TRICARE and Medicare Eligibility
TRICARE For Life (TFL) is the Medicare-wraparound coverage available to all TRICARE beneficiaries, regardless of age and place of residence, provided they have Medicare Part A and Medicare Part B. Beneficiaries are eligible for TFL on the date they have both Medicare Part A and Medicare Part B.
However, the following beneficiaries may delay Medicare Part B enrollment and keep their TRICARE benefits, regardless of premium-free Medicare Part A eligibility.
- ADFMs remain eligible for TRICARE Prime and TRICARE Standard and Extra options while the sponsor is on active duty. However, once the sponsor retires from active duty, the sponsor and his or her family members who are eligible for premium-free Medicare Part A must also have Medicare Part B to keep their TRICARE benefits.
- TRICARE Reserve Select, TRICARE Retired Reserve, CHCBP, and US Family Health Plan (USFHP) beneficiaries are not required to have Medicare Part B to remain covered under these programs.
Note: TRICARE advises beneficiaries to enroll in Medicare Part B when first eligible to avoid a break in TRICARE coverage. Beneficiaries who sign up later may have to pay a premium surcharge for as long as they have Part B. The Medicare Part B surcharge is 10 percent for each 12-month period that a beneficiary was eligible to enroll in Part B but did not enroll.
After turning 65, beneficiaries who are not eligible for premium-free Medicare Part A may remain eligible for TRICARE Prime or TRICARE Standard and TRICARE Extra. They must take the “Notices of Award” and/or “Notices of Disapproved Claim” they received from the Social Security Administration (SSA) to the nearest ID card-issuing facility to update DEERS and get new ID cards.
Beneficiaries who receive disability benefits from the SSA are entitled to Medicare in the 25th month of receiving disability payments. The Centers for Medicare and Medicaid Services notify beneficiaries of their Medicare entitlement date. If a beneficiary returns to work and his or her Social Security disability payments are suspended, his or her Medicare entitlement continues for up to eight years and six months. When disability payments are suspended, beneficiaries receive a bill every three months for Medicare Part B premiums, and must continue to pay Medicare Part B premiums to remain eligible for TRICARE coverage.
Beneficiaries under age 65 who lose Medicare benefits (e.g., because they are declared no longer disabled) must also take their “Notices of Disapproved Claim” to the nearest ID card-issuing facility to update DEERS and get new ID cards to remain TRICARE-eligible.
Eligibility for TRICARE and Veterans Affairs Benefits
Certain beneficiaries are eligible for both TRICARE and Department of Veterans Affairs (VA) benefit programs, and they may choose which benefits they want to use. Further, a beneficiary can seek TRICARE-covered services even if he or she received treatment through the VA for the same medical condition during a previous episode of care. However, TRICARE does not duplicate payments made or authorized by VA for service-connected disability care. Note: Eligibility for VA health care for service-connected disabilities is not considered double coverage. |
