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Medicare-eligible under 65. What now?

I am a retiree under 65 years of age, 100 percent disabled, and on Social Security. I previously had myself and my wife on TRICARE Prime, but now I'm getting a message about Medicare. What guidance might you have about Medicare Part B or any other advice?

You don't say exactly when you retired from the military or went on Social Security, but you are eligible for Medicare earlier than age 65 because of your 100 percent disability rating. As such, you can't use TRICARE Prime; your only option is TRICARE for Life, which consists of Medicare Part A (free in-patient hospitalization coverage) and Part B (premium-based outpatient coverage) as first payer, and TRICARE Standard as second payer.

Note: You must enroll in Medicare Part B and pay the premiums—about $100 a month for most beneficiaries—in order to use the TRICARE portion of your TRICARE for Life benefit.

That said, the fact that you are 100 percent disabled throws a slight wrinkle into your situation.

Many TRICARE for Life beneficiaries with service-connected disabilities choose to use VA facilities for healthcare related to those disabilities. And that's fine—they are perfectly free to do that.

But because TRICARE for Life is comprehensive Medicare wrap-around coverage, beneficiaries run the risk of unexpected out-of-pocket costs if they use a VA facility for care that is not related to their service-connected disabilities.

That's because, by law, Medicare can't pay for care at a government facility (such as a VA hospital). And when a TRICARE for Life beneficiary chooses to obtain care from a provider that Medicare cannot pay, TRICARE Standard—as second payer under TRICARE for Life—pays only up to 20 percent of the TRICARE "allowable charge" (the amount TRICARE is legally allowed to pay for any given service or procedure). This means the beneficiary is responsible for paying the VA for the other 80 percent of the bill.

Because of this, TRICARE and the VA both recommend beneficiaries with service-connected disabilities go to VA facilities for care specifically related to those disabilities.

For other care, TRICARE for Life beneficiaries may still consider using their VA benefit—keeping in mind the cost caveats mentioned above—or they can use TRICARE for Life through a Medicare-certified provider. When using Medicare providers, TRICARE for Life beneficiaries typically have zero out-of-pocket costs for health care services covered by both Medicare and TRICARE.

 

This article reprinted with permission from Military Times.