TRICARE for LIFE (TFL) is a wraparound package provided by TRICARE and is available to all TRICARE Medicare-eligible beneficiaries if they are enrolled in Medicare Parts A and B. This is regardless of the member’s age or place of residence.
What Does Medicare/Medicaid Entail?
The government operates social health insurance programs which include Medicaid and Medicare. These Medicaid and Medicare Services are for:
- People who have reached the age of 65 or older
- People that are below the age of 65 but have certain disabilities
- People that are suffering from ESRD (end-stage renal disease)
Hospital insurance is covered by Medicare Part A while medical insurance is covered by Medicare Part B.
According to federal legislation, a beneficiary of TRICARE who qualifies for a premium-free Medicare Part A due to the presence of a physical disability or end-stage renal disease is qualified. This is on the basis of the individual being aged 65 years or older. The individual must have Medicare part B coverage in order to remain eligible for TRICARE. The only way this would not apply is if the sponsor is on active duty.
As a family member on active duty who is eligible for Medicare Part A which is premium-free, family members do not necessarily need to have Medicare Part B until the sponsor is in the retirement status and then family members of the sponsor can keep the benefits from TRICARE. Eligible members can enroll in Medicare Part B during a special open enrollment period. Family members must have access to the enrollment period when the military sponsor is on active duty or within a period of approximately 8 months after his or her retirement. There is a break in the TRICARE coverage if members are enrolled in Medicare Part B after the date of a sponsor’s retirement.
If you are not enrolled during the period for enrollment, you have an opportunity to enroll in Medicare Part B during the general open enrollment time period. This time frame is usually between the dates of January 1 and March 31. TRICARE coverage will be ineffective until July 1 because that is when the Medicare Part B coverage will begin. There is a possibility that you would be charged a 10% of your Medicare surcharge if you did not enroll for Medicare Part B within a period of 12 months in which you were eligible to enroll for the program.
For those who are considered eligible for premium-free Medicare Part A coverage and are enrolled in the United States Family Health Plan of the United States (which is accessible in approximately six locations), a Medicare Part B plan for family coverage in the United States is not necessary. However, it is encouraged by the Department of Defense that individuals should enroll in Medicare Part B as soon as you are deemed eligible. You will not be considered eligible for other programs offered by TRICARE if you have Medicare Part B and you move out to an area which does not have the United States Family Health Plan or if your enrollment is withdrawn. You can always find more information online about the United States Family Health Plan.
TRICARE Reserve Select
For those who are considered eligible for a premium-free Medicare Part A plan and have enrolled in the TRICARE Reserve Select program, it is not necessary to have Medicare Part B. However, it has been strongly advised by the United States Department of Defense that individual enroll in Medicare Part B when you are first considered eligible. Although you are considered by TRICARE as a family member on active duty while you are in the TRICARE Reserve Select program, your sponsor is not considered by Medicare to be actively employed by the military.
Disability: After the 25th month from the date you started receiving Social Security disability payments, you should be considered eligible for premium-free Medicare Part A and Part B with payment of a monthly premium. The Social Security Administration will notify you of your start date of your Medicare eligibility. You have to ensure that the dates for Medicare Part A and Part B dates match if your disability claim is awarded to you retroactively. If the dates do match, TRICARE will recover the payments that have been made for claims that you paid when you had a Medicare Part A coverage but didn’t have Medicare Part B. You will still continue to receive your Medicare benefits for up to 4 1/2 years after your payments for disability have ended. You still need to have Medicare Part B during this period in order for you to remain eligible for TRICARE coverage.
ESRD: For those with end-stage renal disease (ESRD), it is not automatic for you to receive Medicare coverage. In order to receive Medicare benefits, you must file an application. If neglect to file for these Medicare benefits, it would result in you losing TRICARE coverage.
Your Coverage for Medicare Would Begin:
- The fourth month during which you have been going through renal dialysis
- The month of your admission to a hospital that is Medicare-approved in order to receive a kidney transplant or in the two months after your admission
- Two months prior to the transplant if it has been delayed for a period of more than two months after your admission to the hospital
Age: The age requirement for full payment for Social Security is slowly increasing from the age of 65 to 67. However, to receive Medicare, the age remains at 65 years old.
If you or your spouse has paid into Social Security for a minimum period of 10 years of work, you would be considered eligible for Medicare Part A premium-free. You will lose your coverage for TRICARE if you do not file for the Medicare benefits.
There are numerous provisions to consider when considering Medicare and TRICARE so that you are not left without benefits. You will receive Medicare Part A automatically and would be enrolled in Medicare Part B beginning the initial day of the month when you turned 65 years old if you receive benefits from the Railroad Retirement Board, Social Security, or the office of personnel management. Medicare Part A would be effective on the first day of the preceding month if your birthday happens to fall on the first date of the month.
You need to have file an application for Medicare Part A and Part B if you haven’t yet applied for Railroad Retirement Board benefits, Social Security benefits, or an annuity received from the personnel management office. You need to enroll in Part B during the initial Medicare enrollment period if you want to prevent being penalized for late enrollment.
The initial enrollment period for Medicare is a period of seven months that starts three months before you reach the age of 65 or a period of four months if your birthday falls on the first day in the month. It is advised to enroll during in Medicare about three-four months before you turn 65 years old in order to prevent a lapse in TRICARE coverage. The effective date for your part B and your TRICARE coverage could be delayed if you wait till you become 65 years or if you are enrolled during the final three months of your initial enrollment period.
Those who are eligible for Medicare Parts A and B are considered to beeligible for Medicare part D (Medicare drug prescription coverage). Beneficiaries who are in jail or are overseas would not be eligible for receiving Medicare Part B.
You will still have your TRICARE benefits even if you are not enrolled in Medicare Part D. You would not pay the Medicare part D penalty for late enrollment if you enroll outside your intial enrollment period. This is because the prescription drug coverage plan can be regarded as creditable coverage.
In order minimize your out-of-pocket expenses, TRICARE is in the position of your secondary benefit program even though your primary insurance is Medicare. The covering of Medicare’s deductible and coinsurance is part of TRICARE’s benefits.
For those that use a non-participating or participating Medicare provider, your claims with Medicare would be filed by specific personnel. A portion of Medicare is paid and the claim is electronically forwarded to the claims processor for TRICARE for Life (TFL). The provider is directly paid by TFL for services covered by TRICARE. For services that are covered by TRICARE and Medicare, the first payment is made by Medicare and your remaining coinsurance for services covered by TRICARE is paid by TFL.
You are not required to pay enrollment fees for using TFL, but you have to pay monthly premiums for Medicare Part B. Your income is used to determine the amount of premium you should pay to obain Medicare Part B. For more information you can visit Medicare online.