Retiring from Active Duty
When you retire from active duty, you and your eligible family members experience a “change in status,” and you will all receive new “retired” uniformed services ID cards when DEERS is updated.
As a retired service member, you and your family members will have new health care options, since TPR and TPRADFM are not available to retirees and their families. When on active duty, you were enrolled in either TRICARE Prime (if stationed in a non-remote area) or TPR. After you retire, you can choose to enroll in TRICARE Prime (if located in an area where TRICARE Prime is offered), or you can use TRICARE Standard and TRICARE Extra.
Note: If you stay at your current residence, you may be able enroll in TRICARE Prime if you waive your access standards. Contact Humana Military for details.
Here’s a quick glance at some of the changes in TRICARE when you retire:
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If you enroll in TRICARE Prime:
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You begin paying annual enrollment fees.
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Network copayments/cost-shares will apply.
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Your catastrophic cap increases.
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Minor differences in covered services:
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Annual eye exams are no longer covered, but if you enroll in TRICARE Prime, they are covered every two years.
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Hearing aids are no longer covered.
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If family members were using TRICARE Standard and TRICARE Extra before you retired, the cost-shares will now increase by five percent.
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You must have Medicare Part B coverage for all Medicare-eligible family members to remain eligible for TRICARE.
Review the costs, including applicable TRICARE Prime enrollment fees, in the
TRICARE: Summary of Beneficiary Costs flyer. You and your family members should look at your health care options together and determine which option best meets your needs after you retire. If you decide to enroll in TRICARE Prime, you must submit an
enrollment application with the appropriate fees prior to your retirement start date to have continuous TRICARE Prime coverage. If you do not enroll in TRICARE Prime before your retirement date, the 20th-of-the-month rule will apply for you and your family members, and you are covered by TRICARE Standard and TRICARE Extra until your coverage begins. See
Figure 6.1 for enrollment deadlines.
Becoming Entitled to Medicare
Medicare-eligible active duty family members under age 65 have the option to enroll in TPRADFM or use TRICARE For Life. Active duty family members are not required to have Medicare Part B coverage to remain eligible for TRICARE. When the active duty sponsor retires, Medicare-eligible family members must have Medicare Part B or they lose eligibility for TRICARE.
Deceased Sponsor
When a sponsor dies, TRICARE coverage continues for eligible family members. Surviving spouses remain eligible for TRICARE as long as they do not remarry. If a surviving spouse remarries, he or she loses eligibility for TRICARE and cannot regain eligibility in the case of divorce or the death of the new spouse.
Surviving children remain eligible for TRICARE until they turn age 21 (or 23 if enrolled in college full time and the parent provides more than 50 percent of the child’s financial support).
Note: Children with disabilities may be eligible for TRICARE beyond the normal age limits.
After the death of an active duty service member, all surviving family members continue to be treated as active duty family members for three years. During this three-year “transitional survivor” period, all family members receive the same benefits at the same costs as active duty family members.
Surviving family members may enroll in TRICARE Prime or TPRADFM at the time of the death of their sponsor, or any time thereafter. If they enroll in TRICARE Prime or TPRADFM, they pay nothing for covered benefits other than pharmacy services. If they do not enroll in TRICARE Prime or TPRADFM, they are covered by TRICARE Standard and TRICARE Extra, and active duty family member annual deductibles and cost-shares will apply.
After three years, surviving spouses remain eligible for TRICARE Prime, Standard, and Extra at retired family member rates. TRICARE Prime enrollment fees will apply for surviving spouses who choose to enroll in TRICARE Prime after the three-year transitional survivor period. Surviving children remain eligible for TRICARE (TRICARE Prime, TPRADFM, TRICARE Standard, and TRICARE Extra) for three years after the date of the member’s death or up to age 21, whichever is longer. This age limit extends to age 23 if the surviving children were, at the time of the member’s death, dependent upon the former member for more than 50 percent of their financial support or if they were pursuing a full-time course of education in a secondary school or an institution of higher education. Note: The effective date of this benefit is retroactive to October 7, 2001.
Upon the death of a sponsor, you will receive a letter from DEERS telling you about your program options and how your benefits will eventually change. Contact Humana Military if you have any questions.
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