DECEMBER 15, 2023 – Will you be eligible for Medicare soon? You may have questions about the different parts of Medicare and how they interact with TRICARE For Life (TFL).
“TRICARE For Life is Medicare-wraparound coverage. This means Medicare and TRICARE work together to coordinate your benefits and reduce your out-of-pocket medical costs,” said Anne E. Breslin, TRICARE For Life Program Manager. “You’ll pay nothing out of pocket when the services you receive are a benefit of both Medicare and TRICARE.”
TFL coverage is automatic if you have Medicare Part A and Part B. But what do these terms mean? And how does TFL work with about Medicare Part C and Part D? Read on to learn more.
Q: Who is eligible for Medicare and TFL?
A: Most people become eligible for Medicare the month they turn age 65, as described in the TRICARE and Medicare Turning Age 65 Brochure. You may be eligible earlier if you receive Social Security disability benefits or have certain other health conditions. To learn more about the impact of Medicare eligibility before age 65 on TRICARE eligibility, see the TRICARE and Medicare Under Age 65 Brochure.
TFL is available to military retirees and their eligible dependents who are eligible for TRICARE and have Medicare Part A and Part B. This is regardless of your age or where you live. TFL is an individual entitlement. This means family members who aren’t eligible for Medicare stay eligible for TRICARE Prime or TRICARE Select.
Q: How do I get TFL coverage?
A: Your TFL coverage automatically begins the first day that you have both Medicare Parts A and B. There are no TFL enrollment forms or enrollment fees.
To avoid a gap in your TRICARE coverage, make sure you’re enrolled Medicare Part A and Medicare Part B at least two months before you turn age 65. You can sign up for Medicare on the Social Security website or by contacting the Social Security Administration to set up an appointment.
Check out the TRICARE For Life Handbook to learn more about signing up for Medicare.
Q: What are the different parts of Medicare? Which ones do I need to have TFL?
A: You need to have Medicare Part A and Part B to have TFL.
Medicare Part A is hospital insurance. It covers inpatient costs for hospital care, skilled nursing facility care, hospice care, and some home health care.
Note: Most people are eligible for premium-free Medicare Part A if they or their spouse worked and paid Social Security taxes for at least 10 years. If you aren’t eligible for premium-free Medicare Part A, based on your own record, you may be eligible for Medicare on a current or former spouse’s record.
Medicare Part B is medical insurance. Coverage includes outpatient care, home health care, durable medical equipment, and some preventive services. Medicare Part B has a monthly premium based on your income.
You don’t need Medicare Part C or Part D to have TFL.
Medicare Part C refers to Medicare Advantage plans. Private companies contract with Medicare to offer these plans. Coverage includes Medicare Part A and Part B. Some plans also include vision, dental, and prescription drug coverage.
Medicare Part D is prescription drug coverage. Private companies contract with Medicare to offer these plans.
Q: What should I know about the optional parts of Medicare (Part C and Part D)?
A: With Medicare Part C, you’ll pay a monthly premium in addition to your Medicare Part B premium. If you choose to enroll in Part C:
- You must get all nonemergency health services from that plan’s network of providers.
- You’ll pay copayments at the time of service.
- You’ll need to file paper claims for TRICARE to reimburse you for TRICARE-covered services you receive.
If you need dental and vision coverage, you may qualify to purchase this coverage through the Federal Employees Dental and Vision Insurance Program.
You don’t need to enroll in Medicare Part D to have drug coverage. With TFL beneficiaries remain eligible for the TRICARE Pharmacy Program.
If you enroll in Medicare Part D, you’ll pay a monthly premium. You’ll also need to follow your Medicare Part D plan’s rules for where to get \prescriptions. Learn more about using Medicare Part D with TRICARE.
Q: Does Medicare or TRICARE pay first?
A: If both Medicare and TRICARE cover the service, TRICARE pays last. However, Medicare doesn’t cover all services that TRICARE covers. Be sure to check whether your health care services are covered by Medicare, TRICARE, or both, so you aren’t surprised by any out-of-pocket costs.
Q: What if I have other health insurance?
A: TFL pays after Medicare and other health insurance (OHI), such as insurance based on your or your spouse’s current employment. Find more information about how Medicare and TFL interact with OHI in the TRICARE for Life Handbook.
Be sure to explore all your options and enroll in Medicare at least two months before you turn 65 to avoid any gaps in TRICARE coverage. Keep your contact information up to date in the Defense Enrollment Eligibility Reporting System to ensure timely delivery of your TRICARE benefits.
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Courtesy Story
Defense Health Agency