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.
If we marry and my husband dies, will I be eligible?
December 4th, 2009 | TriCare Help | Posted by Military Times
Q. My fiance is 84, a retired Navy man, and he’s just been diagnosed with pancreatic cancer. He would like me to marry him so I can be covered by Tricare after his death.
My question is, if he dies — say, a month after marriage — would I still be eligible for Tricare benefits?
Your fiance should contact the Defense Enrollment Eligibility Reporting System, better known as DEERS, for instructions to enroll you in Tricare. That can be done only through the uniformed services. DEERS is the official Defense Department agency that will provide the help he will need to do that. The toll-free number for DEERS is 1-800-538-9552.
You will become legally entitled to Tricare the moment your husband kisses the bride. If he were to die in the next minute, your Tricare eligibility will still be in effect. It is the fact of your legal marriage that creates your Tricare eligibility, immediately. To use Tricare, of course, there will be administrative details to accomplish. Call DEERS for help.
You didn’t mention your age. If you are, or if you become, entitled to Medicare, federal law requires you to be enrolled both in Medicare Part A and Medicare Part B to qualify for Tricare eligibility.
For the rest of your life, you will be responsible for checking your registration in DEERS to keep it up-to-date, and to promptly advise DEERS of any changes in your status, such as an address change.
Similarly, you will be responsible for keeping your military identification card up-to-date. At least 90 days before your card expires you will need to contact DEERS for help with renewing it.
Every time a Tricare claim is processed, the claims processing computer automatically contacts the DEERS computer to ensure that the patient on the Tricare claim was eligible for Tricare on the date she received the medical care. At that time, also, Tricare confirms the beneficiary’s eligibility generally by comparing the information on the claim form with the information in the beneficiary’s DEERS record. Thus, you see the need to keep it up to date. Discrepancies can cause claims to be denied until they are corrected.
If you are, or if you become, entitled to Medicare and are enrolled in Part B, you will be eligible for the Tricare program named Tricare for Life, also called TFL for short. TFL is a Tricare plan created by Congress in 2001. It allows a Tricare beneficiary who has Medicare to use Tricare Standard as second payer to her Medicare A and B coverage. In the vast majority of claims, the combined payments by the two federal benefit programs will pay your medical bills in full.
I suggest you visit the official Tricare web site now. Here you can locate your Regional Tricare Office (make a permanent record of the contact information — that will be your primary source for official Tricare help and information), see an overview of the Tricare plans, and — if you are entitled to Medicare now, or will become entitled soon, and are enrolled in Part B — look at the information about TFL and download a Tricare for Life Handbook.
If you are not near Medicare entitlement age (65), your choices for coverage will be Tricare Standard or Tricare Prime.
Prime is not available in all areas, so if you are interested in that plan, call your Regional Office again to ask if Prime is available for persons in your residential area. Tricare Prime costs the least in out-of-pocket expenses, but it also has certain inconveniences for members who travel frequently.
Under Prime, you must use only certain providers in your local area who are under contract with Tricare to provide care at discounted rates. Prime membership also allows you priority access to your nearby military treatment facility where you can get free medical care including hospitalization.
When you become eligible for Tricare, it is for life, unless, as a widow, you remarry. If you remarry, you will lose all military benefits from this husband. They can never be restored, even if the next marriage ends in death or divorce.
All Tricare beneficiaries without exception are automatically eligible for and are enrolled in the Tricare Pharmacy Program. It is one of the very best prescription drug programs in the nation. It needs no help from any other pharmacy insurance plan. You can get a 90-day supply of a drug for the same price as you pay for a 30-day-or-less supply when purchased locally.
Tricare and Medicare Parts A and B
October 15th, 2009 | TriCare Help | Posted by Military Times
Q. I retired from the Army and currently use Tricare Standard as my primary medical insurance. My wife will turn 65 soon and is retired and drawing Social Security. When she contacted the Social Security Administration about registering for Medicare Parts A and B, they said that if she was currently receiving a Social Security benefit she will automatically be signed up for Medicare Parts A and B on the 1st day of the month she turns 65. But I have seen a lot of information that says that you must personally sign up for Medicare Parts A and B or face losing your Tricare coverage. Does my wife need to go to the local Social Security Office and sign up or is this taken care of automatically?
Remember that Medicare and Tricare are totally different and unrelated programs. They operate under the authority of different laws and regulations. Depending on what previous contact you have had with Social Security and Medicare, your Medicare enrollment may, or may not, be automatic. It is your responsibility to contact that office to make sure you are doing things properly.
To allow time for the administrative things to be done, Social Security wants everyone approaching their 65th birthday to apply for benefits at least 90 days before the first day of the month when they will be 65. Only Social Security can tell you the status of your application and whether you still need to apply. The toll-free number for that office is 1-800-772-1213.
