If you become eligible for Medicare at age 65 or due to a disability or end-stage renal disease, there is some important information you should know about your TRICARE coverage.
When you become entitled to premium-free Medicare Part A and have Medicare Part B coverage, you also become entitled to TRICARE For Life (TFL) benefits. TFL is TRICARE’s Medicare-wraparound coverage, which means TFL pays second to Medicare for all services covered by both Medicare and TRICARE.
Wisconsin Physicians Service (WPS) administers TFL. There’s no enrollment application; however, you do have to follow certain steps to make sure you remain TRICARE eligible when you become eligible for Medicare for a seamless transition from TRICARE Standard to TFL.
Verify Your Medicare Eligibility and enroll in Medicare Part B
The Centers for Medicare & Medicaid Services (CMS) manages Medicare, and there are certain rules about if and when you are required to file for Medicare Part A and Medicare Part B. For more information about filing for Medicare, call the Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778) or visit the
Social Security Administration web site.
Once you have Medicare Part A and Medicare Part B, verify that your record in the Defense Enrollment Eligibility Reporting System (DEERS) has been updated to reflect this change. While CMS automatically sends Medicare updates to DEERS, you should verify that the information has been correctly received. (See “Stay Eligible: Keep DEERS Up to Date” for more information on updating your DEERS record.)
It’s important to remember that if you have premium-free Medicare Part A, you also must have Medicare Part B to remain eligible for TRICARE. The exceptions to the Medicare Part B rule are as follows:
- Active duty family members (ADFMs). If you are an ADFM and are eligible for premium-free Medicare Part A, you do not need Medicare Part B to keep your TRICARE benefits. However, the Department of Defense (DoD) strongly encourages you to enroll in Medicare Part B prior to your sponsor’s retirement date to avoid a break in TRICARE coverage. ADFMs may enroll in Medicare Part B during the special enrollment period,which is any time during which your sponsor is on active duty or within the first eight months following your sponsor’s retirement date. The surcharge for late enrollment does not apply.
- TRICARE Reserve Select (TRS) or US Family Health Plan (USFHP) enrollees. If you are enrolled in TRS or the USFHP and are eligible for premium-free Medicare Part A, you do not need Medicare Part B to keep your TRICARE benefits. However, the DoD strongly recommends that you enroll in Medicare Part B when you are first eligible to avoid the Medicare Part B surcharge for late enrollment. The Medicare Part B surcharge is 10 percent for each 12-month period that you were eligible to enroll in Medicare Part B but did not.
See Medicare Providers
When using TFL, there will be a slight change in your benefits and how you get care. You must see Medicare providers in order for Medicare and TRICARE to pay for services that are covered by both programs—otherwise, you could be financially responsible for the care you receive. In most cases, TRICARE-authorized providers are Medicare providers as well. There’s a good chance that the providers you saw using TRICARE Standard are Medicare providers. You can check on this with your provider or Humana Military.
When you receive care that is covered by both Medicare and TRICARE, your provider will file the claim with Medicare; Medicare will pay its portion and then forward the claim to TRICARE, which, in turn, will pay its portion.
If you receive care in an overseas location not covered by Medicare, TRICARE will be the primary payer. To seek reimbursement, you must submit a paper claim to WPS, along with a copy of your provider’s itemized bill and, if applicable, your other health insurance’s explanation of benefits. You are responsible for the applicable TRICARE deductible and cost-share.
Visit the
WPS web site for more program information. Register and you can view the status of claims, update other health insurance information and verify your TRICARE eligibility information through DEERS. You can also find out more about WPS’s explanation-of-benefit processes.
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