Becoming Medicare-Eligible

Event:

QLE?

Becoming Medicare-Eligible

Yes.

You have 90 days after you become eligible for Medicare to change your TRICARE health plan.

NOTE: Plan options will vary depending on your situation (see below).

Medicare is a health insurance program for people:

  • Age 65 or older
  • Under age 65 with certain disabilities. (If you have Medicare due to a disability, you can continue your TRICARE Prime enrollment [if you qualify]. If you do, your Prime enrollment fees are waived. You can also get a refund for any Prime enrollment fees that you paid. Check with your regional contractor for details.)
  • With end stage renal disease
  • With Lou Gehrig's disease
  • Mesothelioma

The Centers for Medicare and Medicaid Services manages Medicare. If eligible, you have the option of using Original Medicare or enrolling in a Medicare Advantage plan.

Original Medicare

Medicare Advantage (Medicare Part C)
  • 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 Ais hospital insurance Which is financed by payroll deductions when you are or were working.
  • Medicare Part Bis medical insurance, which primarily covers outpatient services. You pay a premium each nonth which 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, TRICARE For Life 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 (also known as Medicare Part C) are a Medicare coverage option offered by private companies that contract with Medicare. Medicare Advantage plans provide all of your Part A and Part B services and usually Part D pharmacy coverage.
  • You may pay a plan premium each month in addition to your Medicare Part B premium.
  • You must get all your health care services from the Medicare Advantage plan’s network of providers. This doesn’t apply to emergency services.
  • If you enroll in a Medicare Advantage plan, you’ll have to pay copayments at the time of service.
  • TRICARE For Life can reimburse you for copayments you paid for TRICARE services. You’ll need to file your own claims.
 

>>Get Started with Medicare

Using Medicare and TRICARE Together

If you have Medicare Part A, you must also have Medicare Part B to remain eligible for TRICARE, including prescription drug coverage. Your TRICARE coverage options when entitled to Medicare depend on your age:

Under Age 65

Age 65 and Older

TRICARE Prime

If you're under age 65, entitled to Medicare Part A, and have Medicare Part B, you don’t have to disenroll from TRICARE Prime or the US Family Health Plan. TRICARE Prime will waive your individual enrollment fee.

Please note: If you have TRICARE Prime or receive coverage from TRICARE For Life, 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 TRICARE For Life contractor.
  4. Finally, the TRICARE For Life contractor processes and pays the TRICARE portion of the claims.

If you choose not to enroll in TRICARE Prime or US Family Health Plan, you’ll automatically be covered by TRICARE For Life.

TRICARE For Life

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

 

  • Medicare is your primary payer.
  • TRICARE pays second to Medicare or last if you have other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "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 TRICARE For Life and are no longer able to enroll in other TRICARE plans.

Prescription Drug Coverage

You must have Medicare Part B, unless you qualify for an exception listed above. You can continue to get prescriptions filled with no break in coverage as long as you have Medicare Part B when you first become eligible for Medicare Part A.

Medicare Part D, a prescription drug plan, is available to everyone with Medicare. You don't need Part D to keep TRICARE. If you meet certain income and resource limits, you may qualify for extra help from Medicare to pay Part D premiums. >>Learn More

Enrolled in TRICARE Young Adult?

TRICARE Young Adult is the second payer after Medicare.

Under age 65?

If you have Medicare due to a disability, you can continue your TRICARE Prime enrollment (if you qualify). If you do, your Prime enrollment fees are waived. You can also get a refund for any Prime enrollment fees that you paid. Check with your regional contractor for details.

Has your medical or pharmacy claim been denied?

You may still be covered. >>Learn More

Last Updated 12/19/2017