.
Links to connect you with contacts and forms are listed below.
What Application Do You Submit for VA Health Care?
You must complete a VA Form 10-10EZ, Application for Health Benefits. The VA determines your eligibility for health care services, and if eligible, places you in one of the health care "Priority Groups" that determined by law. It takes very little time to complete the application.
Your eligibility for care is impacted by many factors. Some, but not all, of these considerations are listed in the last two sections below. There is no "one size fits all" VA health care eligibility criteria. While you can learn about the VA from other veterans, remember that your circumstances are likely different and laws change, and therefore, it is very important that you file an application.
Who Can Help You Apply for VA Health Care?
Women Veterans (Health) Program Manager (WVPM)
Every VA Medical Center is expected to have a Veterans Health Administration (VHA) "Women Veterans Program Manager (WVPM)." The WVPM coordinates women veterans' primary, gender-specific, specialty, and mental health care.
Contact your Maine VHA Wome Veterans Program Manager (WVPM):
Name: Ms. LaRhonda Harris
Phone: 207-623-8411, Ext. 4017
Online: Go to the Maine VA directory/locator, click on "VA Maine Healthcare System-Togus," move over to the left-hand menu and click "Health Care Services," and then, "Women Veterans." Your "Women Veterans Program Manager" contact information is listed on this page.
Military Sexual Trauma (MST) Coordinator
Every VA Medical Center is expected to have a Veterans Health Administration "Military Sexual Trauma Coordinator." If you are a military sexual assault/trauma survivor, consider contacting your Military Sexual Trauma (MST) Coordinator. The MST Coordinator can assist you with mental health care, the "VA Form 10-10EZ, Application for Health Benefits," and initiating the disabilities compensation claim process.
President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146) ("Choice Act"). By law, VA provides all "counseling and care and services needed to overcome psychological trauma, which in the judgment of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment" which occurred while the veteran was serving on active duty, active duty for training, and inactive duty training status. Care is now available to female and male active duty, Reserves, and Guard survivors.
Care for Military Sexual Assault/Trauma (MSA/MST)-related condidtions is free to eligible veterans who experienced MSA/MST.
Contact your Maine VHA Military Sexual Trauma (MST) Coordinator:
Name: Ms. Katherine Russin
Phone: 877-421-8263, x4296 or 207-623-8411, x4296
Online: Go to the Maine VA directory/locator, click on "VA Maine Healthcare System-Togus," and the Medical Center's central phone number should be listed on the Medical Center's home page. Ask to be connected with your "Military Sexual Trauma Coordinator."
Your Women Veterans Program Manager can also help coordinate an appointment with an MST Coordinator.
Women Veteran (Benefits) Coordinator (WVC)
Every VA Veterans Benefits Administration (VBA) Regional Benefit Office is expected to have a VBA "Women Veteran Coordinator (WVC)." The WVC helps you submit a VA disabilities compensation claim, including claims for Military Sexual Assault/Trauma (MSA/MST). If your claim results in service-connected disability ratings, you will also need to complete a "VA Form 10-10EZ, Application for Health Benefits" if you haven't already done so.
Meet face-to-face, if possible, with your VBA Regional Benefit Office Woman Veteran Coordinator or with a VA-accredited Veteran Service Organization (VSO) representative, attorney, or claim agent to ensure you accurately complete the claim form, including the online form. The process can also be accomplished by phone and online. See more information below about VA-accredited VSOs, attorneys, and claim agents below.
Contact your Maine VBA Regional Benefit Office Women Veteran Coordinator (WVC):
Name: Changes frequently and not posted on VA web site.
Phone: 877-421-8263, x4499 or 207-623-8411, x4499
Online: Go to the Maine VA directory/locator, click on "VA Maine Healthcare System-Togus," and the Medical Center's central phone number should be listed on the Medical Center's home page. Ask to be connected with your "Regional Benefit Office Women Veteran Coordinator."
