Becoming Medicare-Eligible

Becoming Medicare-eligible at age 65

No.

• TRICARE beneficiaries ages 65 and older and eligible for Medicare:
  • You’re automatically covered by TRICARE For Life when you have Medicare Part A and Medicare Part B.
  • You aren’t eligible to enroll in other TRICARE health plans.

Yes.

• TRICARE-eligible family members under age 65 can:
  • Enroll in a different TRICARE health plan. See below for more information.
  • Request enrollment changes within 90 days of the Medicare-eligible family member’s Medicare effective date.

Yes.

• The person who’s under age 65 and is Medicare-eligible can enroll in a TRICARE Prime option or use TFL.
• TRICARE-eligible family members under age 65 can:
  • Enroll in a different TRICARE health plan. See below for more information.
  • Request enrollment changes within 90 days of the Medicare-eligible family member’s Medicare effective date.

Note: Your plan options vary depending on your situation.

• When using Original Medicare, you may get health care services from any Medicare participating or Medicare non-participating provider, regardless of their specialty.
• Medicare Part A is hospital insurance. It’s financed by payroll deductions when you are or were working.
• Medicare Part B is medical insurance, which primarily covers outpatient services. You pay a premium each month. This is based on your level of income.
• Medicare Supplement Insurance (Medigap) coverage is optional. You pay a premium each month. Medigap pays your out-of-pocket costs in Original Medicare.
• If you’re eligible for TRICARE and have Medicare Part A and Part B, TFL provides wraparound coverage, which pays your out-of-pocket costs in Original Medicare for TRICARE-covered services. Medicare and TRICARE coordinate benefits, which eliminates the need for you to file claims.

• Medicare Advantage Plans are a Medicare coverage option offered by private companies that contract with Medicare. Medicare Advantage Plans provide all of your Medicare Part A and Part B services and usually Medicare Part D pharmacy coverage.
• You may pay a plan premium each month in addition to your Medicare Part B premium.
• Generally, you need to use doctors and hospitals within the plan’s network to get the most coverage. This doesn’t apply to emergency services. 
• If you enroll in a Medicare Advantage Plan, you may have to pay copayments at the time of service.
• TRICARE can reimburse you for copayments you paid for TFL services. You may need to file your own claims.

TRICARE Prime

If you have Medicare Part A due to a disability and you have Medicare Part B, you don’t have to disenroll from TRICARE Prime or the Uniformed Services Family Health Plan. If you’re in Group A, you may have your TRICARE Prime enrollment fee waived. Check with your regional contractor for details. The fee waiver doesn’t apply to Group B.

Note: If you have TRICARE Prime, your claims won’t process through the regional contractor.

1. Providers file claims with Medicare first.
2. Medicare processes and pays their portion of your claims.
3. Then, Medicare forwards your claims to the TFL contractor.
4. Finally, the TFL contractor processes and pays the TRICARE portion of the claims.

If you choose not to enroll in TRICARE Prime or USFHP, you’ll automatically be covered by TFL.

TRICARE For Life

When you have Medicare Part A and Part B, you automatically receive coverage through TRICARE For Life. There are no enrollment forms or enrollment fees for TFL.

• Medicare is your primary payer.
• TRICARE pays second to Medicare, or last if you have other health insurance.
• TRICARE benefits include covering Medicare’s coinsurance and deductible for services covered by Medicare and TRICARE.
• When retired service members or eligible family members reach age 65 and are eligible for Medicare, they become eligible for TFL and are no longer able to enroll in other TRICARE plans.