Available to all the beneficiaries of TRICARE, the TRICARE for Life (TFL) is a wraparound health care benefit plan and is offered regardless of the place of a member’s residence and the age. Coverage is automatic if a member has Medicare Part A and Part B plans. Enrollment is not a requirement but Medicare Part B premiums must be kept paid and up-to-date. When members are in the United States or U.S. territories, TRICARE is the secondary payer after Medicare. In overseas areas, TRICARE is the primary payer for medical care.
What is Medicaid/Medicare?
The Centers for Medicare and Medicaid Services oversees Medicaid and Medicare as a part of the Department of Health and Human Services as regulated by the United States federal government. Medicare is a health insurance program offered to:
- People who are the age of 65 years or older
- People under the age of 65 with certain disabilities
- People with renal disease in the end stage
Medicare Part A covers hospital insurance while Medicare Part B covers medical insurance. It is essential to have Medicare Part B coverage under the federal law if one wishes to take advantage of TRICARE, and for those who will become eligible for premium-free Medicare Part A coverage due to any disability or upon reaching the age 65 years old. The only exception to this case is when one is being sponsored while serving in active duty.
If an individual is an active member and eligible for premium free Part A program under Medicare, then there isn’t any strict rule to have the Part B program under Medicare until the sponsor’s retirement. During a special enrollment period, individuals can enroll in the Medicare Part B program. The special enrollment program is made available to the member whenever the sponsor is on active duty or immediately within the first eight months following the retirement of the sponsor. The TRICARE coverage will be stopped when enrollment under the Medicare Part B program is completed after the retirement date of the sponsor. It is best to enroll in the Medicare Part B program right before the sponsor’s retirement date to avoid any break in the coverage.
If enrollment is not completed during the special enrollment period, then it can be done during the general enrollment period which starts on January 1 and runs until March 31. The Medicare Part B coverage begins on July 1. Due to this, TRICARE doesn’t become effective until July 1. The member also becomes should pay a 12 month, 10% surcharge for enrolling in Medicare Part B. There isn’t any need to enroll for the Medicare Part B coverage when one is eligible for premium-free Medicare Part A coverage and is also covered by the U.S .Family Health Plan that is offered in six locations. However, the Department of Defense, (DOD), strongly recommends that an individual go ahead and enroll in Medicare Part B upon eligibility. A member is not eligible for the TRICARE program if the individual is not enrolled under Medicare Part B, or if the person moves to a non-U.S. Family Health Plan covered area, or if the person withdraws from the U.S. Family Health Plan enrollment. A fee of 10% is to be paid during the 12-month period when enrollment under the Part B program is not completed during the eligibility phase.
If you are an individual who qualifies for Medicaid, you can receive coverage through TRICARE or the VA. This helps individuals who are veterans to lessen medical expenses. Medicaid often covers some services and procedures that the VA or TRICARE may not cover. Sometimes it offers people more options for long-term care services or an increased list of medical providers. If you apply for Medicaidi while receiving health plan coverage as a person who is a veteran, you need to notify the Medicaid program office within your state so that you can get signed up for the correct services that will best suit your needs.
TRICARE Reserve Select Members
There isn’t any strict rule that it is necessary to have enrollment under the Medicare Part B program when one becomes eligible for premium-free coverage under the Medicare Part A program and has already enrolled for the TRICARE Reserve Select (TRS) plan. However, the DOD highly stresses the importance of enrollment under the Part B program during the eligibility period. Medicare doesn’t consider the sponsor to be actively employed under the military even though TRICARE treats the applicant as a family member of an active duty member.
Beginning on the 25th month of receiving the Social Security disability payments, a person becomes eligible for Medicare Part B (upon paying the required monthly premiums) and Medicare Part A (which is premium-free). The notification of the entitlement period of the Medicare program is provided by the Social Security Administration (SSA). It is vital for the Medicare Part A and Part B dates to match if the Medicare entitlement and disability claim are awarded to the applicants retroactively. TRICARE can recoup payments for the claims made when a member has coverage under the Part A plan and not under the Part B.
The Medicare entitlement remains active even after the end of disability payments. This remains active for up to 4 1/2 years. During this phase, however, one is still required to have Medicare Part B coverage to maintain eligibility for the TRICARE program.
End-Stage Renal Disease (ESRD)
No automatic coverage is offered to people who are suffering from ESRD. An application should be filed in order to obtain benefits under the Medicare program. There is a loss of TRICARE coverage when individuals fail to file to claim Medicare program benefits. Medicare coverage begins from:
- The fourth month of the renal dialysis period;
- The month one is admitted for a kidney transplant in an approved hospital under the Medicare program or within two months; and/or
- Two months before the start of the transplant process if it is delayed after a person has been admitted to the hospital.
The age has gradually increased from 65 to 67 for entire Social Security payments. The eligibility for age limit has not changed and still remains to be 65 years old.
- One becomes eligible for premium-free Medicare benefits at the age of 65 if the spouse or the applicant has paid for Social Security. TRICARE coverage becomes invalid when one fails to file for the Medicare Part B benefits program.
- If the benefits from the Railroad Retirement Board (RRB) or the Social Security Benefits are being received, then a person is automatically entitled to receive benefits through Medicare Part A and becomes enrolled in the Medicare Part B program from the very first day that the applicant turns 65. Medicare Part A coverage becomes effective the very first day of the month when the birthday of the applicant falls on the first of any month.
- If a person hasn’t filed an application for the RRB benefits, federal annuity, or for Social Security benefits from the Office of Personnel Management, then the applicant must file for Medicare Part A and Part B coverage. To avoid any additional fees upon submitting a late application, it is critical to enroll in Medicare Part B when the Medicare Initial Enrollment Period (IEP) is open. This is a seven-month time frame which begins three months before the applicant reaches the age of 65 year old.
- It is recommended to enroll in the TRICARE coverage 3-4 months before an individual turns 65 years old in order to avoid any breaks in medical coverage. If putting off enrollment during the IEP phase, this could result in TRICARE coverage going into effect.
Medicare Part D coverage is available to anyone who is eligible for the Part A and Part B Medicare plan benefits. Beneficiaries who are in prison and those living overseas aren’t eligible for Medicare Part D coverage. There is no need for individuals to enroll separately for the Part D program to retain the TRICARE benefits that will begin. No penalty fee will need to be paid during the IEP.
Medicare is a primary insurance and TRICARE acts as a secondary coverage that minimizes the expenses of a beneficiary when living in the United States or U.S. territories. Medicare claims are filed by non-participating or participating providers. The portion is paid by Medicare and forwarded on to the TRICARE for Life claims processor electronically. The provider is paid directly by TRICARE for Life for the services covered under the TRICARE program. Medicare pays first and then TRICARE for Life kicks in when a beneficiary is covered by both TRICARE and Medicare.
There isn’t any need to pay enrollment fees while using TRICARE for Life. However, Medicare Part B requires the payment of premiums. The program coverage is entirely dependent on the income of the beneficiary. For any further information on the Medicare Part B program, visit www.medicare.gov.