65 and Beyond: Understanding Medicare and TRICARE For Life

65 and Beyond: Understanding Medicare and TRICARE For Life
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Editor’s Note: This article is part of MOAA’s 2021-22 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Mercer Consumer. A version of the guide appeared in the November 2021 issue of Military Officer magazine.

 

The milestone of turning 65 signifies a turning point in your health care coverage: Your TRICARE Prime or Select program ends, by law. At 65, you enroll in Medicare, and Tricare for Life (TFL) begins as the supplement to Medicare. Here are steps to make the transition.

 

Plan Ahead for Medicare

Enrolling in Medicare Parts A and B takes place in a seven-month window: three months prior to your birthday month, your birthday month, and three months after your birthday month.

  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.

 

Your military ID card expires just before your 65th birthday to ensure you enroll in Medicare Parts A and B and enroll in TFL. You can delay if you work past 65. See more on that below.

 

Getting Started With Medicare

Do your current medical providers accept Medicare? If not, shop for new ones.

  • Medicare Part B has a monthly premium based on income level, determined by the last reported tax filing two years before from the IRS.
  • Original Medicare works like TRICARE Select or preferred provider organizations (PPOs): You can choose any providers, specialists included, if they accept Medicare.

 

[RELATED: The Benefit Under Threat: Saving TRICARE For Life]

 

Medicare and TFL

You must have Medicare Parts A and B before TFL is functional. TFL covers all residual Medicare costs — other than your Part B premium. Health care providers bill Medicare as the primary payer.

 

Medicare and TFL are linked in-system, and residual costs from Medicare automatically flow to TFL for final payment. There is no need for any other Medicare supplement insurance.

 

Your Pharmacy Plan

Pharmacy plans under Medicare are known as Part D. You do not want another pharmacy plan on top of your TRICARE pharmacy plan. Two things to beware of:

  • If you want a Medicare Advantage plan, be careful because many come with a pharmacy plan, which must pay first before TFL does. You will have to file manual claims to the TRICARE pharmacy for reimbursement of what the other plan did not pay. TRICARE pharmacy copays still apply.
  • You will lose your TRICARE home delivery option by having another pharmacy plan. You must be enrolled in TFL to have the TRICARE pharmacy.

 

[RELATED: Here Are Your New TRICARE Pharmacy Drug Prices]

 

Travel Overseas

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 pay for services overseas out of your pocket and will be reimbursed by TRICARE after you file a claim later.

 

Social Security Retirement Benefits

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 before age 65, you’ll need to enroll in Medicare Parts A and B two to three months prior to your 65th birthday month.

 

Working Past Age 65

If you 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. This 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.

 

[RELATED: TRICARE and Retirement: Steps to Help You Get Ready]

 

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. Your options while working:

  1. Continue your employer plan by itself, no Medicare or TFL and no TRICARE pharmacy.
  2. Drop employer health care; go Medicare/TFL.
  3. Enroll in Medicare/TFL and your employer plan — you’ll pay for both.

 

Retired Civilian Workers

You do not have to enroll in Medicare/TFL if you have a retiree health care plan. You will not have TFL or TRICARE pharmacy. However, if you 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, and it is a supplement for Medicare Parts A and B only — it does not work with any other plans. Many civilian plans can be suspended rather than canceled.

 

What If You Use VA Health Care?

Research how your VA health care works in your situation. It does not cover all VA-rated members, and for some, it only covers service-connected issues. Find out how VA health care will cover you if you are not able to get to a VA facility.

 

U.S. Family Health Plan (USFHP)

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 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, which strongly encourages enrollment in Medicare Parts A and B. So if you 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, you pay the Part B premium and USFHP fees and copays stop (except pharmacy copays). Staying with USFHP includes their pharmacy program.

 

When Spouses Turn 65

The spouse who turns 65 first 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.

 

Medicare/TFL in Retirement

Once under the Medicare/TFL umbrella, it is easier to maintain coverage. Each year, the program you are in will automatically roll over to the next year. Keep your military ID card and all your personal data with DEERS and the Defense Finance Accounting Service (DFAS) up to speed.

 

[RELATED: Do You Need a Medicare Advantage Plan?]

 

If you want to change your Medicare plan, do so during the appropriate Medicare open season:

  • October through December (check exact dates for each year). This 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 Advantage plan members who want to switch Advantage plans or join Original Medicare. The new plan starts the month after the company processes the request. If you have a drop in your current income due to a change in your life situation, such as divorce, retirement, or death, you can appeal your income and Part B premium amount to Medicare.

 

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