Do Tricare benefits kick in at age 60 or 65?
May 11th, 2012 | TriCare Help | Posted by Military Times
You have said that retired reservists can begin receiving Tricare benefits at age 60. When I retired I was informed that the health benefits are free when you are eligible for Medicare at age 65. Which is correct?
Both statements are correct; you’re talking about two different things. When retirement-qualified reservists reach age 60, they become eligible for military health care benefits in the form of Tricare Prime or Tricare Standard. Tricare Prime charges an annual enrollment fee of $230 for an individual and $460 for a family for those enrolled before Oct. 1, 2011, and $260 for an individual and $520 for families for those enrolled after that date. Prime has no annual deductibles. Tricare Standard does not charge an annual enrollment fee, but retirees must pay annual deductibles of $150 for an individual and $300 for a family.
When retirees reach age 65 and become eligible for Medicare, they transition to the program known as Tricare for Life. At the moment, TFL charges no enrollment fees or deductibles, but the program does require retirees to have Medicare Part B, which carries a premium of about $100 a month.
Retirees also pay some out-of-pocket costs for prescription drugs under all Tricare programs.
Why won’t Tricare talk to me about daughter’s claim?
March 7th, 2012 | TriCare Help | Posted by Military Times
My daughter attends college in another state. She is 20 and still covered by my Tricare. She called me recently because she was having trouble with a claim, but when I called Tricare to try to straighten it out, they refused to help me, saying the Privacy Act wouldn’t allow them to talk to me about my own daughter. I tried to explain she was my dependent, even gave them my Social Security number to prove I was who I said I was, but they wouldn’t listen to reason. Who can I talk to at Tricare to make sure other parents don’t go through this?
You may not like this answer, but for purposes of the Privacy Act, your daughter became an adult when she turned 18. She, alone, has the authority to grant someone else access to her Tricare claims and other personal information. That’s easy to arrange, however: She needs to give you a signed and dated written authorization. If she agrees, contact your Tricare Service Center to learn how to proceed.
If it ever becomes necessary to file an appeal of a denied Tricare claim, and if your daughter wants you to deal with the matter on her behalf, she must provide with the appeal a signed and dated statement appointing you as her representative on the appeal.
Just found out Dad isn’t signed up for Part B; what now?
October 21st, 2011 | TriCare Help | Posted by Military Times
My father, an Army retiree, turned 65 in April and has not yet enrolled in Medicare Part B. Are there any penalties for late enrollment? He was recently hospitalized, and I need to know the quickest, and easiest way to help him do this right away so as his insurance doesn’t deny all the bills that he recently had.
If a Tricare-eligible retiree or retiree family member becomes legally entitled to free Medicare Part A, federal law requires that he must be enrolled also in Medicare Part B at that same time. Failure to be enrolled also in Part B results in the immediate loss of Tricare eligibility until the beneficiary has Medicare Part B in force.
Your father should immediately contact the Social Security Administration at 1-800-772-1213 for guidance to enroll in Medicare Part B.
The legal provision to which I refer is part of the law that governs Tricare eligibility. It does not apply to active duty family members or to civilians.
Without delay, your father also needs to contact the Defense Enrollment Eligibility Reporting System, better known as DEERS, at 1-800-538-9552 for an official determination of his Tricare eligibility.
If your father is not enrolled in Part B, it is most likely that his Tricare eligibility was automatically terminated on the first day of the month when he turned 65.
It is unlikely that he can get retroactive coverage for care he received while he was ineligible, but DEERS can give you an official answer.
Do I really have to buy the Young Adult Plan for my daughter?
October 6th, 2011 | TriCare Help | Posted by Military Times
Under Obama’s health care reform, children can be covered under their parents’ policy as long as the child is single and younger than 26. I have a daughter who just graduated from college. She is 22 and is in the process of looking for a job. I have the family plan with Tricare that costs between $450 to $500 per year. Can my daughter still be covered under this family plan? I spoke with one office and was told that I would have to buy young adult insurance for a fee double what the family plan is now costing me. Which is correct?
Because your daughter has reached her 21st birthday but is no longer enrolled as a full-time student, her only option for Tricare eligibility is under the Young Adult Plan.
If she were to enroll again as a full-time student, her Tricare eligibility could be restored for as long as she was enrolled, but only until she turned 23. Then, as now, she could be eligible only under the Young Adult Plan until reaching age 26.
To officially confirm which Tricare plan your daughter is eligible for, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Can I get Tricare for Life if my father was retired military?
September 21st, 2011 | TriCare Help | Posted by Military Times
I was told today by a co-worker that if my father, who is deceased, was retired military, I could receive Tricare as a secondary insurance with Medicare when I turn 65. Could my husband and I qualify for this?
From the information in your letter, it doesn’t sound likely. Certain unmarried, dependent children of a retired or deceased uniformed service members may be eligible for Tricare — but only until they marry or turn 26 years old. Those eligibility rules are established by federal law.
For an official answer to all questions regarding Tricare eligibility, however, please call the DEERS Support Office at 1-800-538-9552.
Does daughter stay eligible if she gets married?
August 8th, 2011 | TriCare Help | Posted by Military Times
Q. I’m a disabled veteran and both my children are currently covered by my Tricare. My daughter thinks that if she gets married, she will still be able to use my Tricare until she’s 26. I don’t think that’s correct. Who’s right?
You are. Under both Tricare’s original 1966 legislation (as amended) and the new law extending children’s eligibility under the parents’ insurance, children lose Tricare eligibility if they marry.
Remember that Tricare eligibility is established by federal law; Tricare does not have the authority to determine whether a given individual meets all the legal criteria for Tricare eligibility. Only the services have that authority by law.
To confirm that with an official source, please contact the DEERS Support Office, toll-free, at 1-800-538-9552.
