TRICARE is a government-sponsored health insurance program for uniformed service members and their families, as well as members and family members of the National Guard and Reserves.  It can interact with Medicare in different ways.  Although it shouldn’t be confusing, many people are left with questions as they transition to TRICARE for Life and Medicare.  

 

What is Tricare?

TRICARE is the health care program for uniformed service members, retirees, and their families.  TRICARE provides comprehensive coverage to all beneficiaries, including:

  • Health plans
  • Prescriptions
  • Dental plans

Generally speaking, your costs with TRICARE (monthly premiums, cost sharing, etc…) will be pretty low.  Your health care costs are different based on who you are and your health plan option. In some cases, you may have to pay a portion of the cost for a health service or prescription in the form of a cost-share or copay.  To determine your costs, you can use the TRICARE compare costs tool.

 

TRICARE & Medicare

You can become eligible for Medicare in a few different ways.  Many people age into Medicare upon their 65th birthday.  However others are eligible for Medicare through a disability.  

Upon your 65th birthday or 25th month of disability, you will most likely be automatically enrolled in Medicare. You can contact social security with questions about Original Medicare enrollment.  If you do need to do so, make sure to enroll within the 7 months surrounding your birthday (three months before, the month of and three months after).  

Original Medicare (Medicare Part A & Medicare Part B) will cover a large portion of your healthcare needs.  Medicare Part A is your hospital insurance.  It will cover:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
  • Hospice care
  • Home health care

Medicare Part B is your outpatient insurance.  It will cover:

  • Clinical research  
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Limited outpatient prescription drugs

You’ll also have access to the full Medicare network with Original Medicare which is rather extensive. 

 

TRICARE for Life

Upon becoming eligible for Medicare, you’ll also become eligible for TRICARE for Life.  There is no enrollment fee.  You  just need to make sure to pay your Medicare Part B monthly premiums.  

Just a reminder, TRICARE for Life will only cover those who are also eligible for Medicare.   

Once you’re enrolled, your deductibles, copays and coinsurance may change slightly.

Services covered by TRICARE and Medicare:

  • Medicare will pay the authorized amount and TRICARE will pay the rest
  • You will not be responsible for any cost

Services covered by Medicare, but not TRICARE:

  • Medicare will pay the authorized amount and TRICARE will pay nothing
  • You will be responsible for any Medicare deductible and coinsurance/copays

Services covered by TRICARE, but not Medicare:

  • TRICARE will pay the allowable amount and Medicare will pay nothing
  • You will be responsible for any TRICARE deductible and coinsurance/copays

Services covered be neither TRICARE nor Medicare:

  • Neither Medicare nor TRICARE will pay anything
  • You will be responsible for the full amount

To receive services, simply present your Medicare card and military ID. 

 

RX, Dental & Vision

Original Medicare does not cover prescription drugs, dental or vision.  However, you do have options.  Ordinarily, you’d need Medicare Part D for RX coverage, but TRICARE for Life already comes with prescription drug coverage.  So, there’s no need to enroll.  Usually the benefits offered by TRICARE are better than those offered by Part D.  The only exception may be the Extra Help program.  If you are living on a fixed income with limited assets and are eligible for Extra Help with Part D, you may want to look into it. 

 

You may also need dental and vision coverage.  Original Medicare does not cover these services.  You can check out benefeds.com to learn more about your options.  Of course, private insurance is always as option as well.  

If you have any questions, call us at iHealthBrokers or schedule an appointment today.