Making the Health Care Decision at Age 65

Making the Health Care Decision at Age 65

Age 65 is a time of decision: employer health plan and/or Medicare-Tricare known as Tricare for Life (TFL)? At age 65, Tricare coverts to a Medicare supplement plan and becomes TFL. Tricare Prime and Select are not available options. 


To be in TFL, you must be enrolled in both Medicare Parts A&B. Part B has premiums based on your income. If your spouse is younger, your spouse will continue under your employer health plan, stay under Tricare Prime/Select or both until age 65. Here are your options. 


A) You continue to work. You can stay in your employer plan and delay Medicare/TFL enrollment. You are allowed to delay Medicare Part B enrollment as long as you are working and covered by an employer’s health plan. There is no Medicare penalty as long as you apply for Part B before you stop working or you enroll in Part B within 8 months of the end of work or the end of the health plan, whichever is first. With this option, you temporarily lose TFL benefits until you enroll in Part B. You can be enrolled in Part A while you work and not pay a Medicare premium. 


B) Go with both the employer plan and Medicare/TFL. Enroll in Parts A/B Medicare, get your TFL benefits and have your employer’s plan. Of course, you’ll pay for all programs and you may be over insured. 


C) Go Medicare/TFL only. Check to see if you can suspend your employer’s plan before you outright cancel it. Suspending leaves you the option to return to the coverage should you want to at some point in the future. Enroll in Medicare Parts A/B three months prior to age 65. You actually have until the third month after age 65 to sign up but that delays your coverage by a month or two. 


As long as you are working and covered by your employer’s plan, the employer’s plan pays first, Medicare second, and Tricare third. 


Once you stop working, even if your employer plan is continued into retirement, Medicare will pay first, then your employer’s plan and finally Tricare. 


If you are TFL only, Medicare is the first payer and Tricare acts as a Medicare supplement. Claims are filed by health care providers to Medicare and Medicare automatically forwards the residual bill to Tricare. Any Medicare provider works under TFL. 


Do not enroll in another drug plan. Enrollment in another drug plan causes it to pay first and you’ll be filing manual claims with Tricare. Plus, another drug plan disqualifies you from the Tricare home delivery program.


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