FALLS CHURCH, Va. –
Turning 65 means it’s time for Medicare. If you’re eligible for Medicare and
TRICARE For Life, and also have employer-sponsored coverage, there are some important decisions to make.
“TRICARE For Life works alongside Medicare coverage, but there are some rules beneficiaries should know,” said Anne Breslin, Program Manager, TRICARE For Life, TRICARE Health Plan, at the Defense Health Agency. “It’s crucial to understand your options, especially if you have employer-sponsored insurance.”
What to know about TFL and Medicare enrollment
Everyone has a seven-month Medicare Initial Enrollment Period that starts three or four months before the month they turn 65. Medicare lets people with employer-sponsored coverage from their current job delay their Part B enrollment. They can sign up later during a
Special Enrollment Period without late enrollment premium penalty.
The Special Enrollment Period for Medicare Part B lasts as long as you or your spouse is working and covered by employer-sponsored insurance, or for the first eight months after employment or employer coverage ends, whichever is first. Whether you delay enrollment or not, it’s important to understand the Medicare enrollment periods. Sign up for Medicare benefits on time to avoid a break in coverage and late-enrollment penalties.
If you choose to delay signing up for Medicare Part B, you’ll use your employer-sponsored coverage. You won’t be eligible for TRICARE during that time. Sign up for Part B before you retire or lose employer-sponsored coverage. That way, your TFL coverage will start right after your employer plan ends.
If you have coverage through the Federal Employee Health Benefits Plan, you can suspend your coverage and use TFL. Suspending your FEHBP will let you enroll in an FEHBP later if you choose. Cancelling your FEHBP means that you won’t be able to re-enroll later. To suspend FEHBP coverage, fill out a suspension form from the Office of Personnel Management or call 888-767-6738.
Remember, once you’re eligible for Medicare Part A, you’ll need to sign up for Medicare Part B to be eligible for TRICARE. You're responsible for Medicare Part B premiums.
Understanding your options
If you’re turning 65 and have employer-sponsored health insurance, you can:
- Keep your employer-sponsored coverage, and enroll only in Medicare Part A. In this case, you won’t have TRICARE coverage. TFL takes effect on the first date that your Medicare Part A and Part B coverage are effective.
- Keep your employer-sponsored coverage and also enroll in Medicare Parts A and B. TFL is effective the first date that both your Medicare Parts A and B take effect. TRICARE is the last payer after your employer coverage and Medicare have paid their portion of the claim.
- Enroll in Medicare Parts A and B only. TFL is effective the first date that both your Medicare Parts A and B take effect. Medicare will be the first payer and TRICARE pays after.
TFL is just for military retirees and their eligible family members who qualify for Medicare. Any TRICARE enrollments for family members who aren’t eligible for Medicare stay the same.
How coverage works together
TFL is
Medicare “wraparound” coverage. This means that it pays your out-of-pocket costs for TRICARE covered services after Medicare pays their part of a claim. TFL coverage begins on the first day you have both Medicare Part A and Part B coverage.
TFL out-of-pocket costs
| TYPE OF SERVICE |
MEDICARE PAYS |
TRICARE PAYS |
YOU PAY |
| Covered by TRICARE and Medicare |
Medicare-allowed amount |
Remaining amount |
Nothing |
| Covered by Medicare only |
Medicare-allowed amount |
Nothing |
Medicare deductible and cost-share |
| Covered by TRICARE only |
Nothing |
TRICARE-allowable amount |
TRICARE deductible and cost-share |
| Not covered by TRICARE or Medicare |
Nothing |
Nothing |
Billed charges (which may exceed the Medicare or TRICARE-allowable amount) |
Employer-sponsored health plans may cover providers, services, or items that Medicare or TRICARE don’t. Compare your employer group health plan benefits and costs to your Medicare and TRICARE benefits and costs to find what’s best for you.
For larger employer-sponsored health plans, that health plan pays first, Medicare pays second, and TRICARE pays last. For plans with fewer than 20 employees, Medicare pays first, the employer plan second, and TRICARE pays last.
| Employer-sponsored insurance type |
Order of payment |
| Greater than 20 employees |
1. Employer plan
2. Medicare
3. TRICARE |
| Fewer than 20 employees |
1. Medicare
2. Employer plan
3. TRICARE |
You’ll need Medicare Part B coverage to get or keep TFL coverage, as described in the TRICARE For Life Handbook. If you turn down Medicare Part B when you’re first eligible, and you don’t qualify for a Special Enrollment Period, you can still sign up for Medicare Part B during its General Enrollment Period of Jan. 1 through March 31 each year. Medicare Part B takes effect the month after you sign up. If you sign up for Medicare Part B without a Special Enrollment Period, you may have a late enrollment premium penalty. The Part B late enrollment premium penalty is an added 10% for each 12-month period that you could sign up for Medicare Part B but didn’t.
Important: COBRA is a law that lets you keep your employer group health plan coverage for a limited time after your job ends. Your Medicare Part B 8-month Special Enrollment Period begins after you stop working or lose your health insurance. COBRA coverage doesn’t count. Sign up for Medicare Part B during that Special Enrollment Period to avoid penalties.
Communication is key
Insurance plans need to know about any other coverage you have so they can avoid payment problems. To help, you should:
If TRICARE pays first and then finds out that you had other health insurance, TRICARE will take back any payments made. TRICARE will only reprocess your claim after your other health insurance does.
Where to look for help
For more information, check out the
TRICARE and Medicare Turning Age 65 Brochure and the
TRICARE For Life Handbook. Once you’re eligible for Medicare, contact your TRICARE contractor for help:
Sixty-five is a major milestone. TRICARE is here to help you make informed decisions about your healthcare coverage options.
Would you like the latest TRICARE news sent to you by email? Visit TRICARE Subscriptions to get benefit updates, news, and more.