Tricare Help

Medicare, Tricare and Social Security

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Q. I’m retired, on Tricare Standard, and collect military retirement plus Social Security retirement. When I turn 65 in March and sign up for Medicare Parts A and B, do I need to notify DEERS, or will Social Security automatically notify DEERS for me? Also, since I’m receiving Social Security Benefits, does Social Security automatically enroll me in Medicare Parts A and B?

A. Individuals who are already receiving Social Security benefits prior to age 65 are contacted by Medicare a few months before reaching age 65 and given all the information they need, and are indeed enrolled in Medicare Parts A and B automatically.

The Social Security Administration has a basic primer on Medicare that can be downloaded here:

www.ssa.gov/pubs/EN-05-10043.pdf

Similarly, individuals who are already Tricare-eligible (as you are) and are enrolled in Medicare Part B are automatically enrolled in, and become eligible to use, Tricare for Life on the first day of the month of their 65th birthday. However, government bureaucracies being what they are … once you are squared away with Medicare, it can’t hurt to contact DEERS just to make sure the information in your file has been updated and reflects your change in status to Tricare for Life. You can do that by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office in California toll-free at 800-538-9552.

When does spouse go on Tricare for Life?

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Q. My husband will turn 65 next year and will enroll in Medicare. Will my Tricare coverage continue until I turn 65 a year later, or should I enroll in my company’s health insurance program for 2014?

A.  You may stay on whatever Tricare plan you currently use (most likely Tricare Prime or Standard) until you also reach age 65, at which time you will make the same transition to Tricare for Life. When your husband receives his Medicare card (which usually happens about three months before reaching age 65), he should contact the Defense Enrollment Eligibility Reporting System, the Defense Department’s eligibility portal for Tricare, to update his information file to reflect the fact that he has transitioned to Tricare for Life. He should do the same for you when you go through that process.

He can engage DEERS by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office in California at 800-538-9552.

Sponsor on TFL due to disability, family on Prime

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I am retired Marine officer currently on Tricare Prime.  I’m only 56, but I’ve been on Social Security Disability for 24 months due to lung cancer.  I have been notified that I will shortly be enrolled in Medicare. This will put me on Tricare for Life, but since I will be  on Medicare earlier than age 65 due to disability, I’ll be able to continue using Tricare Prime rather than the usual TFL component, Tricare Standard.  I have been told that Medicare will pay the Tricare Prime enrollment fee for me, but I’m not sure about my wife and three children, who are also in Prime. Do I need to keep paying the full annual enrollment fee to keep my family covered under Prime?

The usual Tricare Prime family enrollment fee is $547.68 per year. But as you note, because you have Medicare earlier than age 65 due to disability, you may remain in Prime. Beneficiaries in these circumstances have their portion of the Prime enrollment fee waived. So you would pay only $273.84 per year for your family, and your only “fee” would be the monthly Medicare Part B premium. Your claims would be processed by the Tricare for Life contractor (Wisconsin Physician Services), even though you’ll remain enrolled in Prime.

This situation is unique to beneficiaries who have Medicare earlier than age 65 due to disability. If you chose to drop Prime and be covered under the standard Tricare for Life configuration (Medicare plus Tricare Standard) for yourself, you would have to pay the full annual Prime family enrollment fee of $547.68 to keep your family in that program, even though you would not be using Prime yourself.

Employer plan and Tricare, or Tricare and supplemental?

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I am a 60-year-old retiree whose wife is also retired. Our primary coverage is through her former employer, and our secondary coverage is my Tricare Standard. A friend told me that we’d be better off dropping the employer-sponsored plan that costs $390 per month and using Tricare Standard as our primary coverage, with a supplemental plan as a backup.  He said this arrangement will pay essentially the same or more on claims and the supplemental will cost much less than $390 per month. If we drop our current employer-sponsored primary coverage, however, we can’t get it back, since we are retired. What do you think of this idea?

Tricare Help often receives questions like this, but unfortunately there is no definitive answer because the answer will differ for every individual, based on their own unique circumstances and situation. In general, what your friend suggests is probably worth looking into, at least. But you need to shop around for supplementals to get a feel for what they offer, and then you need to carefully compare the costs and benefits of Tricare Standard and a supplemental plan versus your employer coverage with Tricare Standard as a second payer.

One important factor in questions like this is how much health care a beneficiary “consumes” — i.e., whether you and your wife are relatively healthy and don’t need to see doctors that often, or whether you have health conditions that require regular doctor visits and prescription drugs. While Tricare Standard has no enrollment fee, it does charge cost shares and deductibles that may add up over time for beneficiaries who consumer above-average amounts of health care. If that becomes your primary coverage, you could see increased costs from that perspective, although you will have to do your own research to determine how those costs might compare to what you’re paying now under your wife’s coverage.

