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.
What happens to wife’s coverage if I die before 60?
February 17th, 2012 | TriCare Help | Posted by Military Times
I am a 57-year-old gray-area reservist. What will happen to my wife’s Tricare and Tricare for Life eligibility if I die before I am 60?
The death of the military sponsor has no effect on the Tricare or Tricare for Life eligibility of family members.
On your 60th birthday, you will become entitled to retired pay. If you submitted the required applications through your reserve component, you and your family will become eligible for Tricare.
If you die before that time, your eligible survivors will become Tricare beneficiaries on the day you would have turned 60, again contingent upon proper application through your reserve component.
If your widow remains unmarried, if her Defense Eligibility Enrollment Reporting System registration is up to date, and if she is enrolled in Part B of Medicare, she will become entitled to Tricare for Life when her Medicare entitlement begins at age 65.
Can family get Tricare once I move in with fiance?
August 17th, 2011 | TriCare Help | Posted by Military Times
I plan on marrying a retired Coast Guard pilot next year, but my children and I have since moved in and combined our families into one unit. Can my two kids and I join Tricare prior to the marriage while living with him?
No; you’ll have to get married first. You and your children will become Tricare-eligible on the day you marry. Your husband, however, will have to register the family with the Coast Guard and DEERS, and get uniformed service ID cards for you before you can use Tricare. Save all your medical bills until he gets that done.
He should call the DEERS Support Office, toll-free, at 1-800-538-9552, if he needs guidance. His Personnel Section can help him with it immediately if nearby; or, he can try a reserve unit with a personnel shop.
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 my husband prevent me from getting Tricare?
March 17th, 2011 | TriCare Help | Posted by Military Times
I am currently separated from my husband, who is a member of the National Guard. He recently came off active duty orders, and we lost our Tricare Prime. He is signing up our two children and himself for Tricare Reserve Select but is refusing to allow me to be covered. Can he do that?
I am not an attorney, and your letter has legal implications that I am not able to address.
To the best of my knowledge, the legal spouse of an active duty, retired, or deceased uniformed service member is legally eligible for Tricare. The law that created Tricare determines eligibility, and the service member (the sponsor) has no control over the spouse’s eligibility.
I do not know, however, how that would apply in your situation when your husband is not on active duty.
I suggest that you call the DEERS Support Office for information regarding your legal eligibility for Tricare. DEERS cannot give you legal advice, but it can tell you what your rights are and it may be able to advise you how to seek legal help for your problem.
If you live near a uniformed service facility of any branch, you have the right to seek free legal assistance from its Office of the Judge Advocate General (JAG).
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.
How does Tricare coordinate with FEHB, Medicaid?
January 10th, 2011 | TriCare Help | Posted by Military Times
Q. I am a federal employee and a mobilized reservist on active duty, so I have my FEHB – AETNA as well as Tricare. I recently found out that my son, who has Cerebral Palsy, is covered by Medicaid. He had major surgery after I was mobilized. How are the benefits coordinated?
By law, Tricare is always last payer to all other health insurance, medical plans such as HMOs, or medical payments such as you might receive from an auto accident, slip-and-fall injury and the like.
The only exceptions to that rule are in the case when the other coverage is a bona fide, specially written Tricare supplement, or a welfare-related plan such as Medicaid (not Medicare), Indian Health Service, and the like.
In your son’s case, the order of filing will depend on his coverage. If he has Aetna, those claims must be filed first. Then you can file with Tricare (which will probably pay all, or most, of Aetna’s deductibles and copayments), and finally claims can be filed with Medicaid.
How much will Tricare pay as secondary insurance?
August 11th, 2010 | TriCare Help | Posted by Military Times
Q. I am a reserve component retiree who will turn 60 soon and get Tricare. I have a health insurance policy from my second career, which will be my primary coverage. Please tell me how much Tricare Standard will pay in that situation.
It isn’t possible to state the dollar amount Tricare Standard would pay from so little information, so I’m thinking that’s not your question. I’m guessing you want to know what percentage, out of what the other health insurance leaves unpaid, Tricare Standard will pay.
However, I can’t answer that either. As second payer to other health insurance, Tricare doesn’t pay a set percentage. And because Tricare Standard is a government program, its payment rules are set by federal law and regulation. That could cause its payments to be different from what a commercial secondary plan might pay in the same situation.
Generally speaking, though, Tricare Standard will pay the difference between the amount of the patient’s legal obligation to pay and the amount actually paid by the other health insurance. In no case, however, will Tricare Standard pay more than it would have paid if there were no other health insurance.
The calculations a secondary insurer performs to determine the amount it is supposed to pay is called coordination of benefits.
The section at the Tricare Management Activity that is in charge of directing coordination of benefits has said that it isn’t possible to accurately determine the amount Tricare Standard will pay on a given claim without a copy of the original claim and the other plan’s explanation of benefits — the detailed report a health insurance plan provides to the beneficiary that shows all the pertinent information about the way the claim was processed.
That said, it’s probably safe to say that most of the time, Tricare Standard will pay most of what remains of your legal debt after the other health insurance has paid its maximum.
News update: Tricare for gray-area reservists
July 19th, 2010 | TriCare Help | Posted by Military Times
Will Tricare cover my copayments?
October 5th, 2009 | TriCare Help | Posted by Military Times
Q. I’m a reservist and eligible for Tricare. My civilian job has an excellent medical benefit, so I haven’t signed up for Tricare. My question is: If I did sign up, could I use Tricare to cover my copays?
If you are at least 60 years old and have become entitled to receive retired pay, your Personnel Section should have registered you in DEERS when you applied for retirement. To confirm your DEERS registration and Tricare eligibility, please call the DEERS Support Office at 1-800-538-9552.
If you are not properly registered, ask DEERS how to fix it. You cannot use Tricare unless you are properly registered in DEERS.
When you became eligible for Tricare, so did your wife and any unmarried children under age 21 — or under age 23 if the unmarried child is a full-time student at an accredited college or trade school. Like you, they must also be registered in DEERS.
For detailed instructions on filing claims with Tricare as second payer to other health insurance, see this question that I answered a couple weeks ago.