A Roadmap to Medicare and TRICARE For Life (2024)

Note: This article first appeared in Transitioning Into Medicare and TRICARE For Life, a publication exclusive to MOAA Premium and Life members. Find more member-exclusive publications at this link, and check out member-exclusive discounts at this link.

Retirees and their spouses individually lose their TRICARE benefit on the last day of the month prior to their 65th birth month.

Unless covered by their own (or their spouse’s) employer health care plan, they must enroll in Medicare or face premium penalties for late enrollment.

Medicare enrollment entitles a military retiree and their spouse access to TRICARE For Life (TFL). This publication details the process of transitioning into Medicare and TFL.

TFL started Oct. 1, 2001, and restored TRICARE coverage for all Medicare-eligible retired uniformed services beneficiaries who are enrolled in Medicare Part B. TFL ensures eligible beneficiaries will receive all Medicare-covered benefits under Medicare, plus all TRICARE-covered benefits. Beneficiaries must use a Medicare provider. Medicare will be the first payer for all Medicare-covered services, and TRICARE, by law, is the last payer. Under TFL, TRICARE becomes your Medicare supplement plan. TFL also acts as your pharmacy plan, negating the need for Medicare Part D.

Medicare Advantage Plans (MAPs), known as Part C, count as Parts A and B Medicare for TFL, the same as Original Medicare Parts A and B. You have the choice to have the federal government as your insurer (Original Medicare) or a health insurance firm as your insurer (MAP, Part C). While TFL covers Original Medicare and MAP costs, TFL does not always seamlessly link with MAPs and might require manual claim submissions.

TRICARE’s pharmacy benefit remains the same for beneficiaries under and over age 65.

Before you can begin using TFL, you’ll need to do three things:

• Enroll in Medicare Parts A and B.
• Have an accurate record in the Defense Enrollment Eligibility Reporting System (DEERS).
• Have a valid, current uniformed services ID card.

Enroll in Medicare Parts A and B

You enroll in Medicare online. Beneficiaries should sign up for Medicare during their initial enrollment period, which begins three months before the month a beneficiary turns 65 and ends three months after the month a beneficiary turns 65. If your birthday is on the first of the month, your initial enrollment period begins one month earlier and ends one month sooner.

We suggest you enroll prior to your birth month. Early enrollment ensures coverage starts on time with no gap in coverage.

If you or your spouse are still employed and have group health plan coverage through your employer, including the Federal Employee Health Benefit Program (FEHBP), you may wait to enroll in Medicare. However, you will lose TRICARE coverage until you eventually enroll in Medicare. You will not be penalized with a late-enrollment fee if you enroll within eight months of your group health plan coverage ending (which means you are no longer working).

If you elect not to enroll in Medicare when you turn 65 — for example, if a veteran decides to use VA health care — and you are not covered by your employer’s health care policy, there is a 10% premium penalty, compounded each year, for late enrollment in Medicare.

If you enroll in Medicare when you are first eligible but are not yet receiving Social Security, Medicare will bill you for your premiums.

Being retired from the workforce and under an employer’s retired health plan does not qualify for delaying your Medicare enrollment without a penalty. You also will have to wait until the next general enrollment period, which is Jan. 1 to March 31 of each year, with benefits starting July 1.

To enroll in Medicare Parts A and B, contact the Social Security Administration at (800) 772-1213 or visit SSA.gov. For important enrollment and coverage information, click this SSA.gov link.

Medicare Advantage Plan (Part C)

Those eligible for Medicare have the choice of using the federal government as their insurer in Original Medicare or a corporate health care insurer with a MAP. All plans are Medicare Parts A and B as required by law with the same minimum standards of coverage. The Part B premium either goes to the government (Original) or the company insurer (MAP).

MAPs can offer more coverage than Original but never less; they can charge more for the extra coverages. The $0 premium plans you might see advertised are not really free. MAPs charge the same Part B Medicare premiums everyone pays.

The $0 means the amount above the standard Part B premium a person pays. Also note the copays, co-insurance, deductibles, and maximum coverage amounts on the plans, but TFL covers the costs that fall out of Medicare for Medicare-covered costs. And TFL has a catastrophic cap per calendar year to limit your out-of-pocket costs to $3,000 a year for covered costs.

Note that while TFL covers Original and MAP costs, TFL does not always seamlessly link with MAPs and might require manual claim submissions.

Check with the TFL contractor, Wisconsin Physicians Service, at (866) 773-0404 or www.tricare4u.com to see if your MAP will connect to TFL.

When selecting a MAP, be sure the plan does not come with Part D drug coverage. Numerous MAPs automatically come with a drug plan.

Selecting another drug plan messes with the TRICARE pharmacy plan. TRICARE pharmacy becomes the second payer (meaning manual claims and reimbursem*nts), and you lose the ability to use the TRICARE home delivery program.

Have an Accurate, Current Record in DEERS

Five months before turning 65, you will receive a postcard from the Defense Manpower Data Center (DMDC), the office that supports DEERS, with information about keeping TRICARE coverage after age 65.

If you recently have moved or changed status, you’ll need to notify the DMDC Support Office (DSO) to update your DEERS record. There are several ways to inform them of changes in status.

• Visit the DEERS website.
• Visit a local personnel office that has a uniformed services ID card facility. (Call for hours of operation or to update records for housebound individuals.) Locate the nearest military ID card facility using the site locator.
• Call the DSO telephone center at (800) 538- 9552. It is open weekdays between 8 a.m. and 8 p.m. Eastern.
• Fax your address changes to (502) 335-9980.
• Mail the information to: DSO, ATTN: COA, 400 Gigling Road, Seaside, CA 93955

Have a Valid, Up-to-Date Uniformed Services ID Card

All eligible uniformed services family members and survivors of deceased personnel who are age 65 and older are eligible to receive permanent military ID cards. Beneficiaries currently in possession of valid ID cards may obtain new, permanent ID cards within 90 days of expiration.

Contact your nearest ID card issuing facility for more information. You can locate the nearest facility and make an appointment to get an ID card by visiting the ID Card Office Online.

Working at Age 65 and Beyond

The size of the employer and having an employer health plan determines whether you might be able to delay Part A and Part B without having to pay a penalty if you enroll later.

If the employer has fewer than 20 employees, you should sign up for Parts A and B when you’re first eligible. In this case, Medicare pays before your other coverage.

If the employer has 20 or more employees, ask your benefits manager if you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment might be able to delay Parts A and B and won’t have to pay a lifetime late enrollment penalty if they enroll later. If you want to delay both Parts A and B coverage, you don’t need to do anything when you turn 65. If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you are first eligible for Medicare.

NOTE: Although the eligibility age for full Social Security benefits changed in 2015, the eligibility age for Medicare did not.