Does my disability affect my eligibility?
October 1st, 2009 | TriCare Help | Posted by Military Times
Q. I am a retired member of the National Guard. My wife (who is younger than I am) and I receive Tricare Standard. I will be 61 next month and recently applied for Social Security disability. If my application is approved, am I required to do anything? Do I need a new military retired ID? Will my retirement be affected? My disability is not service connected.
I know very little about the rules governing Social Security disability benefits, except that if Social Security finds you eligible for disability benefits, it will have no immediate effect on your Tricare eligibility.
After receiving disability benefits for twenty-four consecutive months, it is my understanding that you will become entitled to Medicare. If you become entitled to Medicare, it will affect your Tricare coverage in one of two ways:
First, a uniformed service member who is entitled to receive retired, retainer or equivalent pay is required by federal law to be enrolled in Medicare Part B if he becomes entitled to Medicare Part A. If the retiree with Medicare Part A does not enroll in Medicare Part B, he will lose his Tricare eligibility on the day his Medicare Part A coverage becomes effective. That is not a Tricare rule. It is a requirement of federal law.
Second, Medicare entitlement makes you eligible for Tricare for Life if you are enrolled in both Medicare Part A and Part B. That program is very favorable for its beneficiaries.
Tricare for Life consists of full coverage under Medicare Part A and Part B plus full coverage under Tricare Standard. You become a Medicare beneficiary because Medicare is your primary health “insurance” plan.
You must seek all your medical care from Medicare providers. The provider will file a Medicare claim for the services he provides to you. Medicare will pay its statutory amount directly to the provider. Then, Medicare will automatically forward the claim to Tricare as second payer.
For every medical service on the Medicare claim that is covered also by Tricare, Tricare will pay to the provider whatever Medicare did not pay. Usually that will be your Medicare copayment and your Medicare deductible, if applicable on that particular claim.
The combined payments by Medicare and Tricare will pay the balance on the Medicare claim. The Tricare payment, together with Medicare’s previous payment, will pay the Medicare claim, and the provider’s bill in full. You will have no out-of-pocket expense for the medical services on that Medicare claim. The vast majority of your Medicare claims will be of that nature.
Apart from the small copayments (called cost shares) for prescription drugs, you will seldom have to pay anything for your medical care.
While you’re still at least two years away from being eligible for that program, you can read more about Tricare for Life on the Tricare web site, or even download a handbook.
Regarding the questions about your retirement, ID card, and Medicare disability, I suggest that you contact DEERS, toll-free, at 1-800-538-9552 for official information.