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How Do I Transition from TRICARE to Medicare?


TRICARE, of course, is the name for the DoD-sponsored health care plan for military members, their families and certain civilian DoD employees. TRICARE for Life covers TRICARE members also eligible for Medicare. Medicare is the federal health insurance program for people over age 65, and those with certain chronic illnesses, such as end-stage renal failure and amyotrophic lateral sclerosis, or Lou Gehrig’s disease.

Some basic information about Medicare is in order here...

There are four parts to the Medicare program:

Part A – Covers inpatient hospitalization charges, subject to a deductible and certain lifetime caps. The premium for Part A is up to $441 per month in 2013 though lower-income individuals may qualify for free or reduced premiums.

Part B – Covers physician’s fees, lab fees, durable medical equipment, and certain preventative medicine services. The premium is $99 per month.

Part C – This is an option called “Medicare Advantage.” Using Medicare Advantage, Medicare beneficiaries can elect to access their coverage via a private managed care plan. Premiums vary depending on the plan you select. You must have Medicare Part A and B to enroll in Part C. Also, Part C is incompatible with special insurance plans called “Medigap,” or Medicare supplement insurance plans. If you are enrolled in a Part C Medicare Advantage plan, you don’t need a Medigap policy, and vice versa. If you are eligible for TRICARE for Life, you probably don’t need an additional Medicare supplement plan or Medicare Advantage plan; TRICARE will generally pick up what Medicare doesn’t cover.

Part D – A prescription drug benefit. Some Medicare Advantage plans include Part D coverage, or you can buy a “stand-alone” prescription drug plan through Medicare. Again, premiums vary depending on the plan you select.

If you are eligible for TRICARE for Life, transitioning to Medicare is pretty easy: Just make sure you enroll in Medicare Part B when you are first eligible – at age 65 unless you are eligible sooner because you have one of the qualifying medical conditions. At that point, you become what Medicare and TRICARE officials call “dual eligible.” That is, you are eligible both for Medicare and for TRICARE for Life.

Getting Started

If you are receiving Social Security Benefits when you turn 65, you will be automatically enrolled in TRICARE for Life. However, you must remain enrolled in Medicare Part B to stay eligible for TRICARE for Life. To avoid penalties, you must sign up for Medicare Part A and B during the open enrollment period, which begins three months prior to your 65th birthday and extends for four months afterward, for a total of seven months. If you miss this window, you will have to pay more for Medicare benefits.

Maintaining Eligibility

You must remain enrolled in DEERS. You can do this via your nearest RAPIDS military ID card issuing authority, or by calling -800-538-9552, or going through the DEERS online portal.

Who Pays?

If you are enrolled in TRICARE for Life and Medicare, Medicare pays first, followed by TRICARE for Life. If you are also enrolled in a workplace plan or other health care plan, the private plan pays first, up to the plan limits. Then Medicare pays. TRICARE for Life is again last in line, to pick up what’s left, up to the limits of plan eligibility.

Prescription Drug Plan

TRICARE for Life offers a prescription drug program. However, you may want to research the Medicare Part D drug plans available in your area, because these Part D plans are occasionally a better match for retirees than the TRICARE for Life prescription drug options, often because of the subsidy available to lower income enrollees. However, if you choose to remain enrolled in TRICARE, you will not be penalized for waiting to enroll in a Medicare Part D plan after your initial enrollment period. This is because TRICARE’s pharmacy plan counts as creditable coverage under Medicare rules. You can switch over to Medicare Part D at a later date without being penalized for late enrollment. The enrollment period for Part D is the same as your Initial Enrollment Period. If you don’t enroll then, the subsequent enrollment periods run from 15 November through 31 December each year. Coverage becomes effective January 1 following the enrollment period.

For more information on Medicare, visit www.medicare.gov.

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