Beneficiaries eligible for both TRICARE and Medicare should be aware of a few key points to protect coverage.
TRICARE is the health care program for service members, retirees, and their families around the world. However, Medicare is a federal program for those over the age of 65 or on disability for 24-months.
TRICARE and Medicare
To avoid a gap in coverage, sign up for Medicare a few months before your turn 65. Beneficiaries with an active-duty sponsor won’t receive a penalty for delaying Part B.
If you have Employer-Sponsored Group Coverage, you may sign up later for Part B.
Keep in mind that you won’t have TRICARE for Life coverage if you don’t have Part B. If you receive SSDI payments, you automatically get Part A and Part B in the 25th month of disability.
Although, be aware of eligibility changes, if you miss the Part B enrollment period you could incur penalties. The Part B premium depends on your income; those with high incomes pay higher premiums than those with lower incomes.
If you have TRICARE, Part D isn’t mandatory.
TRICARE vs Medicare
TRICARE is for service members, retirees, and families of our military. Medicare-wraparound health coverage, TRICARE for Life, is available for eligible beneficiaries who have Part A and Part B.
You don’t pay any enrollment fees for your TRICARE for Life coverage, but you must enroll in and pay the Part B premium.
Part A is free if you pay Medicare taxes for a specific period of time. Then, Part B has a monthly premium.
Medicare is primary and TRICARE is secondary. This just means that Medicare pays the claims first.
Medicare and TRICARE for Life
TRICARE is secondary to Medicare. Also, TFL pays the Part B deductible and coinsurance.
This coverage doesn’t cost an additional fee, and your major responsibility is to keep Part B premium payments active. TRICARE will cover the 20% coinsurance Medicare leaves other beneficiaries responsible to pay.
When you receive a service Medicare covers that TRICARE doesn’t; such as chiropractic care, you pay the 20%. However, for services TRICARE approves that Medicare denies; TRICARE standard becomes the payor and you’re responsible for the deductibles and co-payments.
Although, if you go retire overseas, Medicare isn’t available there. In this case, TFL pays similarly to TRICARE Overseas Select.
TRICARE and Medicare Supplements
It doesn’t make sense to have a Medigap plan and TFL; only because TFL already works as a supplement. You wouldn’t have two supplements; so, you don’t need TRICARE and a Medicare Supplement.
Military families with TRICARE for Life may not need a Medigap plan.
TRICARE and Medicare Part B
If you want to keep your TRICARE benefits, you’ll need Part B. This is because TRICARE is secondary to Medicare.
Medicare must first pay the claim and then TRICARE pays the balance. TRICARE will cover the Part B coinsurance and the Part B deductible.
If you don’t have Part B, you’ll lose your TRICARE and Part D benefits.
TRICARE and Medicare Part D
There is little to no benefit to purchasing Part D if you have TRICARE. Part D isn’t a requirement to remain eligible for TRICARE for Life.
TRICARE beneficiaries are eligible to use the pharmacy benefit. Also, TRICARE is creditable prescription drug coverage.
If you decide to enroll in Part D, TRICARE will pay second. Medicare will be the primary payor.
TRICARE and Medicare Advantage
If you want TRICARE and an Advantage plan that’s your choice; although, you are responsible for paying the Part B premium, and the cost of the Advantage plan.
Also, you must follow the network of doctors the advantage plan sets forth. Basically, the advantage plan becomes the primary payor and TFL remains secondary.
Some beneficiaries find this option is suitable because some Part C plans offer ancillary benefits. This can include dental, vision, hearings, and silver sneakers.
Plus, you don’t need Part D coverage and some advantage plans have lower-cost options on plans that lack drug coverage.
Although, most beneficiaries find that TRICARE and Medicare make excellent coverage. If you decide to enroll in an MA plan consider that the doctor network will be much smaller with an MA plan.
