Beneficiaries eligible for both TRICARE and Medicare should understand how the two medical insurance programs work together. Medicare consists of a few different parts. If you’re familiar with these parts, you might be wondering how each works with TRICARE, and if additional supplemental insurance is necessary for those who are dual-enrolled in both Original Medicare and TRICARE.
TRICARE For Life (TFL) is the health insurance program available to U.S. military retirees who qualify, as well as their beneficiaries, for no cost. It’s different and separate from Medicare. Medicare is the U.S. national health insurance program for individuals 65 years of age and older or who are disabled. It’s crucial for those who are dual-eligible to understand their coverage options.
How Does TRICARE For Life Work with Original Medicare?
TRICARE-eligible beneficiaries will be automatically enrolled in TRICARE For Life when they sign up for both Part A and Part B. This means you don’t need to worry about enrollment forms.
You must pay your monthly Part B premium to remain enrolled. If you enroll in both Medicare and TFL, Medicare will be your primary insurance, and TFL will work as a wraparound.
TFL will help cover costs for which the beneficiary would otherwise be responsible to pay. This includes the Part A hospital deductible and Part B coinsurance.
When used together, TFL and Medicare will cover most procedures deemed medically necessary. It’s also important to know that TRICARE doesn’t issue insurance cards, unlike Medicare which issues its red, white, and blue card.
How Does TRICARE For Life Work with Medicare Advantage?
Some TRICARE For Life beneficiaries choose to enroll in Medicare Advantage plans to access benefits such as gym memberships and dental, vision, and hearing coverage. As Medicare doesn’t cover these benefits, an Advantage plan is a means for the beneficiary to obtain them. Before you enroll in a Medicare Advantage plan, make sure your health care providers are in the plan network – meaning they accept your coverage.
For example, if you have a Medicare Advantage HMO plan and TFL, the HMO is your primary insurance, and TFL acts as a supplement. If you receive care outside your HMO network, the HMO won’t cover any of the costs. Any claim will be forwarded to TFL.
Anything the Advantage plan doesn’t cover, TFL will help to cover. This includes copays and deductibles, for which you would be otherwise responsible.
Therefore, if your providers are in your network, you may ultimately have no out-of-pocket expenses once TFL has paid its share. Thus, underscoring the importance of ensuring your providers are in-network before signing up for a Medicare Advantage plan.
How Does TRICARE For Life Work with Part D?
If you are a TRICARE For Life beneficiary, there is generally no need to enroll in a Part D prescription drug plan under Medicare. TRICARE For Life includes prescription drug coverage, for which there is no additional charge to you.
Prescriptions for maintenance drugs, such as medications for blood pressure or cholesterol, must be filled through TRICARE’s mail order pharmacy. Acute care prescriptions for TRICARE For Life beneficiaries are available at their local pharmacy or military base. In both scenarios, TRICARE For Life pays for the prescriptions, and the beneficiary is usually responsible for a copay.
If you have TRICARE For Life and later decide to enroll in Part D, you won’t have to worry about being penalized. The late enrollment penalty you might otherwise have to pay for Part D gets waived because TRICARE drug coverage qualifies as creditable coverage.
If you have limited income and resources, you could qualify for Extra Help paying for a Part D prescription drug plan.
How Does TRICARE For Life Work with Medigap?
TRICARE For Life acts similar to a Medicare Supplement plan. It’s possible to also enroll in a Medicare Supplement plan if you have both TFL and Medicare. Whether this would be advantageous to you is dependent on your health insurance needs. If you enroll in Medicare, TFL, and Medigap, Medicare will be your primary insurance, the Medicare Supplement plan will be secondary insurance, and TFL will pay last.
How Does TRICARE Prime Work with Medicare?
If you’re under the age of 65 when you have Medicare with TRICARE Prime, you don’t need to disenroll. TFL isn’t mandatory. Those on Medicare because of disability can remain on TRICARE Prime as long as they’re eligible. When you qualify, you’ll get a waiver for Prime enrollment fees or a refund for a past enrollment fee.
MilConnect lets TRICARE beneficiaries save and print an eligibility letter for Proof of Insurance. This information allows you to show creditable coverage for any other insurance you may purchase in the future. This information is available online or through a written request.
How Does TRICARE Plus Work with Medicare?
TRICARE Plus is a primary care program that allows beneficiaries to get primary care appointments at military hospitals and clinics. Each hospital or clinic decides if it accepts TRICARE Plus. You must enroll to participate, but your enrollment is based on where you originally enrolled.
When it comes to benefits, TRICARE Plus offers the same primary care access as TRICARE Prime. It works the same as regular TRICARE in regards to Medicare because it’s still primary coverage. The military clinic or hospital doesn’t cover costs for beneficiaries who receive care from non-military health facilities.
Before scheduling any appointments, beneficiaries should contact their local military hospitals to make sure they accept TRICARE Plus. TRICARE Plus is available for TRICARE-eligible individuals who aren’t enrolled in TRICARE Prime.
Notice of Award or Disapproved Claim
In most cases, you need to take your Notice of Award to the Social Security office, or local ID card office to update your information in the Defense Enrollment Eligibility Reporting System (DEERS) records. When information is incorrect in the database, this causes problems with your health care benefits.
Marital Status and TRICARE Eligibility
The below information details how your marital status affects your eligibility for TRICARE and Medicare.
Single/never married: You continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.
Widow(er): If you’re eligible for premium-free Part A, you should also sign up for Part B. Your TRICARE For Life coverage begins on the date you have both Parts A and B. If you’re not eligible for premium-free Part A, you continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.
Married/divorced (spouse age 62 or older): If you’re eligible for premium-free Part A, sign up for Part B as well. Your TRICARE For Life coverage begins on the first day you have both Parts A and B. If you aren’t eligible to receive premium-free Part A under your spouse’s (or former spouse’s) Social Security number, you continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.
Married/divorced (spouse younger than age 62): You continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday. Three months before your spouse (or former spouse) turns 62, apply for Medicare Part A under their Social Security number.
How Does US Family Health Plan Work with Medicare?
The US Family Health Plan offers the TRICARE Prime benefit to eligible military beneficiaries. As of October 1, 2012, Medicare-eligible individuals over age 65 cannot enroll in the US Family Health Plan. However, if your US Family Health Plan coverage began before September 2012 with no break, you can keep it when you age into Medicare.
TRICARE recommends also enrolling in Part B to avoid the late enrollment penalty. Medicare-eligible individuals under 65 can still stay on the US Family Health plan until aging out and transitioning to TFL. Those over 65 who are ineligible for Part A based on work credits can also still enroll in USFHP.
How to Get Help Understanding TRICARE For Life and Medicare
If you would like more information about how you could benefit from a Medigap plan, give us a call. Our agents can help you understand how your benefits work together. You can also complete our rates form to get quotes for supplemental Medicare plans available in your area.