Tricare Help

Tricare Prime after age 65

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Q. I’m an Army retiree. My wife is still on active duty. I’m enrolled in Tricare Prime as her dependent. Can I continue in Prime at age 65 as an active-duty dependent?

A. You’re no longer eligible for Tricare Prime once you turn 65 and become eligible for Medicare, regardless of whether you’re registered in DEERS as your active-duty wife’s dependent or as your own sponsor. At age 65, Prime beneficiaries must shift to Tricare for Life (Medicare plus TricareStandard).

There’s one exception: Retirees enrolled in Prime under the U.S. Family Health Plan prior to Oct. 1, 2012, may remain in Prime past their 65th birthday, as long as they remain in the USFHP and have no break in coverage. The USFHP is a special Tricare option offered in six specific areas of the country. Retirees enrolled in the USFHP on Oct. 1, 2012, or later must shift to Tricare for Life when they become Medicare-eligible.

Assuming you’re not covered under the USFHP … if your wife serves long enough to become eligible for health care as a retiree herself, you may remain registered in DEERS as her dependent once you turn 65 and shift to Tricare for Life, although that will make no difference in your health care costs. Alternately, since you’re eligible for health care as a retiree in your own right, you may register for Tricare for Life in DEERS under your own sponsorship.

If your wife doesn’t serve on active duty long enough to qualify for retirement benefits, then you, as a retiree, can become the sponsor for your family and she can become your dependent for Tricare purposes.

Tricare for gray-area reservists

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Q. My wife and I use Tricare Reserve Select. I will be retiring from the Reserves when I am about 58; she is three years older than I am. Will we have any options between my retirement and my 60th birthday? Will my wife need to wait for coverage until I turn 60? And when she turns 65, will she go on Tricare for Life while I remain on Tricare Standard?

A. Yes, you do have another option, a relatively new Tricare plan called Tricare Retired Reserve. Like Tricare Reserve Select, Tricare Retired Reserve is a voluntary, premium-based plan for “gray-area” reservists who are no longer in drilling status but are not yet age 60 — exactly what you will be.

There’s one eligibility caveat to Tricare Retired Reserve: You cannot use TRR if you are eligible for Federal Employees Health Benefits coverage.

You can learn more about Tricare Retired Reserve here:

www.tricare.mil/Welcome/Plans/TRR.aspx

Once you turn age 60, you and your wife can be covered under ordinary Tricare Prime or Tricare Standard. Once your wife hits age 65, she will indeed transition to Tricare for Life (Medicare as first payer, Tricare Standard as second payer) while you remain on Prime or Standard until you also reach age 65 and make the same transition. Note: Enrollment in premium-based Medicare Part B is a bedrock requirement for Tricare for Life eligibility.

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.

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.

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.

Can I still get eye exams covered under Tricare for Life?

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I am a military retiree who lives near an Air Force base. I have been using Tricare Prime, but next month I’m eligible for Medicare and Tricare for Life. I’ve been getting bi-annual eye exams and free glasses on base, and I’ve been using them for mammograms and other diagnostic services as well, with no out-of-pocket costs to me. Will I still be able to do that once I have TFL?

Unfortunately, one of the quirks of Tricare for Life is that neither Medicare (the primary payer) nor Tricare Standard (the secondary payer) covers the costs of routine vision and hearing exams or eyeglasses and hearing aids — the very services that Medicare-eligible seniors are most likely to need. However, Medicare does cover a number of other diagnostic services, including mammograms.

The lack of vision and hearing coverage under TFL is the main reason beneficiaries seek out Tricare supplemental policies offered by most of the major military associations. Almost all of these supplemental policies offer vision and hearing coverage, because they know full well that TFL does not. However, before you consider a Tricare supplemental policy, make sure you examine its coverage conditions very carefully to determine whether the premiums would be less than what you’d pay out of pocket for your vision and hearing needs.

How will marriage affect our Tricare options?

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I am an Army reservist who has Tricare Reserve Select. I am in a relationship with an active-duty service member who has Tricare Prime. We are both planning on retiring in the next few years. Upon my partner’s retirement, she will be eligible for Tricare for Life. If we marry either before or after our retirements, what are our options for Tricare? Will I be covered by Tricare for Life with her or will I have to wait until I turn 65? I am 5 years younger than she is.

If you and your partner marry before you retire, you can arrange for her to be your family’s primary sponsor, and you can then sign up for Tricare Prime and drop your Tricare Reserve Select coverage. That will save you some money because your share of the annual enrollment fee for Tricare Prime at the family rate will be about half the total of your monthly TRS premiums over the course of a year.

Once your wife reaches age 65, she will transition into Tricare for Life (Medicare as primary coverage plus Tricare Standard as secondary coverage). Once you reach age 60 and qualify for military retirement benefits, you may stay under Tricare Prime at the individual rate or use Tricare Standard as your only coverage. Once you reach age 65 and become eligible for Medicare yourself, you will also transition into Tricare for Life.