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Turning 65: TRICARE and Medicare

It's important to know how Medicare affects your TRICARE coverage as you approach age 65, and make your Medicare elections.

Remaining TRICARE-eligible
If you are entitled to premium-free Medicare Part A, you must also have Medicare Part B to keep TRICARE, regardless of your age or place of residence (some exceptions are discussed in the Delaying Part B Enrollment section below). Once you have both Part A and Part B, you automatically receive TRICARE benefits under TRICARE For Life (TFL). Keeping your information in the Defense Enrollment Eligibility Reporting System (DEERS) up to date is key to ensuring effective, timely delivery of your TRICARE benefits.

Signing up for Medicare
The month you were born determines when you become Medicare-eligible and when you should visit a Social Security Administration (SSA) office to sign up for Medicare Part A and Part B. See the guidelines that follow and avoid late- enrollment premium surcharges:

  • If you were born on the first day of the month, you become eligible for Medicare on the first day of the month before you turn 65. Sign up for Medicare between two and four months before the month you turn 65. Your TFL coverage begins on the first day you have both Medicare Part A and Part B coverage.

  • If you were born after the first day of the month, you become eligible for Medicare on the first day of the month you turn 65. Sign up for Medicare between one and three months before the month you turn 65. Your TFL coverage begins on the first day you have both Medicare Part A and Part B coverage.

If you live in the United States or U.S. territories (American Samoa, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands) and you already receive benefits from the SSA or the Railroad Retirement Board, you will automatically receive Medicare Part A and be enrolled in Part B at age 65.

In Puerto Rico, Medicare Part A is automatic for those already receiving benefits from SSA; however, Medicare Part B is not. Individuals must sign up for Medicare Part B in Puerto Rico.

If you live outside the United States and U.S. territories, you must apply for Medicare even if you already receive benefits from SSA or the Railroad Retirement Board.

Premium-free Medicare part A
You are eligible for premium-free Medicare Part A if you worked and paid Social Security taxes for at least 10 years (40 quarters total). If you are not eligible through your own work history, you may be eligible for premium-free Part A through your current, divorced, or deceased spouse. If you are not eligible for premium-free Part A through your own or your spouse’s work history, please contact TRICARE to learn how to remain TRICARE-eligible after you turn 65.

Already enrolled in Medicare
If you are already entitled to Medicare due to a medical condition or disability, your Medicare coverage will continue without interruption after you turn 65. If you are paying a premium surcharge for late enrollment in Medicare Part B, it will be removed when you reach age 65. If you are entitled to Medicare Part A, but do not have Medicare Part B, you will be automatically enrolled in Medicare Part B.

Delaying Part B enrollment
If you have group health plan coverage based on current employment, you can sign up later for Part B during a Medicare special enrollment period within the eight months following either (1) retirement or (2) the end of group health plan coverage, whichever comes first. However, without Medicare Part B, you are ineligible for TRICARE.

If you are entitled to premium-free Medicare Part A, you must also have Part B to remain TRICARE-eligible, even if you have group health plan coverage based on current employment. Sign up for Part B before you stop working or lose group health plan coverage to avoid a break in TRICARE coverage. Your TFL coverage begins on the first day you have both Medicare Part A and Part B.

Providers
Under TFL, you can get care from Medicare-participating, nonparticipating, and opt-out providers. Medicare- participating providers agree to accept the Medicare-approved amount as payment in full. Medicare nonparticipating providers do not accept the Medicare-approved amount as payment in full. They may charge up to 15 percent above the Medicare-approved amount, a cost that will be covered by TFL. Providers who opt out of Medicare and enter into private contracts with patients are not allowed to bill Medicare. Therefore, Medicare does not pay for health care services you receive from opt-out providers. When you see an opt-out provider, TFL pays the amount it would have paid (normally 20 percent of the allowable charge) if Medicare had processed the claim; you are then responsible for paying the remainder of the billed charges.

Veterans Affairs (VA) providers cannot bill Medicare, and Medicare cannot pay for services received from VA. If you are eligible for both TFL and VA benefits and elect to use your TFL benefit for non-service connected care, you will incur out- of-pocket expenses when seeing a VA provider. By law, TRICARE can only pay up to 20 percent of the TRICARE-allowable amount. If you receive care at a VA facility, you may be responsible for the remaining liability. If you want to seek care from a VA provider, check with Wisconsin Physicians Service (WPS) to confirm coverage details and to determine what will be covered by TRICARE by calling (866) 773-0404 or visiting www.TRICARE4u.com.

TFL beneficiaries can receive care at military hospitals and clinics on a space-available basis. You may also be able to participate in TRICARE Plus, a program that allows certain beneficiaries to enroll at military hospitals or clinics and have priority access to primary care.

Under TFL, Medicare is the primary payer in areas where Medicare is available (the United States and U.S. territories), and TRICARE pays last. TRICARE is the primary payer for care received overseas unless you have other health insurance and Medicare pays nothing.

Prescription drug coverage
There is usually little or no benefit to purchasing a Medicare have TRICARE. As long as you remain TRICARE-eligible, you do not need Medicare Part D.