As you note, if you go with Tricare Standard and a supplemental, Standard will be the primary payer, and the supplemental will be the secondary payer. By law, Tricare is last payer to all other health coverage except in a very few circumstances. One such circumstance is when Tricare is paired with a supplemental plan.

It’s true: Affordable Care Act won’t affect your Tricare

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Tricare Help has been hearing from a lot of beneficiaries who are worried about how the ACA will change their coverage. But Tricare is not affected by the new law, and because every version of Tricare, including Tricare for Life, is considered sufficient minimum coverage for the purposes of the ACA’s requirements, Tricare beneficiaries will see no change in their benefit and do not have to do anything in regards to the ACA. Military Times health reporter Patricia Kime has the full story. (Know a worried beneficiary? Pass the link on.)

Can wife be covered by husband’s Tricare if she loses her own coverage?

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My husband is covered under Tricare for Life. I have lost my private coverage. Can I enroll in Tricare with this change-of-status event?

If your husband is eligible for Tricare for Life through his status as a military retiree, you are also fully entitled to Tricare coverage as his spouse, whether or not you have your own private coverage. If you are under 65 and not yet eligible for Medicare, you are eligible for Tricare Prime, the military’s version of an HMO, or Tricare Standard, the military’s version of a fee-for-service plan. If you are over 65 and eligible for Medicare yourself, you would be covered under Tricare for Life, in which Medicare acts as first payer and Tricare Standard acts as a backup second payer.

If you are under 65 and are interested in enrolling in Tricare Prime, you should know that the program is not offered everywhere, and the Defense Department has shrunk its coverage areas even further as of Oct. 1.

In order to use your Tricare benefits, your husband must properly enroll you in the Defense Enrollment Eligibility Reporting System (DEERS), the Defense Department’s eligibility portal for Tricare. He can do that by visiting the ID Card/DEERS office on any military installation or calling the main DEERS support office at 800-538-9552.

What happens to spouse’s coverage when they turn 65 first?

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I’m a military retiree under 65 and my spouse is eligible for Medicare. Does he have coverage under Tricare for Life or does he have to wait until I am also over 65?

If your husband is eligible for Medicare, then he must sign up for Medicare Parts A and B and use Tricare for Life, under which Medicare is first payer and Tricare Standard is a backup second payer.

You stay under “ordinary” Tricare (Tricare Prime or Tricare Standard) until you turn 65, when you sign up for Medicare and also transition into Tricare for Life.

Does 18-year-old daughter still have coverage?

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I am active-duty Army. My daughter is 18 and has graduated from high school. She does not intend to attend college. Is she still covered by my Tricare Prime?

If your daughter does not attend college full-time, she remains eligible for Tricare under your sponsorship until she reaches age 21 as long as she remains dependent on you for more than half of her financial support.

You also need to keep her information current in the Defense Enrollment Eligibility Reporting System (DEERS), the Defense Department’s eligibility portal for Tricare. You can contact DEERS through the ID Card/DEERS office on any military installation or by calling the main DEERS support office at 800-538-9552.

Can stepdaughters, 22 and 24, be added to my Tricare?

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My new wife has two daughters, one who is a 22-year-old college student and one who is 24, a recent graduate who lives with us as her primary means of support while she looks for a job. Can I include them in my Tricare family plan?

If your 22-year-old stepdaughter is a full-time college student, she may stay on your Tricare plan (Prime or Standard) until she turns 23.

At age 23, the only Tricare option remaining for dependent children is Tricare Young Adult, which offers similar benefits to regular Prime and Standard but requires payment of monthly premiums. There are other conditions as well: Children must be unmarried, must be dependent on the military sponsor (you) for more than half their financial support, and must not have other health coverage options, such as through a private employer. As long as they meet those criteria, children who are eligible for Tricare Young Adult may stay in that program until they reach age 26.

For them to use Tricare, you will need to register your stepdaughters (and your wife) in the Defense Enrollment Eligibility Reporting System (DEERS), the Defense Department’s eligibility portal for Tricare. You can start that process by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office at 800-538-9552.

Do I need an ID card for Tricare for Life?

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Do I need a Tricare for Life ID card if I am retired military?

There’s no such thing as a Tricare for Life ID card. Your regular military retiree ID card notes on the back that you are eligible for military retirement benefits, including health care. That’s all the ID you need to use Tricare.