MOAA’s 2020-21 TRICARE Guide: Medicare and TRICARE at 65 and Beyond

MOAA’s 2020-21 TRICARE Guide: Medicare and TRICARE at 65 and Beyond
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Editor’s Note: This article is part of MOAA’s 2020-21 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Mercer Consumer. A version of the guide appeared in the November 2020 issue of Military Officer magazine.

 

When you turn age 65, a huge change is coming your way in your health care program: You will enroll in Medicare.

 

Your TRICARE Prime or Select program stops at age 65. Tricare for Life (TFL) takes over at 65. TFL is a Medicare supplement plan, not a primary medical plan.

 

TRICARE policies may be subject to change, so check TRICARE.mil for official up-to-date information on your health care benefit. Click the question below to go straight to the answer, or scroll down to see the entire Q-and-A.

 

Q. I heard I must enroll in Medicare at age 65. Why? Where’s my earned health care for my service?!

 

A. TRICARE Prime and Select end at age 65 by law. Medicare and TFL take over. It has been this way for servicemembers since Medicare was established and TFL was established in 2001.

 

Prior to Medicare, medical services were available on bases starting in 1956. For many, it took a statement of nonavailability in the community to get on base.

 

When the Civilian Health and Medical Program of the Uniformed Services was established in 1966, it also stopped at age 65 and required Medicare enrollment. There was never an established free health care for life program within DoD; the VA health care system provides the health care for life.

 

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Q. What are the steps to make a timely and smooth transition to Medicare?

 

A. Technically, you have a seven-month window to enroll in Medicare Parts A and B. Three months prior to your birthday month, your birthday month, and three months after your birthday month.

 

In reality, you:

  1. Enroll in Medicare online at Medicare.gov, two to three months prior to your birthday month. Early enrollment ensures you receive your Medicare card in the mail, which gives you time to:
  2. Take the Medicare card to your closest military ID card office to update your ID card, and
  3. Enroll in TFL at the ID card office.

 

Take a look at the back of your military ID card. You’ll see it expires just prior to your 65th birthday. This is to ensure you enroll in Medicare Parts A and B and enroll in TFL. If you are working past age 65 and covered by employer health care, see below about delaying Medicare.

 

Medicare Part A has no premium, since we all paid for Part A with our payroll taxes over our careers.

 

Part B has a monthly premium based on your income level. The Part B premium is per person, per month. Medicare uses the last reported tax filing, two years ago, from the IRS to determine your income level.

 

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Check with your current medical providers to determine if they accept Medicare. If yes, keep going to the same providers. If not, shop for new ones.

 

Original Medicare works like TRICARE Select or other preferred provider organizations (PPOs). That means no primary care manager, no referrals for specialists, no being told where to go. You can choose any providers, specialists included, as long as they accept Medicare. More on Original or Advantage Medicare later.

 

Q. How does TRICARE fit with the Medicare coverage?

 

A. At age 65, TRICARE health care plans morph into the TFL Medicare supplement plan. That’s why you must have Medicare Parts A and B before TFL is functional. Health care providers bill Medicare as the primary payer.

 

Medicare and TFL are linked in-system, and the residual costs from Medicare automatically flow to TFL for final payment.

 

TFL covers all residual Medicare costs — other than your Part B premium. There is no need for any other Medicare supplement insurance. Note: Without TFL, you have no TRICARE pharmacy program.

 

Q. Should I consider those Medicare Advantage (aka Part C) options?

 

A. Probably, just to know your consumer options. Medicare comes in two versions: Original, which is government insurance coverage, and Advantage, which is Medicare administered by a commercial health care insurance company.

 

Both versions are Medicare Parts A and B by law. Advantage plans come in two options: health maintenance organizations (HMOs like TRICARE Prime) and preferred provider organizations (PPOs like TRICARE Select and Original Medicare). Advantage plans must have the same coverages as Original Medicare Parts A and B. Advantage plans can offer additional coverages for a possibly greater premium. Ask your doctors about the plans. However, while TFL works with Advantage plans, they don’t work well together. Having an Advantage plan will probably require you to file manual claims to TFL to get the TFL coverage.

