Eligibility depends on sponsor’s age, not spouse’s
February 2nd, 2011 | TriCare Help | Posted by Military Times
Q. I retired from the reserves in 2008 at age 48. My wife is 7 years older than I am. Will she be eligible for Tricare when she reaches 60, or when I reach 60?
You and your wife will become eligible for Tricare on your 60th birthday, at the same time you become entitled to retired pay.
For official information, all questions regarding Tricare eligibility should be referred to the DEERS Support Office by calling, toll-free, 1-800-538-9552.
News update: DoD expands Tricare coverage for older children
January 14th, 2011 | TriCare Help | Posted by Military Times
What will happen to my coverage after husband dies?
January 7th, 2011 | TriCare Help | Posted by Military Times
Q. My husband retired from the Navy in 1992. He is now 80 years old and uses Tricare as secondary coverage for Medicare. I am still working at age 51. We have been married since 1988. Will I remain a military dependent after my husband is no longer alive? If so, will I be eligible for Tricare when I reach Social Security Retirement age?
Unless you remarry, your husband’s death will have no effect on your Tricare eligibility. If you remarry, your Tricare eligibility under your present husband’s sponsorship will terminate immediately. If the second marriage ends in divorce or death, eligibility under your present husband cannot be restored regardless of circumstances.
You can ensure that you are properly registered and eligible for Tricare at this time by calling the Defense Enrollment Eligibility Reporting System (DEERS), toll-free, at 1-800-538-9552. If there is a problem, ask DEERS how to fix it. It is your responsibility to keep your DEERS record and military identification card up-to-date.
If you become entitled to free Medicare Part A at age 65 and enroll in Medicare Part B, you will become eligible for Tricare for Life, or TFL for short. Under TFL you will have full benefits of Medicare Parts A and B as your primary coverage and Tricare Standard as a free Medicare supplement for all medical services that are covered by both Medicare and be Tricare. The vast majority of your Medicare claims will be of that type.
Under TFL, if you receive a medical service that is covered by Tricare but is not covered by Medicare, Tricare will process a claim for that item as if it were your only health insurance. In that case, all Tricare claims processing rules will apply including the Tricare cost share and, if applicable on that claim, the Tricare deductible.
Some people become eligible for free Medicare Part A before they are 65 under a Social Security plan for disabled persons. If they enroll in Part B, they become eligible for TFL just as if they were 65. Call the Social Security Administration about Social Security disability benefits. Social Security cannot give you official information about Tricare or Tricare for Life.
For more information about Tricare Plans, including TFL, please go the official Tricare website. You will also find contact information for your Regional Tricare Office at that site.
Can younger wife get different kind of Tricare?
January 5th, 2011 | TriCare Help | Posted by Military Times
Q. I am going to get married to a lady who is a lot younger than 65 and was wondering, can I put her on Tricare while I am on Tricare for Life?
What is the cutoff age for retirees’ children?
December 27th, 2010 | TriCare Help | Posted by Military Times
What is the cutoff age for a military retiree’s children to obtain a military ID card if he or she is enrolled in an accredited school?
By federal law at this time, the Tricare eligibility of a child who is enrolled as a full-time student at an accredited university, college, or trade school ends at marriage, graduation, termination of full-time status for any reason, or by reaching age 23, whichever occurs first.
For an official response, this question, and all others regarding Tricare eligibility should be referred to the DEERS Support Office by calling, toll-free, 1-800-538-9552. I suggest you call that office for confirmation of the above. Tricare Help cannot provide official responses regarding any Tricare matter.
DEERS is a federal agency. All information is confidential and protected by the Privacy Act.
When can dependents get Tricare until age 26?
November 10th, 2010 | TriCare Help | Posted by Military Times
Q. My daughter is a full-time student, and at age 23 she was dropped from my health coverage. Under the new health care plan, will she qualify for coverage again until 26 years of age?
The new law applies only to commercial health insurance policies and companies. Tricare, however, is not a health insurance policy or company. It is a federal health benefits program similar in that respect to Medicare. Thus, the new law does not apply to it.