Every VA Veterans Benefits Administration (VBA) Regional Benefit Office is expected to have a VBA "Military Sexual Trauma (MST) Claims Coordinator. The MST Claims Coordinator helps you submit a VA disabilities compensation claim for Military Sexual Trauma (MST). If your claim results in service-connected disability ratings, you will also need to complete a "VA Form 10-10EZ, Application for Health Benefits" if you haven't already done so.
Contact your Maine VBA Regional Benefit Office Military Sexual Trauma Claims Coordinator (MST Claims Coordinator):
Name: See names listed under "Maine" on VA MST Coordinator roster.
Phone: 877-421-8263 or 207-623-8411
E-Mail: You can communicate directly via e-mail with the Regional Benefit Office MST Claims Coordinator and/or specifically request a face-to-face meeting to help you complete your MST claim.
Online: Go to the Maine VA directory/locator, click on "VA Maine Healthcare System-Togus," and the Medical Center's central phone number should be listed on the Medical Center's home page. Ask to be connected with your "Regional Benefit Office Military Sexual Trauma Claims Coordinator."
Women Veterans Call Center
Call the VA's Women Veterans Call Center: Call 1-855-VA-WOMEN (1-855-829-6636) during the Call Center's hours of operation. The Call Center associates will do their best to work all your VA health care and other benefit questions and connect you with your Maine VA providers, services, and programs.
Maine Veterans' Services Officers (VSOs)
The State of Maine has several field offices and itinerant service locations providing information and assistance with benefits available through state, federal, and local municipalities. The state veterans' service officers (VSOs) can also assist you with developing a VA compensation and benefits claim. You must submit a VA Form 21-22 and VA Form 21-22A requesting VA-accredited representation, which the VSOs will provide. Consult with your VA-accredited representative before you send in a claim, including the online form. The expectation is that they know how to better "speak VA."
VA-Accredited Chartered Veteran Service Organization (VSO) Representatives/Attorneys/Claims Agents
If you decide to have a veteran service representative from a chartered organization like Veterans of Foreign Wars, The American Legion, American Veterans, Paralyzed Veterans of America and others or an accredited attorney or a claims agent assist you with developing a VA compensation and benefits claim, you must submit a VA Form 21-22 and VA Form 21-22A requesting VA-accredited representation. The representatives will provide these forms. Consult with your VA-accredited representative before you send in a claim, including the online form. The expectation is that they know how to better "speak VA."
What to Do If You Lose Contact With Your VA-Accredited Veteran Service Organization (VSO) Representative/Attorney/Claims Agent
Contact your Maine Veterans Benefits Administration Regional Benefit Office direct should you lose contact with your representative:
Phone: 877-421-8263 or 207-623-8411 (Ask for "Regional Benefit Office Women Veteran Coordinator")
E-Mail: You can communicate directly via e-mail with the "Maine Regional Benefit Office MST Claims Coordinator" to help you if you filed a Military Sexual Trauma claim.
Health Care Enrollment/Renewal Applications &
Disability Claims Forms
What Impacts Your Eligibility for VA Health Care?
Listed below are some, but not all, of the factors that may impact eligibility. Some, all, or none of the considerations in this section and the next may be relevant to you. Eligibility criteria changes as laws are passed. When you apply for VA care, the legal eligibility requirements at that time are what will be considered.
Eligibility for VA services and benefits is based on your one-of-a-kind set of circumstances.
Minimum time on active duty requirements. VA encourages all veterans to apply as there are exceptions to these requirements. They are too numerous to list and may change with new laws.
Separation under any condition other than dishonorable.
Your eligibility can change from year to year because your life circumstances change. You can reapply.
Once enrolled in the VA health care program, you can cancel your VA health care enrollment and reapply any time, but the reenrollment decision is based on the VA eligibility rules at the time. It could mean you may not be able to reenroll.
VA service- and nonservice-connected disability ratings define what VA care you receive.
Income may, but not necessarily, be considered.
Changes with your health care insurance and entitlement (e.g. Medicare) be it private or public insurance. VA health care, by law, is not an insurance plan and is prohibited from billing some insurance plans. To avoid out-of-pocket cost shares for care, consult with the VA Fee Services office to ensure you understand what care is or is not covered and that you secure pre-authorization as required.
