Retired Service Members and Families
If you are entitled to Medicare Part A:
- You must have Medicare Part B to keep your TRICARE coverage, even if you live overseas.
- You will lose your TRICARE coverage if you don't have Part B, if you drop Part B, or fail to pay your Part B premiums.
You should sign up for Medicare Part B when you first become eligible to avoid the Medicare Part B late enrollment higher premium.
This also applies to:
- Medically-retired service members and their families
- Retired Guard/Reserve members age 60 and older
- Family members of retired Guard/Reserve members age 60 and older
Your Health Plan Options with Medicare Parts A & B
- You’re covered automatically by TRICARE For Life and TRICARE's pharmacy benefit.
- If under age 65, you can enroll in TRICARE Prime or the US Family Health plan and your enrollment fees are waived.
Medicare Qualification Scenarios:
- 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 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’ll get a bill from Medicare every three months. You must keep Medicare Part B to keep TRICARE.
If you’re awarded disability on appealThe action you take if you don’t agree with a decision made about your benefit., you generally have a gap of six or more months between your Medicare Part A and Part B effective dates. If you have a Part B effective date of October 2009 or later, you’re not required to retroactively enroll in Medicare Part B to keep TRICARE.
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.
- 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).
You must have Medicare Part A and B in order to have TRICARE coverage when you are 65. Or you must have proof of your ineligibility for Medicare. If you’re 65, but have an active duty sponsor, you don’t have to have Medicare Part B until your sponsor is retired. Sign up before your sponsor retires to avoid a gap in TRICARE coverage.
Are you already getting benefits from Social Security, the Railroad Retirement Board (RRB), or Office of Personnel Management (OPM)?
Yes, I am getting benefits:
No, I’m not getting benefits:
- You’re 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.
- You must sign up for Medicare Part A & B
- Sign-up for Part B during your Medicare Initial Enrollment Period
- 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
- Your Medicare coverage will continue without interruption after your 65th birthday.
- If you don’t 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
Medicare allows you to sign up later during a special enrollment period. This is available:
- Anytime while you are working and covered by employer sponsored coverage
- During the first eight months following the month that (1) employment ends, or (2) group health plan coverage ends, whichever is first.
But remember, to keep your TRICARE coverage you must have Medicare Part B.
- 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 during the special enrollment period described above.
What about my family members?
If you’re turning 65, but you still have family members under age 65, they can continue to use TRICARE Prime, TRICARE Standard and Extra, or whatever plan they're using now until they also become eligible for Medicare Part A & B.