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 do we pay when one spouse switches from Prime to TFL?
March 21st, 2012 | TriCare Help | Posted by Military Times
I will turn 65 in 2014. My husband won’t turn 65 until 2021. I know I must sign up for Medicare Part B at $99.90 per month and will enroll in Tricare for Life. Will I have to continue to pay the annual Tricare Prime fee at the family rate so my spouse will still be covered until he reaches 65? And once he can get Tricare for Life, will we each have to pay $99.90 per month?
Once you become eligible for Tricare for Life, your spouse can continue in Tricare Prime, and you should be able to shift from the family rate to the individual rate for him. Once your spouse turns 65, you will both have to pay the monthly Medicare part B premium; that cost is a standard rate per individual.
For the most definitive response to these kinds of eligibility questions, you should contact the Defense Enrollment Eligibility Reporting System (DEERS) support office, toll-free, at 1-800-538-9552.
Can I keep my doctor after I switch to Tricare for Life?
March 12th, 2012 | TriCare Help | Posted by Military Times
I will be 65 and get Medicare in August. However, I have finally found a doctor I like at my military hospital. He explains things to me and never rushes. How can I keep seeing him after I get Tricare for Life?
I’m afraid I don’t have good news for you: You currently have priority access to the military hospital, and your doctor, under Tricare Prime. But when you turn 65 and get Medicare and Tricare for Life, the Tricare Prime part of your coverage will automatically convert to Tricare Standard. That, along with Medicare Parts A and B, comprise your health coverage. Medicare will become your primary payer, with Tricare paying whatever Medicare does not. You will have to find a new, Medicare-authorized, doctor – hopefully one who communicates as well as your current physician.
What if I want to drop Tricare Prime?
March 5th, 2012 | TriCare Help | Posted by Military Times
I’m a retired reservist. My wife and I switched from Blue Cross Blue Shield’s federal program to Tricare Prime when I turned 60 last year. We had the BCBS plan suspended and used Prime has our primary insurance. Now, because of a problem we’re having with Prime, I want to drop that coverage and switch back to BCBS as primary. How do I do that?
Call or write to your Tricare Prime contractor and tell them of what you want to do. You will not be able to re-enroll in Prime for a year once you have cancelled that service, so you will be restricted to Tricare Standard. Discuss the matter with the contractor to be sure you understand the rules and that your BCBS plan will become your primary insurance.
How soon may wife use Tricare Prime?
February 17th, 2012 | TriCare Help | Posted by Military Times
I am retired Air Force and I just got married. I want to enroll my wife in the Defense Enrollment Eligibility Reporting System so she can be covered under my Tricare Prime, since we live near a military hospital that accepts military retirees for care. How long after enrollment in DEERS will my wife need to wait for benefits?
Your wife’s Tricare coverage became effective on the same day as you were married. For her to use Tricare, however, you must enroll her in DEERS and get her a military ID card. She can use Tricare as soon as her DEERS registration is complete. See your personnel section for help to do those things.
Do we still need Tricare Prime Plus under Tricare for Life?
January 25th, 2012 | TriCare Help | Posted by Military Times
My wife and I just qualified for Medicare and Tricare for Life. We were both enrolled in Tricare Prime. We are also enrolled in Tricare Prime Plus at a military treatment facility. Do we need to continue paying the annual enrollment fee to use Tricare Prime Plus?
If a person is enrolled in Tricare Prime when they become eligible for Medicare and Tricare for Life, his or her Prime enrollment is terminated. On the effective date of Medicare coverage, it is automatically changed to Tricare Standard, which becomes a free supplement to Medicare. The person is no longer eligible for Tricare Prime. He no longer has priority access to free care at a military hospital, and any Tricare Prime enrollment fees paid in advance are lost; they cannot be refunded.
What benefits can retiree’s new wife get?
December 19th, 2011 | TriCare Help | Posted by Military Times
I am a retired Marine. If I get married, is my new wife eligible for Tricare for Life if I enroll her in DEERS? What medical benefits will she get?
If you are entitled to receive retired pay, you are probably also entitled to Tricare. And, if you are entitled to Tricare, your wife will be entitled also, just as soon as you kiss the bride.
You will have to register her with DEERS and get her a military ID card before she can use Tricare, but that won’t take long to do. If you need instructions or other help for getting her on the program, please call the DEERS Support Office, toll-free, at 1-800-538-9552. That office can answer all your questions about Tricare eligibility and walk you through the registration process with your new wife.
