Tricare Help

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.

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.

What are the premiums for Tricare for Life?

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We have Tricare Prime, but my husband will turn 65 next year. I will still be on Prime as I will not be 65 for a few years, but what will his Tricare for Life premium be?

The only “premium” involved in Tricare for Life is the Medicare Part B (outpatient insurance) premium, which for most people is about $100 a month. Enrollment in Part B and payment of the Part B premiums is a bedrock requirement for Tricare for Life eligibility.

Beyond that, your husband may have some out-of-pocket cost shares and co-pays under Tricare Standard, the secondary backup coverage to Medicare under Tricare for Life.

Your husband needs to enroll in Medicare within the seven-month window that runs from three months before the month in which he turns 65 through the three months after the month he turns 65. At that time, he’ll also have to update his and your information in the Defense Enrollment Eligibility Reporting System (database. DEERS is the Defense Department’s eligibility portal for Tricare. Adjustments in DEERS records can be done by visiting the ID Card/DEERS office on any military installation, or by calling the main DEERS support office toll-free at 1-800-538-9552.

Does PPO plan fulfill Medicare requirement for Tricare for Life?

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Does the Humana Medicare Advantage (PPO) health plan fulfill the requirement that to be eligible for Tricare one must have Medicare parts A and B?

No, it doesn’t. Medicare Advantage plans, also known as Medicare Part C plans, are supplemental policies completely separate and distinct from Medicare Part A (free inpatient hospitalization insurance) and Medicare Part B (premium-based outpatient coverage).

Enrollment in Medicare Part B, and payment of the Part B monthly premiums, is a chief requirement for eligibility for Tricare for Life. Medicare Advantage (Part C) plans have nothing to do with that.

What options do we have for Tricare overseas once I turn 65?

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I am a retired service member living overseas. My wife and I have successfully used the Tricare overseas program for nine years. When I reach age 65, will my wife and I still be able to use it? I understand that if I live in the U.S. I would have to enroll in and use Medicare Part B at 65. Since Medicare is not available overseas, it will not be an option for us.

You may continue to use Tricare overseas after reaching age 65, but a big quirk will come into play: You will have to enroll in Medicare Parts A and B, and pay the monthly Part B premiums — even though you will not be able to use Medicare while living overseas. Enrollment in Medicare Part B is a bedrock requirement to be eligible for Tricare for Life. If you’re willing to pay that cost (Part B premiums are currently about $100 per month per beneficiary), then you may use Tricare Standard overseas, which will serve as your primary payer. You’ll be responsible for all applicable cost-shares and deductibles under Standard.

Can I join the USFHP when I turn 65 this year?

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I’m a retiree who will turn 65 in September. Can I join the U.S. Family Health Program? Would this transition affect my wife when she turns 65?

The U.S. Family Health Program is a unique Tricare Prime option that operates in six specific areas of the country. Those regional networks are built around former U.S. Public Health Service hospitals that the Public Health Service gave up years ago.

For years, beneficiaries who enrolled in the USFHP could stay in that plan and keep Tricare Prime indefinitely, even when they turned 65 and became eligible for Medicare, when most other beneficiaries are required to shift to Tricare for Life. However, Congress recently ordered a major change to USFHP eligibility. As of Oct. 1, 2012, the USFHP cannot accept any new enrollees over age 65; they must use Tricare for Life. Those over 65 who were already enrolled in the USFHP before that date can stay in that program indefinitely. As such, if you want to get into the USFHP, you have only a few months to look into that before you turn 65 and are permanently locked out of that option.

Otherwise, at age 65 you will shift to Tricare for Life if you intend to continue using military medical facilities for any portion of your health care. One of the bedrock requirements for Tricare for Life eligibility is enrollment in Medicare Parts A and B and payment of the monthly Part B premiums, currently about $100 a month for most beneficiaries.
Under Tricare for Life, Medicare acts as the primary payer on health care claims, and Tricare Standard is an automatic secondary backup payer.

Tricare beneficiaries are strongly advised to sign up for Medicare Part B as soon as they become eligible, because Medicare charges a penalty to those who are eligible for Part B but, for whatever reason, delay enrollment. The penalty is equal to 10 percent of the Part B premium for each year an individual was eligible to sign up for Part B but did not.

All the same guidelines will apply to your wife when she turns 65. She will also shift to Tricare for Life and will have to enroll in Parts A and B and pay the Part B premiums.

Since when do retirees have to pay for Tricare and Medicare Part B?

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When did the requirement to pay Medicare Part B to get our free health care for life go into effect? I’m on Medicare now and my wife goes on next year. At that time we’ll be paying $2,400 a year (if they don’t raise the premiums) for our “free” health care. Before we retired from our civilian jobs we paid $570 a year for Tricare Prime. How is it right that when you go on fixed income, you pay more for something that was promised to be free for life?

The requirement to have Medicare Part B in order to be eligible for Tricare for Life has been in place ever since Tricare for Life was enacted by Congress in 2001.

I understand your frustration with the cost, but look at it this way: Prior to the enactment of Tricare for Life, there was no Tricare option at all for Medicare-eligible retirees age 65 and older. Their only option was Medicare — which still would have required payment of the Part B premiums.

The issue of “free health care for life” is hotly debated in the veterans’ community, but the Defense Department and Veterans Affairs Department insist that “free health care for life” for military retirees was never something that was promised or guaranteed by the government. DoD and VA say individual recruiters may have made that promise, but if they did, they were doing so without official authority.

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

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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.