An initiative has been introduced to apply that part of the law to the children of active duty and retired members and extend their eligibility to age 26. At this time, however, such a change is in the hands of Congress, and the old law remains in effect until Congress acts to change it.
If and when Congress approves the initiative, it will be widely publicized.
Why can’t students keep Tricare coverage until age 26?
October 14th, 2010 | TriCare Help | Posted by Military Times
Q. I want to know why Tricare does not extend the benefit for college students intil the age of 26. You would think that would be a big help to the military family. Why shouldn’t the military community have this benefit?
The new health care reform law enacted by Congress earlier this year applies to health insurance policies and companies.
Tricare is neither health insurance nor an insurance company. It is a federal health benefits program created by Public Law 89-614, effective on July 1, 1966. As a result, the new law does not apply to Tricare.
All Tricare operations are governed by federal law and regulation. That includes covered and noncovered services, rules for filing claims, methods and amounts of payments, and the like.
The law that created the program now called Tricare is specific in establishing the criteria for Tricare eligibility, including the ages at which the eligibility of children ends.
Tricare eligibility for most children ends, by law, when they marry or turn 21 years old, whichever comes first.
If a child is a full-time student at an accredited college, university, or trade school, and his military sponsor pays at least 50 percent of his or her financial support, Tricare eligibility ends at marriage, graduation, failure to be enrolled as a full-time student, or reaching age 23, whichever comes first. Again, these requirements are a provision of federal law.
To effect a permanent change in the law that governs the ages at which Tricare eligibility ends would require action by Congress to change the law that governs Tricare or to enact a law that supercedes it. Only Congress can make or change a federal law.
Now the good news.
A bill was submitted for inclusion in the Defense Authorization Act for 2011 that will allow certain children to be authorized the extension of their Tricare benefits to age 26. Details are not available because it is likely that some elements of the bill, as originally written and submitted, will be changed for it to be passed by the Congress.
If the bill is passed by Congress, some unknown amount of time will pass before it can be implemented by the Defense Department.
Daughter, 22, just divorced — can we cover her?
September 30th, 2010 | TriCare Help | Posted by Military Times
Q. My husband is on active duty and we have Tricare Prime. Our oldest daughter, who is 22, just divorced her Navy husband of less than a year and she is not in college or working. She is asking us if she is eligible for Tricare coverage under my husband. She is currently not living at home but will move back in with us shortly. Is she eligible for coverage under my husband?
By law, most children of active duty members, retirees, and deceased members lose their Tricare eligibility automatically when they marry or reach age 21, whichever comes first.
Only the uniformed services have the authority to determine whether a particular individual meets the legal criteria for Tricare eligibility, to register that person in the Defense Enrollment Eligibility Reporting System (DEERS), and to issue him or her a uniformed service identification card. Information on the back of the card can be used to prove Tricare eligibility. Tricare itself does not have the legal authority to do any of those things.
If a child is enrolled as a full-time student at an accredited college, university, or trade school, and if the uniformed service sponsor pays at least 50 percent of the child’s support, Tricare eligibility may be extended until marriage, graduation, or reaching age 23, whichever comes first.
If a child becomes disabled and incapable of self-support prior to reaching age 21, eligibility may be extended indefinitely for as long as the disabling condition persists. If the disabling condition improves so the child becomes capable of self-support, and if the child is not Tricare-eligible otherwise, eligibility will be terminated and may not be restored even if the disabling condition recurs.
A stepchild who was never legally adopted by the uniformed service sponsor will lose Tricare eligibility, regardless of age, if the military sponsor and the unadopted child’s natural parent are divorced.
A stepchild who was legally adopted by the uniformed service sponsor has the same rights to Tricare as the sponsor’s natural children.
For official details and confirmation of this or any Tricare eligibility issue, please call the DEERS Support Office, toll-free, at 1-800-538-9552. I recommend that you call DEERS to discuss your daughter’s situation and to get official information and answers to all questions regarding her Tricare eligibility.
Can my two adult sons’ Tricare be restored?
