What happens when I get Medicare before age 65?
September 3rd, 2010 | TriCare Help | Posted by Military Times
Q. I have a question about Medicare and Tricare, but all the info I find is for people over 65 and I am only 49. My husband is retired military and we have both been on Tricare Prime. About two years ago I became disabled and am getting disability each month. Now I have received a letter saying I am on Medicare. I called and they said if I want to continue getting my disability check I have to take Medicare part A and B. They told me to keep Tricare for the supplemental and keep the prescription benefits. Can I do that? They also say that I cannot have Tricare Prime, but can I have Tricare Standard while my husband keeps Prime.
If a Tricare beneficiary becomes entitled to Medicare at any age or for any reason, federal law requires him or her to be enrolled in Medicare Part B on the same date as Medicare Part A eligibility becomes effective.
Failure to be enrolled in Medicare (Part B) at the same time Part A is effective will result in the immediate loss of all Tricare eligibility until the beneficiary has Medicare (Part B) in effect.
A Tricare beneficiary cannot have Medicare Part A and Tricare unless he or she is enrolled also in Medicare Part B.
There are two exceptions to that provision of federal law:
- Active-duty family members.
- Tricare beneficiaries who are enrolled in the US Family Health Plan, a particular plan formed from some former US Public Health Service system of hospitals and clinics. (If you do not know what that is, it is very unlikely that you are a member.)
If a Tricare beneficiary is enrolled in Medicare Part A and Part B, he or she is automatically eligible for the Tricare plan called Tricare for Life, or TFL.
TFL members are no longer eligible for Tricare Prime. Their Tricare Prime membership will be switched to Tricare Standard automatically.
They must seek all their medical care from Medicare providers only. A Medicare provider is one that will file Medicare claims for all the services it provides. Medicare will pay its share directly to the provider. Then, it will forward the claim to Tricare Standard which will pay whatever Medicare did not pay on the vast majority of claims — those for medical services that are covered also by Tricare or by Tricare only.
On those claims, Tricare Standard will act as the beneficiary’s free Medicare supplement. The combined payments by Medicare and by Tricare will pay the Medicare claim, and the provider’s bill, in full.
If the Medicare claim contains a service payable only by Tricare, such “Tricare only” claims will be subject to all Tricare Standard claims processing requirements including those for the Tricare deductible and cost care provisions.
Your transition from Tricare Prime to Medicare (A and B) plus Tricare Standard results in your eligibility for Tricare for Life. That change in your eligibility will have no effect on your husband’s Tricare Prime eligibility. His Tricare Prime coverage will continue unchanged.
You will no longer pay $230 per year for your Tricare Prime, but you will be required to pay a monthly premium for Medicare Part B. That premium is required by federal law and is unavoidable. The premium will be deducted from your monthly disability checks.
As you will no longer be eligible for Tricare Prime and must now use Medicare providers only, you will no longer be able to use the military hospital as you did in the past. If you do not use a Medicare provider, your claims will not be paid in full. Only the Tricare Standard portion of your TFL benefits will be paid. That will be subject to the Tricare deductible and cost share. When your Medicare benefits are in effect, you must use Medicare providers only.
As Tricare Standard will be part of your TFL coverage, you will retain your Tricare pharmacy benefits as they have always been. Do not enroll in Medicare Part D, the Medicare Pharmacy Program. You do not need it. Health Affairs does not recommend it.
If you have already enrolled in Part D, you can call Medicare to cancel it without penalty.
For more information about Tricare for Life visit the Tricare website, where you can also download a free handbook.
Tags: Medicare, Part A, Part B, Tricare For Life, Tricare Prime
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