Age can be a factor. If you participate in Medicare at 65 years of age and older, VA is generally prohibited from billing Medicare, but can bill Medicare supplemental health insurance for covered non-service connected care. To avoid out-of-pocket cost shares for care, consult with the VA Fee Services office to ensure you understand what care is or is not covered and that you secure pre-authorization as required.
Don't self-eliminate...it takes little time to apply. File an "VA Form 10-10EZ, Application for Health Benefits" and let the VA determine your eligibility. Learn what VA care you may incur out-of-pocket cost shares for.
Who is Considered for VA Health Care?
Veterans with varying lengths of active duty service time and varying active duty-related experiences, some but not all of which are listed below.
Former members of the Reserves or National Guard who were called to active duty by a federal order and completed the full period for which they were called or ordered to active duty.
Combat and non-combat veterans. One does not take away from the other. The VA's budget is based on how many veterans are using (not just enrolled) in their services and benefits programs.
Certain veterans may be afforded "enhanced eligibility status." See extensive list for specifics.
Veterans with service-connected, nonservice-connected, and no disabilities, and in some cases their families and caregivers, seek available assistance.
Veterans of all ages.
Veterans with overseas, stateside, and overseas and stateside active duty tours of duty use the VA.
Veterans with VA-recognized presumptive illnesses, diseases and/or conditions like ALS (Lou Gehrig's disease) or defined Agent Orange- and/or Camp Lejeune contaminated water-related conditions. See the VA "Environmental Health Registry" for a current list of recognized environmental hazard exposures.
Veterans below VA's National Income or Geographical-Adjusted Thresholds and/or receiving a VA pension.
Veterans who are employed and unemployed.
Veterans with both public and private insurances. Before using VA care, validate what care VA covers based on your particular circumstances, what care your insurance will cover, and what care you will have to pay out of pocket (cost share).
Veterans with one or more of the criteria listed above, and possibly other criteria not listed here. Legislation can change the criteria every year just as your personal circumstances change.
Job-based Health Care Plans
A job-based health care plan could be health care coverage from a military veteran's employer or a family member's employer. Employers offering health care insurance may pay part or all of the insurance premiums. As with all insurance plans, it's important to know all possible out-of-pocket cost shares.
Even with job-based health care plans, you can explore other "Marketplace" health care plans.
Enroll207: Maine's Health Care Insurance Marketplace
The Maine Health Access Foundation (MEHAF) sponsors Maine's "Enroll207" health care insurance marketplace site to help Maine individuals and families enroll in an affordable health care insurance plan. They offer a 4-step process, cost calculators, links to "certified assisters" and "insurance brokers," and other booklet and video resources.
Small business owners can also access information which will help them determine employee insurance obligations if any, who to contact in Maine about insurance plans, tax credits, and other tips.
External Website: Enroll207
Public, Private, and Employer Plans for the Unemployed/Uninsured
To learn about health plans and medical insurance coverage and benefits programs for the unemployed and/or uninsured, visit these links:
COBRA (Consolidated Omnibus Budget Reconciliation Act)
When you lose job-based insurance, you may be offered COBRA continuation coverage by your former employer. The Department of Labor's "Employee's Guide to Health Benefits Under COBRA" explains employee options and rights under the COBRA program. Visit the Marketplace to explore whether or not you are eligible and interested in health plans other than COBRA.
Marketplace Health Insurance Plans
If you don't have coverage through a job, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or another source, the Marketplace helps you find and enroll in a plan that fits your budget and meets your needs.
You can apply online, by phone, or with a paper application.
Other Health Care Insurance Outside the Marketplace
Some individuals need or want to find private health plans available outside of the federal Health Insurance Marketplace that best meet their budget and personal requirements. Available insurance plans can be searched on the "Plan Finder."
MaineCare: Medicaid in Maine
MaineCare is the state's Medicaid program which is managed by the Maine Department of Health and Human Services.
MaineCare provides free or low-cost coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities, and other situations.
In addition to covering services like doctor's visits, prescription drugs, and preventive care, MaineCare helps seniors and people with disabilities receive long term services and supports in their communities as well as in nursing homes.
