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.

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.

Can I stay on Prime after husband switches to TFL?

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My husband will turn 65 in early October. I am eight years his junior. On the first of October when he transitions to Tricare for Life, will I remain with Prime or move to Standard? Also, if I understand correctly, he will no longer have a premium payment for Tricare, but will have for Medicare Part B. Can you tell me what my premiums per month will be? When he went to the Social Security office, they told him there was nothing he had to do to sign up for Medicare Part B, but I keep reading that you must register before the end of August. Can you advise me on that, too?

When your husband transitions to Tricare for Life, the question of whether you will remain with Prime or switch to Standard depends on where you live. As of Oct. 1, the Defense Department plans to shrink the Tricare Prime service areas to within 40 miles of current or former military bases. Those living outside these zones may seek a waiver if they live less than 100 miles from one of the new Prime service areas after the boundaries are redrawn on Oct. 1, but Tricare advises that these beneficiaries may face long travel times for primary and specialty care. Most people caught in this situation will switch to Tricare Standard, which requires no enrollment and charges no premiums.

As for your husband, you are correct, once he transitions into Tricare for Life, he no longer has to pay the Tricare Prime annual enrollment fee, but he will pay the monthly Medicare Part B premium, which currently runs about $100 a month for most beneficiaries.

Generally, the only people who are automatically enrolled in Medicare Parts A and B upon reaching age 65 are those with disabilities who have been receiving Social Security for at least 24 months prior to their 65th birthday.

Those who are not disabled must take a few simple steps to enroll in Parts A and B. If your husband is not disabled and is not receiving Social Security (and has not already received his red, white and blue Medicare card), he must enroll. The standard enrollment window runs for seven months — three months before the month in which the beneficiary turns 65 until three months after the month in which the beneficiary turns 65. If your husband’s birthday is in early October, his enrollment window is already open and will run through early January.

If I’m still working at 65, can I keep Tricare Prime?

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I am a widowed dependent who will turn 65 in October, and I am on Tricare Prime. I do not plan to retire in October but plan to work until I am 67. Will I continue with Tricare Prime until I retire in 2015 or will I have to go on Medicare parts A and B and Tricare would then become my co-pay coverage?

You will not be able to stay on Tricare Prime past age 65; your only potential Tricare option at that point would be Tricare for Life (Medicare plus Tricare Standard). However, beneficiaries in your situation have several options.

If you have access to health coverage through your employer, you can use that coverage and delay Medicare and Tricare for Life enrollment. You may delay Medicare Parts A and B enrollment as long as you are working and covered by an employer’s health plan, and you will not have to worry about the Part B late enrollment penalty as long as you apply for Parts A and B before you stop working, or within eight months of the end of work or the end of your employer coverage, whichever is first. Under this option, you will not have any access to Tricare coverage until you enroll in Parts A and B.

Second, you can use your employer plan and also enroll in Medicare Parts A and B and Tricare for Life when you turn 65. This means you will pay premiums both for your employer plan and for Medicare Part B – and will probably be over-insured. But some people like that extra layer of coverage.

Third, you can bypass your employer coverage and go solely with Medicare/Tricare for Life when you hit 65. If you go this route, check to see if you can suspend your employer plan before cancelling it outright. If you can suspend the employer’s coverage, you leave yourself an option to return to the coverage should you want to at some point in the future. Under this option, you have a seven-month window to enroll in Medicare Parts A and B that starts three months before the month in which you turn 65 and runs for three months after the month in which you turn 65.

What does DOMA mean for partner’s Tricare?

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Q. I am an Air Force Reserve retiree. At age 60 I went on Tricare Prime and at 65 I started on Medicare with Tricare for Life as my supplemental insurance. As of the recent Supreme Court decision striking down the Defense of Marriage Act I will now be able to marry my life partner of 22 years.

Once we have our marriage certificate, and I register her under the Defense Enrollment Eligibility Reporting System, I understand that she will be able to start receiving all the benefits of a military spouse. She is younger than I am and will not be eligible for Medicare for several years. Since I was on Tricare before the age of 65, will my new spouse also be elibigle for Tricare for Life until she reaches the age of 65? I understand that I will have to pay the Tricare for Life annual enrollment fee for her and network copayments.

Your spouse will not be eligible for Tricare for Life until she reaches age 65 and enrolls in Medicare Parets A and B. There is one exception to that rule: If she is entitled to Medicare before age 65 due to disability, she can be covered under Tricare for Life earlier than age 65.

Assuming she is not eligible for Medicare earlier than age 65 due to disability, her options until then will be Tricare Prime or Tricare Standard. Then when she reaches age 65, she’ll transition into Tricare for Life, with Medicare as her first payer and Tricare Standard as her backup second payer.

