Tricare Help

Covered by Standard and federal plan – what happens when I turn 65?

Q. This September I will be 65 years old and eligible for Medicare. I am retired from the Navy, and have Tricare Standard for myself and my family. I am also retired from federal service, and I am enrolled in the Government-wide Service Benefit Plan (BlueCross BlueShield) for government retirees. This is my primary health insurance. My wife will not be eligible for Medicare for another seven years.

What should I do about my health insurance needs when I turn 65 and go on Medicare? I know I will have Tricare for Life, and I realize I need to get Part B of Medicare. Am I correct to assume that my wife and child (20 years old) will still be eligible for Tricare Standard, and I will have TLF and Medicare? What should I do about my government retiree plan?
 
In your case, unfortunately, your transition from “ordinary” Tricare to TFL will be expensive for you.  Here’s why.
 
Your transition to TFL will have no effect of any kind on your family’s eligibility for “ordinary” Tricare Standard.  And, they will continue to need other health insurance – the federal employees plan (FEP) — in addition to Tricare, just as they do now.  Your family’s coverage will not change in any way.
 
Your FEP premium is at the family rate — two or more family members.  That will not change, because you will still have the FEP plan.
 
You cannot leave the FEP plan.  You, the former employee and sponsor, must also be enrolled in the FEP in order for your family to have FEP coverage.  You will have to pay the FEP monthly premium at the family rate just as you do today for two or more family members.  

Now about your TFL.  You know that federal law requires you to be enrolled in Medicare Part B when your free Medicare Part A becomes effective.  That means you will have to pay a monthly premium for Medicare Part B in addition to the FEP premium. 
 
Your own personal costs for health insurance will increase by the amount of the Part B premium.  Your first payment will be due on August 1.  You will pay for Part B one month in advance.  For the remainder of this fiscal year, which ends on September 30, it’s around $100.  You can arrange for the premium to be taken from your OPM pension.
 
For your family, the FEP will be primary and Tricare will act as a free supplement (second payer) for it, just like today.  Nothing will change for them.
 
For you, Medicare will become primary on Sept. 1, the FEP will be secondary, and Tricare, by law, is always last. Your Medicare coverage, Part A and Part B, will be effective on Sept. 1.  You will get a Medicare ID card in August that shows Sept. 1 as the date for your Part A and Part B to become effective. 
 
Social Security wants people to apply for benefits at least 90 days prior to the effective date of their coverage. You must apply for Part B at that time according to the law that governs Tricare.  That is a different law from the one that governs Medicare.
 
As of Sept. 1, you must seek all your civilian medical services from Medicare providers.  That is, providers that will file Medicare claims for their services.  Do not use any provider who cannot, or will not, file Medicare claims for your bills.  If you do, Medicare will deny payment on the claim.
 
When the provider asks about your secondary insurance or Medicare supplement, tell them it is your FEP plan.  Show them your FEP ID card.  After Medicare pays a claim, it will automatically forward the claim to the FEP as second payer.
 
FEP will be primary and Tricare will be your second payer for all medical care you receive until midnight on Aug. 31.  

When Medicare and the FEP are both done with a claim, and both have sent you EOBs, it’s time to file a Tricare claim, even if there is nothing left to pay.  You should always file a Tricare claim as third payer in order to get family credit on your Tricare Catastrophic Cap
 
Call your Tricare Service Center for help with filing the Tricare claim the first two or three times until you learn how to do it yourself.  Your FEB will not forward the claim to Tricare.  You must file it.

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