You can enroll your wife in Tricare Standard, which is free, but she will have a $150 deductible every fiscal year and a copayment of 25 percent of the amount Tricare allows on each of her claims up to a total of $3,000 for the two of you.
Then there is Tricare Prime, which is not available everywhere. But, if you live in an area where you can get Prime, it’s the least expensive in terms of out-of-pocket costs. Prime, however, has a yearly enrollment fee of $260 per person, or $520 for a family of two or more people. Prime is also great because it gives you priority access to free care in military hospitals.
Finally, you mentioned Tricare for Life. That’s the best deal of all, and I get the idea you already know about it. If your new wife is entitled to Medicare and is enrolled in Part A and Part B, she is set for life Tricare for Life.
If you go to the Tricare web site, you can get official information about all Tricare plans and rules, including the free Tricare Pharmacy Program. Note: Do not enroll your wife in the Medicare Pharmacy Program, called Medicare Part D. She won’t need it, and it will block her from using the Tricare Mail Order Pharmacy Plan, which is a big money-saver. If she is already enrolled in Part D, she can call Medicare and cancel it.
What happens to younger spouse when I get Medicare?
December 5th, 2011 | TriCare Help | Posted by Military Times
I am retired Navy and in another year will turn 65. For the last 15 years my family has been enrolled in Tricare Prime. My plan is to continue with Tricare for Life. My spouse is four years younger than I, however. When I enroll in Medicare, is my wife covered by Tricare for Life until she becomes eligible for Medicare?
As a uniformed service retiree, you will be required by the law that governs Tricare to be enrolled in Medicare Part B on the same date that your Medicare Part A becomes effective. If you are not enrolled in Part B on that date, you will lose all of your Tricare eligibility automatically until you are enrolled in Medicare Part B.
If a beneficiary enrolls in Medicare Parts A and B in a timely manner, his or her Medicare coverage and TFL eligibility will begin on the first day of the month of his or her 65th birthday.
Your wife will not qualify for Medicare or Tricare for Life until she is 65 years old, but she can continue her Tricare Prime coverage until that time.
Do we have to use other health insurance if it’s available?
November 22nd, 2011 | TriCare Help | Posted by Military Times
My husband has Tricare Prime. He is considering a full-time job with full benefits. If health insurance is an optional benefit, does Tricare require that he take it?
No, Tricare does not require or forbid its beneficiaries from enrolling in other health insurance. It is completely up to the beneficiary. However, if he is enrolled in other health insurance, federal law requires that he use (file claims with) that plan first.
After the other health insurance has processed the claim, paid its maximum, and issued an Explanation of Benefits, the beneficiary or the provider may file a Tricare claim for all amounts the other insurance may have left unpaid. Usually, that will be the patient’s copayment and, when applicable, the deductible. That is commonly called the “patient’s share” of the bills.
The Tricare claim must consist of:
- A properly completed Tricare Claim Form DD2642;
- A copy of exactly the same bill(s) that was/were sent to the other health insurance;
- A copy of the other insurance’s EOB reporting its actions on each of the charges on the provider’s bill.
Send the package to the proper Tricare claims processing contractor for your place of residence.
Can I still go to military doctors once I’m on Tricare for Life?
November 11th, 2011 | TriCare Help | Posted by Military Times
I will get Medicare and Tricare for Life on Dec. 1. I live near an Air Force base and have been getting most of my health care from specialists there. I know that under Tricare for Life, I need to get my care from Medicare providers, which is fine, but can they still refer me to the military doctors if necessary?
When most Tricare beneficiaries turn 65, get Medicare and are enrolled in Part B, those who were formerly enrolled in Tricare Prime are automatically transferred from Prime to Tricare Standard, which, along with Medicare, makes up your Tricare for Life coverage. If you are no longer enrolled in Prime, your access to free medical care at your local military treatment facility will likely be curtailed.
Retirees and their family members have priority access to military hospital care as a result of being enrolled in Tricare Prime. Once you are switched from Prime to Standard, you do not have the same priority access.
As there are individual differences among MTFs, however, the facility near your home may still have space and personnel available to allow non-Prime enrollees to access their services. You will need to ask the patient administration office if you can continue to use their facilities, including their pharmacies.