How Does TRICARE Work With Medicare?

The relationship between Medicare and TRICARE can be confusing. You can be eligible for both programs. Whether you need Medicare Part B varies based off circumstance and what type of TRICARE you have. Generally, if you are eligible for TRICARE and Medicare Part A, you must get Part B to keep TRICARE. While typically the case, however, there are certain instances that Part B is not required. Review your situation carefully to ensure you keep your TRICARE coverage.

Active Duty Service Members

Service members on active duty are not required to have Medicare Part B to keep TRICARE. However, if you await medical retirement determination or plan to retire soon, Part B is encouraged. Enrolling in Part B will ensure your Part B coverage continues after retirement.

Similarly, when you become eligible for Medicare due to disability, Part B is encouraged before retirement. If you receive Social Security disability payments, you become Medicare eligible regardless of age. You will be able to enroll in Medicare during a special enrollment period that spans either:

  • The duration that you are on active duty, or
  • within the first eight months after retirement or loss of TRICARE.

Individuals suffering from End Stage Renal Disease (ESRD) are also eligible for Medicare before 65. In this case, you are also, and even more so, encouraged to enroll in Medicare Part B. If you decline Part B coverage, you will likely pay a late enrollment penalty if you apply later. You will not have a special enrollment period like those receiving Social Security Disability payments do. Enrolling in Part B upon eligibility is often your best course of action.

Active Duty Family Members

Family members of service members that receive TRICARE benefits are also not required to enroll in Part B. However, as with service members, you must have Part B to keep TRICARE once the family member retires. Family members receive the same Special Enrollment Period that service members do. Active duty family members are similarly encouraged to enroll in Part B despite it not being required.

Those receiving Social Security payments, or suffering from ESRD, are also encouraged to enroll in Part B. The rules for those apply the same for Active Duty Family Members as they do for Active Duty Service Members.

Retired Service Members and Their Families

For retired service members, and sponsored family members, Medicare Part B is required to keep TRICARE coverage. This applies throughout your TRICARE and Medicare eligibility, even if you live overseas. This means that you will lose your TRICARE coverage if you decline Part B, drop it, or fail to pay your premiums.

When you first become entitled to Medicare Part A, you should enroll in Part B. This both keeps your TRICARE coverage, and prevents you from being subject to a late enrollment fee.

Beneficiaries of TRICARE Reserve Select

If you receive benefits from TRICARE Reserve Select, Medicare Part B is not required. You can purchase or keep TRICARE Reserve Select without Part B. However, Medicare does not consider you or your sponsor to be actively employed by the military. You also may be required to pay a late enrollment fee if you deny Part B initially. Due to this, Part B is recommended for all beneficiaries of TRICARE Reserve Select.

Beneficiaries of TRICARE Retired Reserve

Much like TRICARE Reserve Select, you are not required to have Medicare Part B to Purchase TRICARE Retired Reserve. However, you will pay the late enrollment fee if you decline Part B coverage and apply later.

Beneficiaries of US Family Health Plan

Beneficiaries of US Family Health Plan that are entitled to Part A are not required to get Part B. However, you must have Part B to be eligible for other TRICARE benefits if:

  • You disenroll from the US Family Health Plan, or
  • you move to an area outside of US Family Health Plan coverage

If you enrolled in the US Family Health Plan after October 1st, 2012, you will be transferred to TRICARE For Life when you become Medicare-eligible. Those who enrolled before then, and had no break in coverage, may stay enrolled. If you are Medicare-eligible, you cannot enroll in the US Family Health Plan.

Beneficiaries Who Don’t Qualify For Medicare Part A

If you received notice saying you are ineligible for Medicare Part A, you may still be eligible for Part B. If so, it is recommended to enroll, as you will face the late enrollment penalty for enrolling later. Those ineligible for Part A should follow the steps below to keep your TRICARE coverage:

Single, never married

If you never married, you are still eligible for TRICARE Prime or TRICARE Select past your 65th birthday. To continue TRICARE, you need your Notice of Aware or Disapproved claim that notified you of your Part A ineligibility. Then, at your local ID card office, update your DEERS record and get a new ID card.

Widow/Widower

Those who have a deceased spouse may be allowed to use their spouses work history to qualify for Part A. This is allowed under the condition that you were married at least one year before your spouses death. Otherwise, you qualify for Part A under it’s normal eligibility requirements. Your TRICARE coverage can vary depending on:

  • If you are eligible for free Part A:
    • You’ll get a Notice of Award from the Social Security Administration.
    • Sign up for Part B. Your record in DEERS automatically updates to show your Part A and Part B coverage.
    • Your TRICARE For Life coverage begins on the date you have both Part A and Part B.
  • If you are not eligible for free Part A:
    • You’ll get a Notice of Award, Disapproved Claim or both from the Social Security Administration, based on your deceased sponsor’s social security number.
    • Take the Notice of Award, Disapproved Claim or both to your local ID card office to update your DEERS record and get a new ID card.
    • You continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.

Married/Divorced: Spouse Age 62 or Older

Similarly, former spouses who are divorced may be allowed to use their spouses work history. For divorcees, you must have been married at least 10 years before the date of your divorce to qualify.

  • If you’re eligible for free Part A:
    • You’ll get a Notice of Award from the Social Security Administration.
    • Sign-up for Medicare Part B. Your record in DEERS automatically updates to show your Part A and Part B coverage.
    • Your TRICARE For Life coverage begins on the date you have both Part A and Part B.
  • If you’re not eligible for free Part A under your spouse’s (or divorced spouse’s) social security number:
    • You’ll get a Notice of Award, Disapproved Claim or both from the Social Security Administration.
    • Take the Notice of Award, Disapproved Claim or both to your local ID card office to update your DEERS record and receive a new ID card.
    • You continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.

Married/Divorced: Spouse Younger than Age 62

When you sign up for Part B, you:

  • Take your Notice of Award, Disapproved Claim or both to your local ID card office to update your DEERS record and receive a new ID card.
  • You continue to be eligible for TRICARE Prime or TRICARE Select past your 65th birthday.
  • Three months before your spouse (or divorced spouse) turns 62, apply for Medicare Part A under his or her Social Security Number.

 

Health coverage can be a tricky landscape to navigate. If you have TRICARE and need help adding Medicare coverage, speak to a Medicare Advocate. We are licensed in all 50 states to bring you the best plans available. We will ensure you end up in a plan that fits your unique health needs and situation.

Get a personal consultation.

Call us today at 1-800-940-0633