FALLS CHURCH, Va. –
Do you have Medicare, or will you soon be eligible to enroll? Medicare has four parts: A, B, C, and D. It’s important that you understand how each part differs and which parts you’ll need for
TRICARE For Life (TFL).
TFL provides secondary coverage to
Medicare, which is known as Medicare-wraparound coverage. TFL is an individual entitlement. This means it’s only available to military retirees and their eligible family members who qualify for Medicare. TRICARE enrollments for family members who aren’t eligible for Medicare remain the same.
Here’s what you need to know about the 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 through payroll taxes. It helps provide coverage for:
- Inpatient care in hospitals
- Skilled nursing facility care
- Some home health care
- Hospice care
Most people become eligible for premium-free Medicare Part A at age 65 if they worked and paid Social Security taxes for at least 10 years. If you aren’t 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 aren’t eligible for premium-free Medicare Part A based on your own or your spouse’s work history? Check out the
TRICARE and Medicare: Turning Age 65 Brochure for instructions on how to remain TRICARE eligible after you turn age 65.
Some people become eligible for Medicare before age 65 based on a disability or a health condition. Some qualifying conditions include end-stage renal disease or Lou Gehrig’s Disease. Check out the
TRICARE and Medicare Under Age 65 Brochure for instructions on how to remain TRICARE eligible when you become eligible for Medicare before age 65.
Medicare Part B: Medical Insurance
You also need
Medicare Part B to have TFL coverage. Medicare Part B is medical insurance funded through monthly premiums. It helps cover:
- Services from doctors and other health care providers
- Outpatient care
- Home health care
- Durable medical equipment (wheelchairs, walkers, and hospital beds)
- Preventive services (screening, vaccines, and yearly wellness visits)
As outlined in the
TRICARE and Medicare: Turning Age 65 Brochure, the
Medicare Part B premium is based on your income and is taken from your monthly
Social Security retirement or disability payment. If you aren’t receiving either of these payments, you’ll receive a bill every three months for your premiums.
Both Medicare Parts A and B make up Original Medicare. If you’re eligible for Medicare Part A, you must have Part B to have TFL coverage. This requirement doesn’t apply to active duty family members or to individuals who’ve been enrolled in the
US Family Health Plan continuously since Oct. 1, 2012.
“You should sign up for Medicare Part A and Part B when you’re first eligible, to avoid a break in your TRICARE coverage, or having to pay a penalty,” said Anne Breslin, TRICARE For Life program manager at the Defense Health Agency. “If you sign up for Medicare Part B after your
Initial Enrollment Period, you may have to pay a late enrollment premium penalty for as long as you have Part B.”
The only way you won’t have to pay the late enrollment penalty when you delay your enrollment in Medicare Part B is if you qualify for a
Special Enrollment Period.
The other two Medicare Parts (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 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 the Medicare Advantage plans include Medicare Part D drug coverage.
Considering enrolling in a Medicare Advantage plan? You should be aware of the following: You may pay a monthly plan premium, plus your Medicare Part B premium. You’ll also have to pay copayments at the time of service. This means you’ll have to
file a claim with TFL to be reimbursed for any copayments. TRICARE can reimburse you for copayments for
TRICARE covered services. You must also get health care services from the Medicare Advantage plan’s network of providers, with the exception of emergency services.
Medicare Part D: Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription drugs. However, you don’t need Medicare Part D. TFL beneficiaries remain eligible for the
TRICARE Pharmacy Program. This means you still have the same
pharmacy options to fill your covered prescriptions.
If you sign up for Medicare Part D, it’s important to remember that Part D has a monthly premium which varies depending on which plan you choose. Medicare Part D coverage and costs can change each year, so it’s important to review your options annually. If you get Medicare Part D, it would be the primary payer for your prescription medication. And the TRICARE Pharmacy Program would be the last payer for all TRICARE covered prescription drugs.
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 eligibility and the four parts of Medicare by checking out
Becoming Medicare-Eligible on the TRICARE website.
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