 

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Both Original and Advantage will cost you the Part B premium, but Advantage plans can add some to your Part B premium amount. Additional coverages can include dental, vision, gym memberships, therapies, or additional preventative care options.

 

Advantage plans can offer a pharmacy plan also but more on this later. TFL works the same with either Original or Advantage plans.

 

Q. What about a pharmacy plan?

 

A. The pharmacy plans under Medicare are known as Part D. You do not want another pharmacy plan on top of your TRICARE pharmacy plan.

 

Be careful if you want to choose a Medicare Advantage plan since many come with a pharmacy plan as a part of their program. The other pharmacy plan must pay first. Then you will have to file manual claims to the TRICARE pharmacy for reimbursement of what the other plan did not pay. However, TRICARE pharmacy co-pays still apply.

 

Oh, and you will lose your TRICARE home delivery option by having another pharmacy plan. You must be enrolled in TFL to have the TRICARE pharmacy.

 

Q. What if I travel overseas?

 

A. Medicare plans do not work overseas. In this case, your TFL converts to TRICARE Select Overseas and you are covered by TRICARE Select at TRICARE Select rates. You will pay for services overseas out of your own pocket and be reimbursed by TRICARE after you file a claim later.

 

[TRICARE GUIDE: Travel Reimbursement for Specialty Care]

 

Q. How do Social Security retirement benefits figure into the transition?

 

A. Regardless of when you choose to start Social Security retirement benefits (ages 62 to 70), Medicare enrollment is still at age 65. (See my response to the next question for more.)

 

If you are receiving Social Security retirement benefits at least four months prior to your 65th birthday month, you are automatically enrolled in Medicare Parts A and B on the first day of your 65th birthday month.

 

If you are not receiving Social Security retirement benefits prior to age 65, you’ll need to enroll in Medicare Parts A and B two to three months prior to your 65th birthday month. Enroll online at Medicare.gov.

 

Q. What if I’m working and covered by my employer health plan at age 65?

 

A. If you continue to work past age 65 and you are covered by your employer’s health care plan, then you can delay Medicare enrollment until your employment ends or your employer’s health plan stops — whichever comes first. This situation is the only scenario that allows for delayed Medicare enrollment without the Medicare late enrollment premium penalty. Then you have eight months to enroll in Medicare.

 

Plan carefully to start Medicare to prevent a gap before your employer plan ends. Medicare cannot be delayed by using a civilian retiree health plan, and TRICARE Prime and Select end at age 65.

 

Remember, TFL is a Medicare supplement, so no Medicare Parts A and B, no TFL and no TRICARE pharmacy. So, your options while working are:

  1. Continue your employer plan by itself; no Medicare nor TFL (no TRICARE pharmacy).
  2. Drop employer health care and go Medicare and TFL.
  3. Enroll in Medicare/TFL and your employer plan; you’ll pay for both.

 

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Q. Do retired civilian workers with a retiree health care plan need to enroll in Medicare? And will TFL work with retiree health plans?

 

A. Technically, no. You do not have to enroll in Medicare/TFL with a retiree plan. You will not have TFL nor TRICARE pharmacy.

 

However, if you should ever want to enroll in Medicare later, you will pay a premium penalty for delayed Part B enrollment for the rest of your life. TFL will start at enrollment in Parts A and B. Many civilian plans can be suspended rather than cancelled.

 

TFL does not work with any other health plans. It is a supplement for Medicare Parts A and B only.

 

Q. What about those of us who use VA health care?

 

A. You need to research how your VA health care works in your situation. VA health care does not cover all VA-rated members and for some, it only covers service-connected issues. Make sure you know where you stand with your VA health care. Understand how VA health care will cover you if you are not able to get to a VA facility.

