TRICARE, Your Military Health Plan

Medicare-Eligible Beneficiaries

The Centers for Medicare & Medicaid Services manages Medicare.  Medicare is a health insurance program for:

• people age 65 or older
• people under age 65 with certain disabilities
• people with ESRD
• people with Lou Gehrig's disease
• people with Mesothelioma, who live or previously lived in Libby or Troy, Montana

Medicare Part A is hospital insurance.  Medicare Part B is medical insurance.

Under Federal law, TRICARE beneficiaries who have Medicare Part A, must have Medicare Part B coverage to remain TRICARE-eligible, with a few exceptions (see below).

If you have an active duty sponsor, you are strongly encouraged to enroll in Medicare Part B no later than the month your sponsor retires to avoid a break in TRICARE. You must get a letter from DEERS which validates your
TRICARE coverage and eligibility for a Medicare Part B special enrollment period.

Active duty service members who are awaiting a medical retirement determination are strongly encouraged to keep Medicare Part B when they become entitled to Medicare Part A. Active duty service members who decline
Medicare Part B will have a break in TRICARE coverage when a medical retirement is processed.

If you do not have an active duty sponsor, you are strongly encouraged to enroll in Part B when first eligible to avoid having to pay the Medicare Part B late enrollment surcharge (10 percent for each 12 month period that you could have enrolled but didn't). If you are under 65 when you first become eligible for Medicare, the enrollment surcharge is paid each month until you are 65 years old. If you are over 65 and delay enrollment in Part B you will pay the late enrollment surcharge as long as you have Medicare Part B.

Medicare Part B
Regardless of when you become eligible for Medicare Part A, whether under your or your spouse's SSN, you should enroll in Medicare Part B to avoid the Medicare surcharge for late enrollment (10% for each 12-month period that you could have enrolled in Part B but didn't). Unless you meet one of the exceptions listed above, you must have Medicare Part B even if you have an employer-sponsored health plan based on your or your spouse's current employment. Scroll below to learn more about the scenarios when you're not required to have Medicare Part B.

Medicare Part B Premiums
Your Part B premium is based on your income.  Most people pay the standard monthly premium.  However, your monthly premium is higher if you file an individual tax return and your annual income is more than $85,000, or if you're married (file a joint tax return) and your annual income is more than $170,000.  These amounts change each year.  For more information about Part B premiums, call Social Security at 1-800-772-1213  (TTY: 1-800-325-0778).

If you're receiving Social Security Retirement, Social Security Disability or Railroad Retirement Board (RRB) benefits, your Part B premiums are taken from your monthly payment.  If you aren't receiving any of these payments, you'll be billed quarterly for your Part B premiums. 

Scenarios When Medicare Part B is NOT Required
In the following scenarios, you are not required to have Medicare Part B coverage.

Please note: If you are required to have Medicare Part B coverage, but don't have it, you are not eligible for any TRICARE benefits. If you refused Medicare Part B coverage when you first became eligible,you may re-enroll in Part B during the general enrollment period which occurs each year January 1 through March 31. You may be responsible for paying a Medicare Part B premium surcharge, which is 10% for each 12-month period that you were eligible to enroll in Part B, but did not.

Active Duty Service Members Who Qualify for Medicare
If you are entitled to Medicare Part A, you are not required to have Medicare Part B to keep TRICARE, but you are encouraged to keep Medicare Part B if a medical retirement is in process.  This will ensure that you don't have a break in TRICARE coverage when you retire. 

If you are entitled to Medicare based on a disability, you're eligible for a Medicare Part B special enrollment period anytime while on active duty or within the first eight months following retirement or loss of TRICARE, whichever comes first. To avoid a break in TRICARE coverage, you should enroll in Medicare Part B before you retire.   