Tricare for Life requires no annual enrollment fees; the only payment required is the monthly Medicare Part B premiums, currently about $100 a month for most beneficiaries, plus any applicable co-pays and cost shares for care.
Tricare Prime does require an annual enrollment fee; if you and your spouse choose that plan for her, you would pay the individual, not the family, enrollment fee.

If you cover your spouse under Tricare Standard only, there is no enrollment fee, just applicable cost-shares and deductibles.

If Medicare won’t cover vaccine, will Tricare step in?

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I am a 77-year-old retiree covered by Tricare for Life. My civilian doctor recently said I needed a combination shot for tetanus, pertussis and whooping cough, although he said Medicare may not cover it. If Medicare rejects that bill, will Tricare for Life pay it?

As you’ve discovered, Medicare is a bit finicky about which immunizations it will cover for senior citizens. The only preventive vaccines routinely covered are for flu, pneumonia and hepatitis B. Medicare covers other vaccines only if you are actually exposed to the virus or disease that the vaccine is meant to deter. For example, if you step on a rusty nail, Medicare will cover a tetanus shot.

For Tricare for Life beneficiaries, Medicare acts as first payer and Tricare Standard acts as a backup second payer to cover things Medicare does not. This doesn’t mean Tricare will cover every conceivable medical procedure or service, but it generally will cover anything that is deemed “medically necessary” by a health care provider. That includes coverage of age-appropriate doses of vaccines.

To find out if this specific immunization would be covered, you should contact the Tricare managed-care contractor for the Tricare region in which you live.

If doctor stops taking Medicare, can we go to an MTF instead?

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I am retired Army and my wife and I use Tricare for Life. Recently, one of our providers stopped taking Medicare. My wife needs a treatment that would cost $3,500 out of pocket. If we relocate near MacDill Air Force Base, Fla., could we get all our medical needs met at the military treatment facility there? If so, what would it cost us?

Unfortunately, once beneficiaries transition to Tricare for Life and lose eligibility for Tricare Prime, they have no expectation of access to military treatment facilities for their health care. They’re generally expected to seek all their medical care from Medicare providers, with Tricare Standard as a backup secondary payer.

It is possible that you could be granted access to an MTF at MacDill, but Tricare has nothing to do with that; such decisions are strictly up to each local MTF commander, and those decisions are based on the MTF’s available capacity, staff and resources. You will need to contact the patient administration office, discuss your situation, let them know that you and your wife are in TFL, and see what they have to say.

In the specific case of your wife’s near-term treatment, your best bet would be to find another nearby provider that does take Medicare. You should also check on whether Tricare Standard, as secondary payer, will cover that cost. However, since this is a case of a specific provider refusing to participate in Medicare not a case of Medicare itself refusing to cover the treatment I think Tricare likely will tell you that you first need to look for another provider who does take Medicare.

You should contact the Tricare managed-care contractor for the Tricare region in which you live to further discuss this matter.

I don’t need Medicare Part B under USFHP — why pay for it?

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I retired from the reserves in 2003. In 2008, when I turned 60, I signed up for the U.S. Family Health plan here in Maryland and have used that plan since. The recent notice of transition to Medicare and Tricare for Life indicated that those enrolled in US Family Health prior to October 2012 need not sign up or pay for Medicare Part B. Is this correct? Why would I sign up and pay for Medicare part B if not required to?

You are correct that Tricare beneficiaries enrolled in the USFHP prior to Oct. 1, 2012, may stay in that program indefinitely under Tricare Prime or Tricare Standard, even when they reach age 65, the normal age for Medicare eligibility. You’re also correct in that as long as you remain in the USFHP, you won’t be using Medicare.

However, there is one major reason that TFL beneficiaries in the USFHP may still want to sign up for Medicare and enroll in Parts A and B: Medicare charges a penalty to beneficiaries who are eligible for Part B but for various reasons (participation in the USFHP being one) do not sign up for it. The penalty is equal to 10 percent of the Part B monthly premiums for every year a beneficiary was eligible for Part B but did not sign up.

This would come into play only if you someday decided to disenroll from the USFHP or moved to an area where that program does not operate, and you had to fall back on the Medicare/Tricare Standard combination that makes up Tricare for Life. If that were to happen a number of years after you first became eligible for Medicare Part B, the potential penalty could be quite steep.

Tricare recommends that Medicare-eligible beneficiaries using the USFHP still sign up for Part B at age 65 precisely for the reason outlined above. But that’s a decision each beneficiary must make for himself.