June 1st, 2010 | TriCare Help | Posted by Military Times
Q. My son has been enrolled in the Continued Military Health Care Benefits Plan. I can no longer afford to continue this insurance. If I discontinue this plan, will my son remain eligible if the new health care plan goes into effect?
Also, my youngest son will turn 21 this summer. He was enrolled in college this spring for only 11 credit hours, which is not considered full time. This means he will lose his eligibility on his 21st birthday. This fall he plans to become a full-time student. Will he be able to reinstate his eligibility under my Tricare Prime?
The new law on extending dependent health care coverage to age 26 has not yet been implemented. It has not yet even been determined whether it applies to Tricare (although legislation has been introduced), so I cannot answer your question about the restoration of your elder son’s Tricare eligibility.
When your younger son is enrolled as a full-time student, his Tricare eligibility should be restored. But restoration will not be automatic. It will be necessary for him his military sponsor to apply for restoration based on his full-time student status.
I recommend that you call the DEERS Support Office for official clarification of the rules and instructions about these matters and help with any administrative actions needed. The toll-free number for that office is 1-800-538-9552.
When one spouse gets TFL before the other
March 12th, 2010 | TriCare Help | Posted by Military Times
Q. My wife is three years older than me. As long as we are still on Tricare Prime, this poses no problems. However, she will reach 65 and become eligible for Medicare before I will. What steps will we need to take to get her Tricare for Life before me? If it makes a differrence, we live near a military medical facility.
Tricare couples are very seldom exactly the same age, and it doesn’t matter which of the two is the elder.
At least 90 days before the month when she will be 65, your wife should contact the Social Security Administration to apply for Medicare Part A and Part B. Medicare will review her application, and if it finds she is eligible, it will send her a Notice of Award and a Medicare ID card a few weeks before she is 65.
Social Security is supposed to automatically notify DEERS when your wife is enrolled in Medicare Part B so it can make the transition to Tricare for Life (TFL) in her DEERS record. Federal law requires her to be enrolled in both Medicare Part A and Part B to keep her Tricare eligibility and have TFL. She should not enroll in the Medicare Pharmacy Program (Part D of Medicare) because she has the free Tricare Pharmacy Program.
When she gets the Medicare ID card, she should call DEERS, toll-free, at 1-800-538-9552 to make sure it has updated her record to show Part B enrollment and TFL eligibility.
DEERS will automatically change her Tricare Prime to Tricare Standard, and she will become eligible for Tricare for Life on the first day of the month when she is 65. She may no longer use Tricare Prime. She must get all her civilian medical care from Medicare providers because Medicare will become her primary coverage and Tricare Standard will automatically become her secondary coverage and free Medicare supplement for the vast majority of her Medicare claims.
I recommend that she start looking for a Medicare provider who will accept her as a new patient at the same time as she applies for Medicare.
You will go through the same process three years later when you turn 65 and get Medicare.
The Medicare provider will file a Medicare claim each time she sees him. Medicare will pay its share to the provider and automatically forward the claim to Tricare as second payer. On the vast majority of her claims, Tricare will pay the balance on her Medicare claim for every service that is also covered by Tricare. Those two payments — Medicare’s and Tricare’s — will pay the provider’s bill in full.
The only times she will have any out-of-pocket costs for medical care is if she get a medical service that is not covered by both Medicare and by Tricare. That will not be very often. Some TFL beneficiaries go more than a year without any such claims.
For her last enrollment period in Tricare Prime, your wife should arrange to pay her Prime enrollment fee on a month-to-month basis. That is so she doesn’t pay in advance for Tricare Prime she will no longer be able to use once her Medicare begins. That may mean she will no longer be able to use the military medical facility. She will have to ask.
She will no longer have to pay $230 per year for Tricare Prime, but she will have to begin paying the monthly premium for Medicare Part B. Medicare will bill her every 90 days for the premium until she is old enough for Social Security checks. Then the premium will come out of her check as an allotment to Medicare.
In the meantime, she should go to the official Tricare web site and read up on Tricare for Life. She can also download a TFL Handbook, which will be very useful.