 

Q. What about overseas travel or travel in general?

 

A. If you find gaps in coverage or want peace of mind concerning your coverage, enroll in Medicare Parts A and B.

 

Remember, if you change your mind about Medicare in the future and decide to enroll, you will pay a Part B premium penalty for the rest of your life.

 

Q. What about members of a U.S. Family Health Plan (USFHP)?

 

A. If you were enrolled in USFHP as of Sept. 30, 2012, you can stay in it at age 65-plus.

 

If you were not enrolled in USFHP until Oct. 1, 2012, or after, you will be disenrolled in USFHP and must enroll in Medicare Parts A and B and TFL. TFL does not work with the USFHP.

 

USFHP strongly encourages enrollment in Medicare Parts A and B. This ensures that if you should ever drop USFHP, you are covered by Medicare without the premium penalty due to delayed enrollment.

 

If you are enrolled in Medicare Parts A and B with USFHP, your Part B premium is what you pay and USFHP fees and co-pays stop (except pharmacy co-pays). Staying with USFHP also includes their pharmacy program.

 

Again, no Medicare Parts A and B, no TFL, no TRICARE pharmacy.

 

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Q. My spouse and I are different ages. How does TRICARE work as one of us hits age 65?

 

A. The spouse who turns 65 enrolls in Medicare/TFL, and the younger spouse stays in TRICARE Prime or Select until age 65. Change the younger spouse’s Prime or Select fees to the single rate rather than the family rate.

 

Q. What happens once I’m under Medicare/TFL in retirement?

 

A. Once under the Medicare/TFL umbrella, it is easier to maintain coverage. Keep your military ID card and all your personal data with DEERS and Defense Finance Accounting Service (DFAS) up to speed.

 

Medicare has two open seasons. If you like your health care plan, do nothing. Each year, the program you are in will automatically roll over to the next year.

 

If you want to change your Medicare plan, you must do so during the appropriate Medicare open seasons.

  • October through December (check exact dates for each year). This open season is for Original Medicare enrollees who want to switch to an Advantage plan or join Original Medicare from an Advantage plan. New plans start Jan. 1.
  • Jan. 1 through March 31. This is for current Advantage plan members who want to switch Advantage plans or join Original Medicare. The new plan starts the next month after the company processes the request.

 

Your Part B premium is based on your income level from your tax return two years ago. That is the latest completed tax return available for the IRS to provide Medicare.

 

If you have a decrease in your current income level due to change in your life situation, you can appeal your income and Part B premium amount to Medicare.

 

Changes to income must be due to a life change like retirement, divorce, or death. Changes to income level do not count if due to a one-time decision like a home sale or investment gain.

 

Q. What about dental and vision programs for retirees?

 

A. The Federal Employee Dental and Vision Insurance Program (FEDVIP) is the dental and vision program for service retirees and their families.

 

The TRICARE Retiree Dental Program was discontinued.

 

Enroll at www.BENEFEDS.com. Normally, you would enroll or change your plan during the annual open season.

 

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Each year, open season runs from the Monday of the second full work week in November through the Monday of the second full work week in December.

 

Members who are newly eligible for the program or have a qualifying life event do not have to wait for an open season.

 

A qualifying life event can be marriage, the loss of a previous dental/vision program due to a job change or your employer dropping your plan, a birth, a death, or a move.

 

Besides FEDVIP, you can always shop for other dental and vision plans.

 

Many use their employer options; some use dental/vision plans as a part of their Medicare Advantage plan.

 

Still others use plans from memberships in associations such as MOAA or from commercial firms you can find at ehealthinsurance.com.

 

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About the Author

Lt. Col. Shane Ostrom, USAF (Ret), CFP®
Lt. Col. Shane Ostrom, USAF (Ret), CFP®

Ostrom retired from the Air Force in 2000 and joined the MOAA team in 2006. His responsibilities include researching and answering member inquiries regarding military benefits, health care, survivor issues, and financial concerns.