Tricare Help

Can wife, over 65 but ineligible for Medicare, be put on Tricare Prime?

I am retired from the Navy. I am under 60 years old and enrolled and paying for Tricare Prime for myself. My wife is over 65 and enrolled in Medicare but was denied Medicare benefits due to not having enough work related points (she’s a half point short). Because of this I am currently paying Medicare parts A and B for my wife. She is enrolled with DEERS in Tricare for Life. I have checked with Medicare to see if we could use my SSN to qualify my wife for Medicare Part A benefits, but since I am under 60, we were told that was not possible. I am trying to see if there is a way to enroll my wife in Tricare Prime instead of Medicare Part A due to her not qualifying for Medicare benefits. I would want to keep Medicare Part B.

You are correct that your wife can’t apply for Medicare Part A benefits under your Social Security Number because you are not yet old enough, but it’s because you are not yet age 62; in such scenarios, the age threshold for the Tricare sponsor is age 62, not 60.

What you need to do is contact your local Social Security Administration office and make them aware that your wife is not eligible for Medicare Part A under either her own work history or yours. As such, she should be eligible to receive a “Notice of Disapproved Claim” from the SSA. Once you have that in hand, take it to your nearest military installation ID Card/DEERS office. DEERS is the Defense Enrollment Eligibility Reporting System, the Defense Department’s eligibility portal for Tricare. The SSA’s “Notice of Disapproved Claim” should be sufficient to allow your wife to retain eligibility for Tricare Prime, Standard and Extra even though she is already past her 65th birthday, once you update your wife’s DEERs registration file and get a new ID card for her.

Then three or four months before you turn age 62, your wife should reapply for Medicare Part A under your Social Security Number to see if she qualifies under your work history. If so, she can then transition into Tricare for Life. If not, she can continue under Tricare Prime It’s entirely possible for an over-65 beneficiary to be eligible for Medicare Part B even if he or she is not eligible for Part A. Even though your wife will be in Tricare Prime, maintaining her enrollment in Part B and paying the monthly premiums now will allow you to avoid the late enrollment penalty — 10 percent of the monthly premium for every year that a beneficiary could have enrolled in Part B but did not.

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