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. Medicare is a government health insurance program for seniors and younger people with certain illnesses and disabilities.
If you’re enrolled in a TRICARE plan and wondering if you should switch to Medicare, you may be surprised at your options.
What does TRICARE cover?
TRICARE may cover physical health care, mental health care, dental care, and vision care. In addition, TRICARE offers a prescription drug benefit. TRICARE benefits depend on your duty status, where you live, and the plan you choose.
If you are retired or active-duty and eligible for Medicare, you may still be eligible for coverage through a TRICARE plan.
Do I need to switch to Medicare from TRICARE when I turn 65?
When you are enrolled in both Part A and Part B, you are automatically covered by TRICARE for Life if you qualify. There are no additional monthly premiums for TRICARE.
You can delay your Part B enrollment and keep your TRICARE Prime or TRICARE Select plan if you are still on active duty when you become eligible for Medicare. You will need to enroll in Medicare Part B to maintain your TRICARE eligibility when active duty ends.
What does TRICARE for Life cover?
TRICARE for Life is coverage that works with your Medicare coverage. Under TRICARE for Life, Medicare is the primary payer and TRICARE pays after Medicare for covered services. Payment is made directly to your provider to keep your out-of-pocket costs low.
If you are overseas and need health care, TRICARE is your primary insurer, since Medicare does not cover services in a foreign country except in very limited circumstances.
Do I get vision and dental benefits under Medicare or TRICARE for Life?
There are no benefits for routine vision and dental care under Medicare. However, if you are covered by TRICARE for Life, you may be able to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP). This is a voluntary program and there is an additional monthly premium for FEDVIP if you are eligible.
If you choose to get your Medicare benefits through a Medicare Advantage plan, your plan may include coverage for routine vision and dental services. Not all plans include these extra benefits, however, so you should compare plans available in your area to see which one has the type of additional coverage you want.
Do I need a Medicare Part D Prescription Drug Plan if I have TRICARE for Life?
TRICARE for Life includes creditable prescription drug coverage under Medicare rules. You don’t need to enroll in a Medicare Part D prescription drug plan to remain eligible for TRICARE for Life.
If you choose to enroll in a Medicare Advantage plan with Part D coverage included, you do not lose your pharmacy benefits under TRICARE for Life. Your TRICARE plan will pay after your Medicare prescription drug plan for covered prescription medications.
Should I buy a Medicare Supplemental Insurance if I have TRICARE?
Medicare Supplement insurance plans generally cover some or all of your out-of-pocket costs with Part A and Part B. You pay a separate monthly premium for Medicare Supplement plans.
Since TRICARE for Life pays after Medicare pays, people covered by both plans tend to have very few out-of-pocket costs. TRICARE for Life is premium-free to qualifying enrollees. Therefore, generally TRICARE for Life members do not need to buy a Medicare Supplement plan.
(click here or image above)
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Find out who can join a Medicare SNP.
If you meet certain income and resource limits, you may qualify for a program called Extra Help from Medicare to pay the prescription costs, premiums, deductibles, and coinsurance of Medicare prescription drug coverage.
In 2020, prescription costs are no more than $3.60 for each generic/$8.95 for each brand-name covered drug for those enrolled in the program.
Some people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.
In 2020, you may qualify if you have up to $19,140 in yearly income ($25,860 for a married couple) and up to $14,610 in resources ($29,160 for a married couple).
If you don't qualify for Extra Help, your state may have programs that can help with prescription costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.
Countable resources include:
• Money in a checking or savings account
• Stocks
• Bonds
Countable resources don't include:
• Your home
• One car
• Burial plot
• Up to $1,500 for burial expenses if you have put that money aside
• Furniture
• Other household and personal items
Apply for Extra Help.
Some people automatically qualify for help with prescription costs
You automatically qualify for lower prescription costs through Extra Help if you have Medicare and meet any of these conditions:
• Have full Medicaid coverage
• Get help from your state Medicaid program paying your Part B premiums (from a Medicare Savings Program)
• Get Supplemental Security Income (SSI) benefits
Even if you automatically qualify this year, you may not qualify for Extra Help next year. Changes in your income or resources may cause you no longer to qualify for lower prescription drug costs through one of the programs listed above. You’ll get a notice (on grey paper) by the end of September if you no longer automatically qualify. Even if you get this notice, you may still qualify for help with prescription costs, but you need to apply to find out.
• If your copayment amounts change next year, you'll get a notice (on orange paper) in the mail in early October with the new amounts.
• If you don't get a notice from Medicare, you'll get the same level of Extra Help that you got for this year.
It’s important to understand how your current coverage works with Medicare. If you have questions about your current insurance, the best source of information is your benefits administrator, insurer, or plan provider.
CLICK HERE FOR MORE INFORMATION
