Tricare & Medicare | How These Plans Work Together
If you have been, or are a dependent of anyone in the military, there’s a high chance that your eligible for Tricare. Enrolling in your military health care policy provides you with some of the most comprehensive coverage available.
What happens when you become eligible for Medicare as well?
If you have dual eligible, for Tricare and Medicare, you’ll have double the coverage for a portion of the price. Here’s how these two government programs work together to keep you covered.
What is Tricare?
Managed by the Defense Health Agency under the leadership of the Assistant Secretary of Defense, Tricare is a health care program for active military personnel, retirees, and family members who qualify. Acting as a health insurance plan, Tricare plans to meet the requirements of the Affordable Care Act’s minimum essential coverage and provide comprehensive coverage that includes health plans, special programs, prescriptions, and dental plans.
Formerly known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), Tricare was created to remedy the lack of space available for growing numbers of patients in military medical facilities. When Congress passed the Dependents Medical Act of 1956 and the Medicare Program of the Uniformed Services in 2966, it allowed the Secretary of Defense to increase access to healthcare for military personnel by contracting with civilian health care providers.
Here's Who Is Eligible
Tricare eligibility is not very restrictive, and is available to you if you meet any of the following criteria:
- You are retired, active-duty member.
- You are retired from reserves or National Guard and are 60 years or older.
- You served in the military- and were awarded the Medal of Honor.
- You are a dependent (spouse or child) of any eligible veterans.
- You are a surviving spouse of a military member who died on active duty.
- You are an ex-spouse of a military member or retiree if you were married to the eligible party for a minimum of 20 years, and your ex was in the military for at least 20 years of the marriage. Note, Tricare benefits will expire one year after the date of divorce.
How Tricare and Medicare Work Together
If you are eligible for both Tricare and Medicare, you can be enrolled in both health coverage options at the same time. However, if you are eligible for premium-free Medicare Part A, which most Americans are, then you will have to opt for Medicare Part B in order to keep your Tricare coverage. In order to ensure you're getting the most out of your Tricare benefits, it’s imperative that you keep your information in the Defense Enrollment Eligibility Reporting Systems (DEERS) up to date.
When you are enrolled in both Tricare and Medicare, you’ll enjoy the benefits of the highest level of coverage available, with minimal out-of-pocket costs. You’ll have two options when it comes to seeking out care. You can either find a medical provider who participates in Medicare, or a provider who has opted-out of Medicare, which you’ll usually end up paying 80% of the charge.
When you have dual coverage, Medicare generally becomes the primary coverage, and Tricare the secondary. That boils down to Medicare taking the brunt of the cost since it receives your medical claims before Tricare does. Whatever Medicare doesn’t cover, usually about 20% of your costs, is sent to Tricare to pay the remaining balance.
If you are receiving care that isn’t covered by Medicare, then Tricare will become your primary coverage. A popular example of this is when you are abroad and require medical attention. Since Medicare doesn’t cover your health care expenses outside the US, Tricare will step in. Although, because you’ll only be getting benefits from Tricare, you’ll likely end up paying higher out-of-pocket costs.
With Advantage Plans
The primary insurance would be your Medicare Advantage plan. When you go to the doctor, you request that your Advantage plan is named the primary insurance. The physician's office or hospital will bill your primary insurance first, then your secondary insurance with any remaining balance.
You are still eligible to sign up for an Advantage plan, despite having military insurance for life. You do not need to have traditional Medicare to qualify for both insurance plans. Select an Advantage plan that is right for you and sign up. You will never lose your military benefit.
With Supplement Plans
Regardless of which Medicare Supplement (Medigap) plan you choose, you will still need to pay your Part B premium in order to qualify. You will not have an option to go back to a Medigap plan once you leave to go back to an Advantage plan or Original Medicare.
The Supplement plans generally will take your health conditions into consideration when qualifying you for a Supplement plan. It is something they are permitted to do. If you have a Supplement plan and military insurance, it will work the same as traditional Part A and Part B or an Advantage plan with military insurance.
With Prescription Drug Plans
Medicare Part D is a prescription-only plan. Despite not paying copays and coinsurance with both insurance plans, once you reach the donut hole, you will need to make a small copay with your military insurance. There will still be a donut hole with your Advantage plan, Supplement plan, or Part D plan.
If you have military insurance on top of your chosen plan, your military insurance will pick up where your donut hole leaves you. That being said, you will have small copays to make with your military insurance for prescriptions.
Does Tricare End At 65?
Absolutely not, you will still be eligible for both Tricare and Medicare. Having served your country for a minimum of 20 years, you will be eligible for the insurance for a lifetime. This is true for your spouse as well.
Also, if you have a child with a qualifying disability, they too will qualify for both insurances. Traditional Part A will cover any hospitalizations you have. Traditional Part B will cover office visits. Your military insurance will cover both. It will become the secondary insurance, covering all the copays for Part A and Part B.