How do I keep coverage for younger husband when I get TFL?
March 25th, 2011 | TriCare Help | Posted by Military Times
Q. I’m a retired reservist and retired federal employee with employees’ health insurance. I have a civilian husband who is three years younger, but no children. I’ll be 65 in August and get Medicare and Tricare for Life. What can I do at that time to ensure I still have coverage for my husband?
When you transition to Tricare for Life on Aug. 1, your husband’s federal employee plan and Tricare coverage will continue unchanged until he gets Medicare at age 65 — assuming you keep your own coverage under the federal employees plan. Family members can’t be covered unless the former employee also is covered. Confirm this with the Office of Personnel Management.
For your own transition, you should apply for Medicare Part A and Part B at least 90 days before Aug. 1. If you enroll properly, your coverage will be effective on that date. If your Defense Enrollment Eligibility Reporting Service record reflects your Part B enrollment, you will retain your Tricare eligibility and become eligible for TFL.
TFL consists of full coverage by Medicare Parts A and B plus Tricare Standard. Because you must retain your federal employee plan coverage for your husband’s benefit, however, that plan — not Tricare — will be second payer on your Medicare claims. Tricare Standard will be last payer, and you must file those claims yourself.
Call the DEERS support office at 800-538-9552 to check the accuracy of your and your husband’s DEERS records.
Can graduate students keep Tricare?
March 21st, 2011 | TriCare Help | Posted by Military Times
I am enrolled as a full-time student in college and am covered under Tricare. I will graduate this spring but I will be enrolling in medical school during the summer. Will I still be covered as a full-time student under Tricare until I am 23, or is the full-time student eligibility only applicable to undergraduates?
Whether your eligibility will continue depends on your enrollment status with your university, not the program you are in.
If you are officially enrolled in a full-time student status, your Tricare eligibility will continue until you marry, graduate and leave school, or reach your 23rd birthday, whichever comes first.
For an official reply to your question, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
What happens to my Tricare Prime when I turn 65?
March 8th, 2011 | TriCare Help | Posted by Military Times
How much is Tricare for Life, and do I have to pay for Medicare supplements when I reach 65? (I have Prime now.)
Most Tricare beneficiaries become eligible for the Tricare plan called Tricare for Life (called TFL for short) when they become entitled to free Medicare Part A, are enrolled in Medicare Part B, and are appropriately registered in the database of the Defense Enrollment Eligibility Reporting System, best known by its acronym, DEERS. That usually comes about on the first day of the month when the beneficiary will have his or her 65th birthday.
The Social Security Administration advises potential Medicare beneficiaries to apply for Social Security benefits at least 90 days prior to the first day of the month when he or she will be 65 years old. That gives the agency time to do the required paperwork.
TFL consists of full coverage by Medicare Part A and Part B plus full coverage by Tricare Standard. Beneficiaries registered in Tricare Prime will have that coverage switched automatically to Tricare Standard when they become eligible for TFL. TFL beneficiaries, then, are covered by two full service, high quality federal health benefit plans, each of which acts as a health insurance policy, and one of them is free.
Under TFL, the beneficiary’s primary coverage is Medicare. All care must be received from a provider that is registered with Medicare and is authorized to file Medicare claims for medical services provided to Medicare beneficiaries, as under TFL.
Medicare will process the claim and pay its legally authorized share directly to the provider. That will usually be 80 percent of the amount Medicare approves of the cost of the medical service(s) after satisfaction of the Medicare deductible. The remaining 20 percent is the patient’s copayment.
When Medicare completes processing and pays its share, it will automatically forward the claim to Tricare Standard. For all services that are covered by both Medicare and by Tricare, Tricare will pay the balance on the Medicare claim (whatever Medicare did not pay — usually the patient’s Medicare deductible and copayment). Medicare’s payment plus Tricare’s will pay the patient’s Medicare claim in full. As a result the TFL beneficiary has no out-of-pocket expenses for his or her Medicare- and Tricare-covered medical services. Claims of that type constitute the vast majority of a TFL beneficiary’s health care claims.
If the beneficiary receives care that is covered by only one of his two plans — that is, a service covered only by Medicare or covered only by Tricare — the beneficiary must pay out-of-pocket the part of the claim that plan does not pay. That is, if a service is covered only by Medicare but not by Tricare, as for example, chiropractic care, the patient must pay whatever Medicare does not pay, such as the Medicare deductible and copayment on that particular claim because Tricare, in that case, may pay nothing. Such claims will be uncommon.
Under TFL, the patient is primarily a Medicare beneficiary. He must get all his care from Medicare providers only. As last payer, Tricare will act as a free Medicare supplement. No other supplement is needed. As Medicare Part A is free and Tricare Standard is free, the only cost for TFL coverage is the monthly premium for Medicare Part B. That premium must be paid by all Medicare beneficiaries who are enrolled in Medicare Part B. To learn the premium amount for 2011, call Social Security.
Federal law requires the vast majority of TFL beneficiaries to be enrolled in Medicare Part B. The only people excluded from that rule are certain active-duty family members who become entitled to Medicare under Social Security rules for certain disabled persons.
For official information about a given individual’s Tricare and/or TFL eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552. For information regarding Medicare eligibility, please call the Social Security Administration.
Can my wife keep Tricare if I drop it?
February 8th, 2011 | TriCare Help | Posted by Military Times
Q. I’m over 65 and am enrolled in Tricare for Life. My wife is 63 and enrolled in Tricare Prime. If I decide to drop TFL and go with a private carrier supplement, can my wife continue to be enrolled in Tricare Prime until she’s 65?
Yes. Regardless of what you do, your wife can retain her Tricare Prime coverage until she becomes entitled to Medicare and Tricare for Life, probably at age 65.