Tricare and Medicare Under 65
Once you’re retired military, you’re either required or it’s highly recommended that you enroll and buy Part B when first eligible. Waiting to enroll can mean later you’re responsible for a Part B late enrollment penalty.
Now, if you or your family members are active duty, then you don’t need Part B. However, you need to use the Special Enrollment Period that is anytime during active duty, the month active duty ends or the month TRICARE ends; whichever comes first.
TRICARE Prime and 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 you’re eligible. When you qualify, you’ll get a waiver for Prime enrollment fees or a refund for a past enrollment fee.
Talk to your regional contractor about questions on your account.
Tricare Proof of Coverage
MilConnect lets TRICARE beneficiaries save and print an Eligibility Letter for “Proof of Insurance“. This information allows you to show creditable coverage to any other insurance you may purchase in the future.
This information is available online or through a written request.
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 Defense Enrollment Eligibility Reporting System (DEERS) records. When information is incorrect in the database this causes problems with your healthcare benefits.
Are you single, never married? You continue to be eligible for TRICARE Prime or Tricare Select past your 65th birthday.
Are you a widow or widower? If you’re eligible for free Part A, sign up for Part B. Your TRICARE For Life coverage begins on the date you have both Part A and Part B. If you’re not eligible for 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 free Part A, sign up for Part B. Your TRICARE For Life coverage begins on the date you have both Part A and Part B. If you’re not eligible for free Part A, under your spouse’s (or divorced 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 divorced spouse) turns 62, apply for Medicare Part A under his or her social security number.
Do You Need A Medicare Supplement if You Have TRICARE For Life
No, TRICARE For Life is already a wrap-around plan that acts similar to a supplement. It doesn’t make sense to purchase a policy similar to a policy that you’re already getting for free.
I Have TRICARE, Do I Need Medicare
Yes, if you don’t have Part B when eligible you’ll lose TRICARE. Most people enroll in Part B before turning 65, this way the effective date coincides with your eligibility date.
What Doctors Accept Medicare and TRICARE For Life
When you have both TFL and Medicare, you can see any participating provider in the U.S and U.S. Territories. If you do see a doctor that doesn’t accept assignment, TRICARE pays the amount they would’ve if Medicare did process the claim; so, they only pay 20% and you pay 80%.
Sometimes if access to care is limited, TFL will likely pay primary. For example, TFL is the primary payer in all overseas areas.
Medicare and TRICARE, which is Primary
TRICARE pays after Medicare in the US and the US Territories. However, it pays first in all other overseas areas.
In most cases, TFL and Medicare Benefits, leave you with no out of pocket for covered services.
The coverage is available worldwide and you can see any provider you choose. You won’t receive a separate TRICARE wallet card. You only need your Medicare card and your military ID as proof of coverage.
You’ll pay more if you get care from Veterans Administration providers or from providers who opt-out of Medicare because they are not allowed to bill Medicare. Ask your provider ahead of time to avoid unwelcome surprises.
What is Covered with TRICARE and Medicare
Part A covers inpatient care and Part B covers outpatient care; then, TRICARE covers the deductibles and coinsurances for most services. Part D is rolled into TFL, so there’s no need to buy a separate policy.
How Do I Enroll in Medicare with TRICARE For Life
Enrolling in Medicare is simple, you can do this through Social Security either over the phone, online, or in-person at a local office.
Will My TRICARE For Life Begin Automatically When I Get Medicare
Yes, coverage is automatic for TFL when you enroll in Part A and Part B.
When Do I Have to Switch From TRICARE to Medicare Military Retiree
For the most part, you have 90 days after the first day of retirement to enroll in a TRICARE plan.
If I Have TRICARE Why Am I Paying for Medicare
Since Medicare is primary, you need Medicare to get proper coverage from TRICARE.
Does TRICARE For Life Cover Medical Alert Systems
Since Medicare won’t cover medical life alert systems, it’s unlikely that TRICARE would cover them. However, some MA plans cover medical alert systems.