Some MaineCare services require applicants to be both financially and medically eligible. MaineCare sends payments directly to health care providers. Care recipients may be asked to pay a part of the cost (co-payment) for some medical services.
Consider Maine VA Care as Well
A veteran may be eligible for comprehensive care through the Maine Department of Veterans Affairs. Eligibility for Maine VA health care, and cost sharing if any, is primarily but not exclusively, determined by an income means test and/or service-connected disabilities.
In an effort to connect women and men with military service to veteran health care services, they may be asked if they have applied for medical care through the Maine Veterans Affairs (Maine VA) Healthcare System. If a veteran is eligible for Maine VA care, and if the required care is available and accessible, using Maine VA health care services may be an alternative to, or usiing it in conjunction with, state-sponsored health care services. A veteran's spouse and/or children may still need MaineCare assistance.
It's best to apply and let the VA assess your individual circumstances. Don't self-eliminate or allow "barracks counseling" to deter you from validating whether or not you are eligible for VA care. It costs you very little time to complete the application below.
Visit other Maine WomenVetsUSA Health Care Plans and Programs sections and Maine WomenVetsUSA Health Care Services pages for more detailed women veteran's health care program and contact information.
External Website: MaineCare
Marketplace to Medicare: Turning 65 or Already 65?
If you're nearing 65 years of age, it's time to learn about Medicare and apply for benefits when allowed.
If you're already 65 and having a problem because you didn't switch from your insurance plan to Medicare, connect with the knowledgeable resources provided below.
Every person's situation is different. It's very important to talk with someone you can trust who will have the most current and accurate information to help you avoid losing affordable health coverage and future penalties.
Office Phone/Maine Area Agencies on Aging: 1-877-353-3771
External Website: Enroll207
TRICARE: Continuing With TRICARE When Medicare Eligible
TRICARE-eligible veterans in Maine who become Medicare-eligible may become either a:
- TRICARE for Life beneficiary/enrollee, or
- US Family Health Plan/TRICARE Prime beneficiary/enrollee.
Which plan a Medicare-eligible veteran is enrolled in depends on the date of a veteran's enrollment into the US Family Health Plan (TRICARE Prime) and whether or not they remained enrolled in that program.
US Family Health Plan/TRICARE Prime Beneficiary
Enrolled September 30, 2012 or earlier
A veteran is eligible to remain in the US Family Health Plan (TRICARE Prime) when Medicare eligible at age 65 if the veteran enrolled on or before this date and remained enrolled.
Martin's Point HealthCare manages the US Family Health Plan (TRICARE Prime) in Maine.
TRICARE for Life Beneficiary
Enrolled October 1, 2012 and later or disenrolled from the USFHP
A veteran is eligible for TRICARE for Life when Medicare eligible if the veteran enrolled on or after this date. Additionally, Medicare-eligible veterans who disenroll from the US Family Health Plan (TRICARE Prime) are also TFL-eligible.
More Information on These TRICARE Programs
Visit the WomenVetsUSA Health Care Plans and Programs national pages for more detailed information about and links to TRICARE for Life (TFL) and the US Family Health Plan (USFHP)/TRICARE Prime. Eligibility, key points, other resources, and contact information are covered on the national pages.
Family Member and Survivor Health Care Programs (Department of Veterans Affairs)
Civilian Health and Medical Program of VA (CHAMPVA)
Certain family-members and survivors (spouse, widow or widower, child) can receive medical expense reimbursements for the following: inpatient and outpatient care, mental health, skilled nursing care, durable medical equipment and prescription medication.
CHAMPVA telephone assistance: 1.800.733.8387
Write: VA Health Administration Center, CHAMPVA, P.O. Box 469028, Denver CO 80246
Stay Current and Learn More About CHAMPVA
VA Dental Insurance Program (VADIP)
CHAMPVA beneficiaries have the opportunity to purchase dental insurance at reduced rates under VA Dental Insurance Program.
MetLife telephone assistance: 1.888.310.1681
Delta Dental telephone assistance: 1.855.370.3303
Stay Current and Learn More About VADIP
Eligibility and other program information: