Retired Service Members and Families
If entitled to Medicare Part A, you must have Medicare Part B to remain eligible for TRICARE, even when you live overseas. This is also true for medically-retired service members and their families and retired National Guard or retired Reserve members age 60 and older and their families.
Qualifying for Medicare due to a Disability
You become eligible for Medicare beginning the 25th month of receiving Social Security disability payments. The Social Security Administration (SSA) notifies you of your Medicare entitlement start date. If you return to work, your Social Security disability benefits will be suspended if your income exceeds the threshold. However, your Medicare entitlement may continue up to eight and a half (8 1/2) years following the suspension of disability benefits. You will receive a bill from Medicare every three months. You must pay your Medicare Part B premiums to keep TRICARE.
If you are awarded disability on appeal, you generally have a gap of six or more months between your Medicare Part A and Part B effective dates. Those with a Part B effective date of October 2009 or later are not required to retroactively enroll in Medicare Part B to keep your TRICARE coverage. TRICARE will remain your primary coverage for the period you have Medicare Part A only. You must keep Medicare Part B from the initial effective date forward to keep your TRICARE coverage.
If you Have End Stage Renal Disease (ESRD)
Medicare coverage isn't automatic for people with ESRD. You need to sign-up for Medicare benefits. Failure to sign-up for Medicare benefits will result in loss of TRICARE coverage. Your Medicare coverage begins:
- The fourth month you're on renal dialysis;
- The month you're admitted to a Medicare-approved hospital for kidney transplant, or in the following two months; or
- Two months before your transplant if your transplant is delayed more than two months after admission to the hospital.
Getting Medicare at Age 65
You become eligible for Medicare Part A at age 65 if you or your spouse paid into Social Security for at least 40 quarters (at least ten years of work). Failure to file for Medicare benefits results in loss of TRICARE coverage.
If you already receive benefits from Social Security, the Railroad Retirement Board (RRB), or Office of Personnel Management, you are automatically entitled to Medicare Part A and are enrolled in Medicare Part B starting the first day of the month you turn 65. (If your birthday is on the first of the month, Part A and Part B are effective on the first day of the previous month.)
If you aren’t receiving Social Security benefits, RRB benefits, or a federal annuity from the Office of Personnel Management, you must sign-up for Part A and Part B. To avoid the Medicare surcharge for late enrollment, you must sign-up for Part B during your Medicare Initial Enrollment Period (seven-month period that begins three months before you turn 65, or four months before you turn 65 if your birthday is on the first of the month). To avoid a break in TRICARE coverage be sure to enroll no later than two months before you turn 65. If you enroll any later, your Part B effective date will be delayed and you will have a break in TRICARE coverage.
If You Were Already Entitled to Medicare before Age 65
If you are entitled to Medicare due to a medical condition or disability, your Medicare coverage will continue without interruption after your 65th birthday. If you do not have Part B, you will automatically be enrolled the month you turn 65, or the previous month if your birthday is on the first of the month. If you were paying a premium surcharge, it will be removed.
If You Have Employer-Sponsored Group Health Plan Coverage
If you have employer-sponsored group health plan coverage (based on your employment or your spouse’s employment), Medicare allows you to delay your Part B enrollment. Medicare allows you to sign up later during a special enrollment period during the first eight months following the month that (1) employment ends, or (2) group health plan coverage ends, whichever is first.
However, without Medicare Part B, you won’t have TRICARE coverage. So, if you delay your Part B enrollment, you won’t be covered by TRICARE For Life and TRICARE won’t act as a second payer to your employer sponsored group health plan coverage.
To have TRICARE coverage when your employer sponsored group health plan coverage ends, you should sign up for Part B before your group health plan coverage or employment ends, whichever occurs first, to avoid a break in coverage.