Becoming Medicare-Eligible | TRICARE

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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 & Medicaid Services manages Medicare:

  • Medicare Part A is hospital insurance. You usually don't pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working.  
  • Medicare Part B is medical insurance. You pay a premium each month.
  • Medicare Part D is pharmacy coverage. You pay a premium each month.

>>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. 

You don't need to sign up for Part B if you're: 

  • An active duty service member 
  • An active duty family member
  • Enrolled in TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, or the US Family Health Plan.

Family Members

If you’re turning 65 and your spouse is under age 65, they can continue to use TRICARE Prime, TRICARE Select, or whatever plan they're using now until they also become eligible for Medicare Part A & B. Your eligible children may also continue in their current plan until they lose eligibility.

If you're turning 65, but still have a spouse enrolled in Prime, that’s okay. The enrollment fees will reduce to the single rate. If you also have children enrolled, the fees will stay at the family amount.

If you’re turning 65, but you still have family members under age 65, they can continue to use TRICARE Select.

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

TRICARE For Life

When you have Medicare Parts A and B, you can use TRICARE For Life.

  • Medicare is your primary payer.
  • TRICARE is the second payer, so your out-of-pocket expenses are less.
  • TRICARE benefits include covering Medicare's coinsurance and deductible for services covered by Medicare and TRICARE.
  • When retired service members and their families become eligible for TRICARE For Life they are no longer able to enroll in TRICARE Prime.

US Family Health Plan

As of October 1, 2012 once you become eligible for Medicare at age 65, you can no longer enroll or stay enrolled in the USFHP. >>Learn More

If you enrolled in USFHP before October 1, 2012, you can stay enrolled as long as you stay enrolled and there is no break in coverage.

TRICARE Prime

If you're enrolled in a Prime option when you have Medicare, you don't have to disenroll. You're not required to use TRICARE For Life.

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