Editor’s Note: This article is part of MOAA’s 2023-24 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 2023 issue of Military Officer magazine.

TRICARE beneficiaries “age out” of TRICARE Prime or Select on the last day of the month prior to their 65th birth month. For example, if your 65th birthday is Nov. 21, TRICARE coverage ends Oct. 31. This means you’ll need to plan ahead for when your coverage stops.

Your three options are to:

• Enroll in Medicare.
• Use an employer-provided plan.
• For the veteran, use VA health care.

Your options for Medicare plans are:

• Original Medicare (OM) Part A (hospitalization) and Part B (medical insurance)
• Medicare Advantage Plan Part C, the open-market civilian equivalent to OM Parts A and B

Seven-Month Window

The seven-month window for you to sign up for Medicare Parts A and B starts three months before your birthday month and ends three months after your birthday month. Your military ID card expires in the month before your 65th birthday to ensure you enroll in Medicare Parts A and B and in TRICARE For Life (TFL). It’s best to enroll in Medicare sooner rather than later as it might take several weeks to receive your Medicare card, at which point you can renew your military ID card.

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Here are the steps:

• Enroll in Medicare online at Medicare.gov two to three months before your 65th birthday month. However, 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.
• When you receive your Medicare card in the mail, take it to a nearby military ID card office to renew your ID card.
• Show the ID clerk your Medicare insurance card, and ask for confirmation that your TFL is activated.

If You’re Still Working

There is one case that allows for you to delay Medicare enrollment without incurring the Medicare late enrollment premium penalty. If either the 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. At that point, you have eight months to enroll in Medicare. Plan carefully to start Medicare to prevent a gap before your employer plan ends.

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While working, you have these options:

• Continue your employer plan by itself, no Medicare nor TFL and no TRICARE pharmacy.
• Drop employer health care and opt for Medicare and TFL.
• If you don’t mind paying for both plans, enroll in Medicare/TFL and keep your employer plan.

First Steps With Medicare

Do your current medical providers accept Medicare? If not, look for providers who do. OM (Parts A and B) works like TRICARE Select or preferred provider organizations (PPOs): You can choose any providers that accept Medicare, including specialists. You’ll pay a monthly premium for Medicare Part B. The amount is based on income level, determined by the previous two years’ reported tax filings from the IRS.

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How Medicare and TFL Work

Medicare and TFL are linked in-system. Health care providers bill Medicare as the primary payer. Residual costs from Medicare automatically flow to TFL for final payment. No other Medicare supplement insurance is needed.

Medicare enrollment in Parts A and B, or a Medicare Advantage Plan Part C, entitles military retirees, spouses, and surviving spouses to TFL, which acts as your Medicare supplement, covering the Medicare annual deductible ($226 in 2023) and 20% copays. TFL is also your pharmacy plan, negating the need for Medicare Part D.

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 date for the Defense Enrollment Eligibility Reporting System and Defense Finance Accounting Service or the Coast Guard Pay and Personnel Center.

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Spouses Turning 65

The spouse who turns 65 first enrolls in Medicare/TFL, and the younger spouse stays in TRICARE Prime or Select until age 65. Your TRICARE contractor should adjust the annual enrollment fee from family to single rate for the younger spouse if he/she is an empty nester.

Changing Plans

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

• Oct. 15 through Dec. 7 is for OM enrollees who want to switch to an Advantage plan or join OM from an Advantage plan. New plans start Jan. 1.
• Jan. 1 through March 31 is for Advantage plan members who want to switch Advantage plans or join OM. The new plan starts the next month after the company processes the request.

If your income drops because of a change such as divorce, retirement, or death, you can appeal your income level and Part B premium amount.

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Pharmacy Plans

Pharmacy plans are Part D under Medicare. You do not want another pharmacy plan on top of your TRICARE pharmacy plan. Keep in mind:

• 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 will apply.
• By having another pharmacy plan, you lose your TRICARE home delivery option.

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Retired Civilian Workers

If you have a retiree health care plan, you do not have to enroll in Medicare/TFL. You will not have TFL nor TRICARE pharmacy. If you 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 (or a Medicare Advantage Plan Part C) — it does not work with any other plans.

Many civilian plans can be suspended rather than canceled.

Overseas Travel

Medicare plans do not work when you are overseas. Instead, your TFL converts to TRICARE Select Overseas. You are covered by TRICARE Select at that plan’s rates. You pay for services overseas out of pocket. You will file a claim to TRICARE for the expenses, and TRICARE will reimburse you.