FALLS CHURCH, Va. –
Maintaining health care coverage through all phases of life supports good health for you and your family members. When you or a family member becomes eligible for
TRICARE For Life, you may have questions about how TFL coverage for one person affects TRICARE coverage for other members of your family.
“There are several factors that make you eligible for TFL. One is your entitlement to Medicare,” said Anne Breslin, TRICARE For Life Program Manager, TRICARE Health Plan, at the Defense Health Agency. “Each person becomes eligible for Medicare based on their birth date, or for those under 65, based on an illness or disability. This qualifies them for Social Security Disability Insurance benefits and, subsequently, Medicare. For these reasons, one family member’s eligibility for TFL and Medicare doesn’t affect other family members’ TRICARE enrollment. They may stay in their current TRICARE plan.”
Here are some commonly asked questions when sponsors or one of their family members will soon be eligible for TFL and Medicare.
Q: What is TFL?
A: As described in the TRICARE and Medicare Turning 65 Brochure, TFL is Medicare wraparound coverage. TRICARE and Medicare work together to minimize your out-of-pocket expenses.
A beneficiary’s TFL coverage doesn’t extend to their family members. If family members are TRICARE-eligible, they’ll keep their own TRICARE health plan.
Q: Who’s eligible for TFL?
A: TFL is for uniformed services retirees and their family members who are TRICARE-eligible and have Medicare Part A and Part B, regardless of age or where they live. TFL coverage is automatic once:
Be sure to keep your and your family members’ contact information up to date in DEERS.
Q: Is becoming Medicare-eligible a TRICARE Qualifying Life Event?
A: If you or a family member becomes eligible for Medicare at age 65, it isn’t a TRICARE Qualifying Life Event for the person turning 65.
However, it’s a QLE for your family members who are under age 65. What does this mean? These family members can make eligible changes to their TRICARE health plan. They must make these changes within 90 days of the Medicare-eligible family member’s Medicare-effective date.
To learn more, go to Becoming Medicare-Eligible.
Q: I missed signing up for Medicare Part B during my Initial Enrollment Period. Does this affect my family members’ TRICARE coverage?
A: No. Family members who aren’t eligible for Medicare may stay in their current health plan as long as they’re TRICARE-eligible.
Remember, to have TFL coverage, you must have Medicare Part A and Part B. This also applies to people living overseas and those with employer-sponsored health plans.
Did you only sign up for Medicare Part A during your Initial Enrollment Period? You may sign up for Medicare Part B during either a Special Enrollment Period or the annual General Enrollment Period. For example, did you opt to use your employer-sponsored health coverage instead of Medicare Part B? If so, sign up for Medicare Part B during a Special Enrollment Period. The Special Enrollment Period is available:
- Anytime you or your spouse are covered by an employer-sponsored health plan
- Up to eight months following loss of employment or loss of an employer-sponsored health plan
Sign up for Medicare Part B a month before your employment or employer-sponsored coverage ends, whichever happens first. This ensures you have Medicare Part A and Part B and TFL coverage when your employer’s coverage ends.
Check out the TRICARE For Life Handbook for details about Medicare Part B sign-up options.
Q: When I become eligible for Medicare, will my family’s TRICARE annual enrollment fee change?
A: Are your family members enrolled in a TRICARE Prime or TRICARE Select plan? Their enrollment fee may change. For example:
- If you only have one family member enrolled in TRICARE Prime or TRICARE Select, the enrollment fee changes to the individual rate.
- If you have two or more family members enrolled in TRICARE Prime or TRICARE Select, the enrollment fee stays at the family rate.
Health Plan Costs can help you understand your costs. You can also call your TRICARE regional contractor.
Q: As a spouse, if my sponsor passes away, does this affect my eligibility for TFL?
A: If your sponsor dies after they retire from active duty, you stay eligible for TRICARE unless you remarry (unless the new spouse is a retired service member). You’ll have TFL when you, the surviving spouse, have both Medicare Part A and Part B.
Q: How can I learn more?
A: TRICARE offers the following resources:
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