Do you have Medicare or will you be able to sign up soon? Medicare has four parts: A, B, C, and D. It is important that you understand how each part is different and which parts you will need for TRICARE For Life (TFL).
TFL provides secondary coverage to Medicare, which is known as global Medicare coverage. TFL is an individual right. This means that it is only available to eligible military retirees and their eligible family members who are eligible for Medicare. TRICARE enrollments for family members who are not eligible for Medicare remain the same.
Here’s what you need to know about all four parts of Medicare.
Medicare Part A: Hospital Insurance
You need Medicare Part A to have TFL coverage. Medicare Part A is hospital insurance funded by payroll taxes. Helps to provide coverage for: Hospital care in hospitals Care in specialized nursing centers Some medical care at home Hospice care
Most people are eligible for Medicare Part A without a premium at age 65 if they worked and paid Social Security taxes for at least 10 years. If you are not eligible for Medicare Part A based on your own work history, you may be eligible based on your spouse’s work history. What if you are not eligible for Free Medicare Part A based on your employment history or your spouse’s history? See the TRICARE and Medicare brochure: Turning 65 to learn how to remain eligible for TRICARE after age 65.
Some people are eligible for Medicare before age 65 based on a disability or health condition. Some qualifying conditions include end-stage kidney disease or Lou Gehrig’s disease. See the TRICARE and Medicare brochure for children under 65 for instructions on continuing to be eligible for TRICARE when you are eligible for Medicare before age 65.
Medicare Part B: Health Insurance
You also need Medicare Part B to have TFL coverage. Medicare Part B is a health insurance funded by monthly premiums. Help to cover: Services of doctors and other health care providers Outpatient care Home medical care Durable medical equipment (wheelchairs, walkers and hospital beds) Preventive services (detection, vaccinations and annual wellness visits)
As described in the TRICARE and Medicare booklet: At age 65, your Medicare Part B premium is based on your income and is deducted from your monthly Social Security retirement or disability payment. If you do not receive any of these payments, you will receive an invoice every three months for your premiums.
Medicare Parts A and B form original Medicare. If you are eligible for Medicare Part A, you must have Part B to have TFL coverage. This requirement does not apply to in-service family members or individuals who have been enrolled in the U.S. Family Health Plan on an ongoing basis since October 1, 2012.
“You should enroll in Medicare Part A and Part B when you first qualify, to avoid an interruption in your TRICARE coverage or to pay a penalty,” said Anne Breslin, TRICARE For Life program manager. the Defense Health Agency. . “If you enroll in Medicare Part B after your initial enrollment period, you may have to pay a late enrollment premium penalty while you have Part B.”
The only way you will not have to pay the late enrollment penalty when you delay your Medicare Part B enrollment is if you meet the requirements for a special enrollment period.
The other two parts of Medicare (C, D) are optional. You don’t need them to have TFL.
Medicare Part C: Medicare Advantage
Medicare Part C refers to Medicare Advantage plans. This is an optional coverage offered by private companies that contract with Medicare. A Medicare Advantage plan must cover Medicare Part A and Part B services. These plans may offer you additional benefits not covered by Medicare or TRICARE. And about half of Medicare Advantage plans include Medicare Part D drug coverage.
Are you considering enrolling in a Medicare Advantage plan? Please note the following: You may pay a monthly plan premium, plus your Medicare Part B premium. You will also have to pay co-payments at the time of service. This means that you will need to file a claim with TFL to be reimbursed for any copayments. TRICARE can reimburse you for co-payments for services covered by TRICARE. You must also get health care services from your Medicare Advantage plan provider network, with the exception of emergency services.
Medicare Part D: Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription drugs. However, you do not need Medicare Part D. TFL recipients remain eligible for the TRICARE Pharmacy Program. This means you still have the same pharmacy options to fill your covered prescriptions.
If you enroll in Medicare Part D, it’s important to remember that Part D has a monthly premium that varies depending on the plan you choose. Medicare Part D coverage and costs may change each year, so it’s important to review your options annually. If you receive Medicare Part D, it will be the primary payer of your prescription drugs. And the TRICARE Pharmacy Program would be the last payer of all prescription drugs covered by TRICARE.
You have different options for your Medicare coverage. But remember, you only need Medicare Part A and Part B to have TFL coverage. You can learn more about TFL and the four parts of Medicare eligibility by looking at How to Become Medicare Eligible on the TRICARE website.
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