If you are entitled to Medicare because you have end stage renal disease (ESRD), you're strongly encouraged to keep Part B even though it is not required while on active duty because you will not be eligible for a special enrollment period. If you decline or terminate Part B coverage, you may enroll in Medicare Part B during the general enrollment period which occurs each year January 1 through March 31. The late enrollment premium surcharge will apply (10% for each 12-month period that you could have enrolled in Part B but didn't).  Your Part B and TRICARE coverage will be reinstated on July 1^st of the year in which you enroll in Medicare Part B.  TRICARE will not pay any claims during the period of time when you have only Medicare Part A.

Additional Information About Your Medicare Entitlement
Your Medicare entitlement is based on a disability, end stage renal disease or age. Learn more about each of these below:

Disability. You become eligible for Medicare beginning the 25th month of receiving Social Security disability payments. The Social Security Administration (SSA) notifies you of your Medicare entitlement start date.  If you return to work, your Social Security disability benefits will be suspended if your income exceeds the thresh hold. However, your Medicare entitlement may continue up to eight and a half (8 1/2) years. You will receive a bill from Medicare every three months. You must pay your Medicare Part B premiums to keep TRICARE.

Beneficiaries are awarded disability on appeal generally have a gap of six or more months between their Medicare Part A and Part B effective dates.  Those with a Part B effective date of October 2009 or later are not required to retroactively enroll in Medicare Part B.  TRICARE will remain primary for the period where the beneficiary has Medicare Part A only and recoupments will not be initiated.

End Stage Renal Disease.  Medicare coverage isn't automatic for people with ESRD.  You need to file an application to receive Medicare benefits.  Failure to file for Medicare benefits will result in loss of TRICARE coverage.  Your Medicare coverage begins:

• The fourth month you're on renal dialysis;
• The month you're admitted to a Medicare-approved hospital for kidney transplant, or in the following two months; or
• Two months before your transplant if your transplant is delayed more than two months after admission to the hospital.

Age.  The age Medicare eligibility is age 65.  

• You become eligible for Medicare Part A at age 65 if you or your spouse paid into Social Security for at least 40 quarters (at least ten years of work).  Failure to file for Medicare benefits results in loss of TRICARE coverage. 
• If you already receive benefits from Social Security, the RRB, or Office of Personnel Management, you automatically receive Medicare Part A and are enrolled in Medicare Part B starting the first day of the month you turn 65. (If your birthday is on the first of the month, Part A is effective on the first day of the previous month.)
• If you haven't filed for Social Security benefits, RRB benefits, or a federal annuity from the Office of Personnel Management, you must file an application for Part A and Part B.  To avoid the Medicare surcharge for late enrollment, you must enroll in Part B during your Medicare Initial Enrollment Period (seven-month period that begins three months before you turn 65, or four months if your birthday is on the first of the month).  To avoid a break in TRICARE coverage be sure to enroll no later than two months before you turn 65.  If you enroll any later, your Part B effective date will be delayed and you will have a break in TRICARE coverage.

What if I applied for Medicare benefits on my own Social Security Number (SSN) and I'm not eligible for Medicare Part A at age 65?
If you're not eligible for Part A based on your work history, download the Scenario Chart to find the one that fits you best and follow the necessary steps to remain TRICARE-eligible.  Even if you're not eligible for Part A at age 65, you're still eligible for Part B.

Keeping Your Medicare Status Updated
To avoid a delay in receiving your Medicare benefits and to ensure timely reporting of that information to DEERS, you should apply for Medicare benefits no later than two months before you turn 65.  

To keep your TRICARE eligibility beyond your 65^th birthday when you aren't eligible for Medicare Part A either under your or your spouse's SSN, you must take the notices received from the SSA, based on your record and your spouses record to an ID card office to update your DEERS record and to receive a new ID card. 

If You Still Have Questions
If your eligibility for Medicare changes or you're unsure about your eligibility for TRICARE benefits, contact the nearest ID card office, or the Defense Manpower Data Center Support Office (DSO) to check your eligibility status by calling toll-free, 1-800-538-9552.