Beneficiaries eligible for both TRICARE For Life and Medicare should understand how the two work together. Medicare consists of a few different parts. If you are familiar with these parts, you might be wondering how each works with TFL, and if additional supplemental insurance is necessary for those who are dual-enrolled in both Original Medicare & TFL.
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.
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. 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 for paying. This includes the Part A hospital deductible and Part B 20% coinsurance.
When used together, TFL and Medicare will cover most procedures deemed medically necessary.
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 healthcare 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 will cover 0% of the costs. Any claim will be forwarded to TFL.
Anything the Advantage plan doesn’t cover, your TFL will help cover. This includes copays and deductibles, for which you would be responsible otherwise. 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 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. 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 supplement 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 you’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 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.
How Does US Family Health Plans 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.
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 will be able to 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.