Both Medicare and Tricare have rules about when a person is required to be enrolled in Medicare Part B.
Medicare’s rule concerns the penalty for failure to enroll in Part B within a grace period after the effective date of their Medicare Part A entitlement. That is an important rule and it applies to all Medicare beneficiaries, both civilian and military. If you call Medicare regarding Part B enrollment, you will get information about that rule. Do not ask Medicare about any rules concerning Tricare.
Tricare’s rule is even more important because it affects all uniformed service retirees, their eligible family members, and survivors of deceased active duty and retired personnel. It does not apply to active-duty family members. Because you are a retiree, however, it does apply to both of you at the time each of you, individually, becomes entitled to Medicare.
If you have applied properly for Medicare, you will receive an award notice a few weeks before the first day of the month when you will be 65. It will contain a number of information documents, but three are very important:
- An official notification that you have been awarded Medicare Part A and Part B.
- An official Medicare Identification Card confirming that you are entitled to Medicare Part A and Medicare Part B, effective on the first day of the month when you will be 65. That is your proof of insurance that you will have to show to Medicare providers when you go to get care.
- A post card that you can sign and return to Medicare. It states that you wish to drop out of Medicare Part B. If you sign and return that card, your Part B entitlement will be canceled. Do not sign and return that card.
Federal law requires that every uniformed service retiree, eligible retiree family member, or survivor who becomes entitled to Medicare Part A must be enrolled also in Medicare Part B, effective on the same day that their Part A entitlement becomes effective.
Failure to be enrolled in Part B causes the immediate loss of all Tricare eligibility. It cannot be restored until the beneficiary has effective Medicare Part B coverage.
Social Security/Medicare is supposed to notify DEERS automatically when you are enrolled in Medicare Part B. Occasionally, through human or machine error, that does not happen. So, a couple of weeks after you receive your Medicare packet and ID card, call the DEERS Support Office, toll-free, at 1-800-538-9552. Ask if your DEERS record has been updated to show Part B enrollment and Tricare for Life eligibility. If your record has not been updated, ask DEERS what you need to do to fix it.
One more thing: Call your Tricare for Life service center, toll-free at 1-866-773-0404, and ask them to send you a free Tricare for Life Handbook. Or you can download one here.
I’m already on Medicare Part A
September 15th, 2009 | TriCare Help | Posted by Military Times
Q. I turn 60 in February. I have been disabled for the last 10 years and am on Medicare Part A. I didn’t have to accept a penalty for not signing up for Part B because my wife works and I use her insurance. Do I have to sign up for Part B to receive any Tricare benefits? My wife retires in March and we will still be covered by her policy until she becomes eligible for Medicare.
The following information is unofficial. For official information about avoiding the late enrollment penalty for Part B, call Social Security at 1-800-772-1213. For official information about getting Tricare when you are 60, call DEERS at 1-800-538-9552.
Both Medicare and Tricare have laws about when a person must enroll in Medicare Part B. The Tricare law is going to affect you first when you turn 60. Then, the Medicare law will affect you when your wife retires. Either way, you are going to have to be enrolled in Medicare early next year. Here’s why.
The law that governs Tricare says that a retiree who has Medicare is required to be enrolled in Part B. Although you are not 65, you got Medicare early due to your disability. That means you must have Part B up and running in order for you to get Tricare when you are 60 next February.
Because you will be a retiree with Medicare at age 60, you must be enrolled in Part B for your Tricare eligibility to go into effect. You will begin your Tricare eligibility by being enrolled in Tricare for Life.
If you did not have Medicare already, your Tricare eligibility would begin on your 60th birthday Because you have Medicare, however, you have to be enrolled in Medicare Part B before your Tricare eligibility can start.
You need to contact Social Security in October and enroll in Medicare Part B. Arrange with Social Security for your Part B to become effective on the first day of February because that is the month when you will be 60 years old. Your Medicare Part B must be in effect when you turn 60 because you cannot get Tricare without it.
You can hold off one more month enrolling in Part B because you wife is still employed by the company that provides her and your health insurance. But, as soon as she retires, the grace period for you to enroll in Part B without penalty will start to run. And you can’t get Tricare until you are enrolled in Part B due to your already having Medicare.
You will save yourself a lot of needless administrative hassles by starting your Part B and Tricare on the first of February as I suggested above. The longest you can hold off enrolling in Part B will be the grace period between the date of your wife’s retirement and the end of the grace period for enrolling in Part B without penalty. That will be two or three months at most, and during that time, you will not have Tricare.
You cannot get Tricare and Tricare for Life until you are enrolled in Medicare Part B.