Editor’s Note: This article is part of MOAA’s 2022-23 TRICARE Guide, brought to you by MOAA Insurance Plans, administered by Association Member Benefits Advisors (AMBA). A version of the guide appeared in the November 2022 issue of Military Officer magazine.
When you turn 65, your health care coverage takes a turn, too. Your TRICARE Prime or Select program comes to a stop, and that’s the law. Now you enroll in Medicare, along with the supplement Tricare for Life (TFL). Timing is essential. Here are steps to make the transition:
Plan Months Ahead
To enroll in Medicare Parts A and B, you have a seven-month window: Your birthday month, and three months before and after that. It’s best to enroll sooner:
- 2 to 3 months before your 65th birthday month: Enroll in Medicare online at Medicare.gov. Early enrollment ensures you receive your Medicare card in the mail, which gives you time to visit the closest military ID card office and update your military ID card (take the Medicare card with you) and enroll in TFL.
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 age 65. See more on that below.
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 still need to enroll in Medicare Parts A and B two to three months prior to your 65th birthday month.
There is one case that allows for delayed Medicare enrollment without the Medicare late enrollment premium penalty. If either retiree or spouse works past age 65 and can be covered by the employer’s health care plan, then either spouse can delay Medicare enrollment until the working spouse’s employment ends or the employer’s health plan stops. 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. Options while working are:
- Continue your employer plan by itself, no Medicare nor TFL and no TRICARE pharmacy.
- Drop employer health care and opt for Medicare and TFL.
- Enroll in Medicare/TFL and keep your employer plan. You’ll pay for both.
Getting Started With Medicare
Find out if your current medical providers accept Medicare. If not, look for new ones.
Original Medicare (Parts A and B) works like TRICARE Select or preferred provider organizations (PPOs): You can choose any providers, specialists included, if they accept Medicare.
Medicare Part B has a monthly income-based premium, determined by the last reported tax filing two years before from the IRS.
Medicare and TFL
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. You won’t need any other Medicare supplement insurance. You must have Medicare Parts A and B to use TFL, which covers all residual Medicare costs — other than your Part B premium. Health care providers bill Medicare as the primary payer.
Medicare/TFL in Retirement
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 up to speed for the Defense Enrollment Eligibility Reporting System (DEERS) and Defense Finance Accounting Service (DFAS).
If you want to change your Medicare plan, do so during the appropriate Medicare open season:
- Oct. 15 through Dec. 7. 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 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.
If you have a decrease in your income level due to change in your life situation, such as divorce, retirement, or death, you can appeal your Part B premium amount to Medicare.
Your Pharmacy Plan
Pharmacy plans are Part D under Medicare. You do not want another pharmacy plan on top of your TRICARE pharmacy plan. Two things to be aware of:
- If you want a Medicare Advantage plan, choose carefully, as many come with a pharmacy plan, which must pay first before TFL does. To be reimbursed for what the other plan does not pay, you will have to manually file claims to the TRICARE pharmacy. TRICARE pharmacy copays still apply.
- You will lose your TRICARE home delivery option by having another pharmacy plan.
What If You Use VA Health Care?
VA health care does not cover all VA-rated members, and for some, it only covers service-connected issues. Research how your VA health care works in your situation, and fi nd out how it will cover you if you are not able to get to a VA facility.
U.S. Family Health Plan (USFHP)
USFHP is an additional TRICARE Prime option available in six areas of the U.S. through networks of community-based, not-for-profit health care systems. How it works:
- You can stay in USFHP at age 65 and beyond if you were enrolled as of Sept. 30, 2012. If enrolled 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.
- 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.
- USFHP strongly encourages enrollment in Medicare Parts A and B so if you ever drop USFHP, you are covered by Medicare without the premium penalty due to delayed enrollment.
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.
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 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, 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 cancelled.
Medicare plans do not work overseas. Here's what happens:
- Your TFL converts to TRICARE Select Overseas and you are covered by TRICARE Select at that plan’s rates.
- You pay for services overseas out of pocket and TRICARE will reimburse after you file a claim.
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