Becoming Medicare-Eligible

Event:

QLE?

Becoming Medicare-Eligible at Age 65

No.

  • TRICARE beneficiaries age 65 and entitled to Medicare:
    • Are automatically covered by TRICARE For Life.
    • Aren't eligible to enroll in other TRICARE health plans.

Yes.

  • TRICARE-eligible family members under age 65 can:
    • Enroll in a different TRICARE health plan. See below for more information.
    • Request enrollment changes within 90 days of the Medicare-eligible family member's Medicare effective date.
Becoming Medicare-Eligible Under Age 65

Yes.

  • The person who's under age 65 and is Medicare-eligible. They can enroll in a TRICARE Prime option or use TRICARE For Life.
  • TRICARE-eligible family members under age 65 can:
    • Enroll in a different TRICARE health plan. See below for more information.
    • Request enrollment changes within 90 days of the Medicare-eligible family member's Medicare effective date.

NOTE: Your plan options vary depending on your situation.

What is Medicare?

Medicare is a health insurance program for people:

  • Age 65 or older
  • Under age 65 with certain disabilities. (If you have Medicare due to a disability, you can continue your TRICARE Prime enrollment [if you qualify]. If you do, your Prime enrollment fees are waived. You can also get a refund for any Prime enrollment fees that you paid. Check with your regional contractor for details.)
  • With end stage renal disease
  • With Lou Gehrig's disease
  • Mesothelioma

The Centers for Medicare and Medicaid Services manages Medicare. If eligible, you have the option of using Original Medicare or enrolling in a Medicare Advantage plan.

Original Medicare

Medicare Advantage (Medicare Part C)

  • When using Original Medicare you may get health care services from any Medicare participating or Medicare Non-participating provider, regardless of their specialty.
  • Medicare Part A is hospital insurance which is financed by payroll deductions when you are or were working.
  • Medicare Part B is medical insurance, which primarily covers outpatient services. You pay a premium each month, which is based on your level of income.
  • Medicare Supplement Insurance (Medigap) coverage is optional. You pay a premium each month. Medigap pays your out-of-pocket costs in Original Medicare.
  • If you’re eligible for TRICARE and have Medicare Part A and Part B, TRICARE For Life provides wraparound coverage which pays your out-of-pocket costs in Original Medicare for TRICARE covered services. Medicare and TRICARE coordinate benefits which eliminates the need for you to file claims.

 

  • Medicare Advantage plans (also known as Medicare Part C) are a Medicare coverage option offered by private companies that contract with Medicare. Medicare Advantage plans provide all of your Part A and Part B services and usually Part D pharmacy coverage.
  • You may pay a plan premium each month in addition to your Medicare Part B premium.
  • You must get all your health care services from the Medicare Advantage plan’s network of providers. This doesn’t apply to emergency services.
  • If you enroll in a Medicare Advantage plan, you’ll have to pay copayments at the time of service.
  • TRICARE For Life can reimburse you for copayments you paid for TRICARE services. You’ll need to file your own claims.
 

>>Get Started with Medicare

Using Medicare and TRICARE Together

If you have Medicare Part A, you must also have Medicare Part B to remain eligible for TRICARE, including prescription drug coverage. Your TRICARE coverage options when entitled to Medicare depend on your age:

Under Age 65

Age 65 and Older

TRICARE Prime

If you're under age 65, entitled to Medicare Part A, and have Medicare Part B, you don’t have to disenroll from TRICARE Prime or the US Family Health Plan. TRICARE Prime will waive your individual enrollment fee.

Please note: If you have TRICARE Prime or receive coverage from TRICARE For Life, your claims won’t process through the regional contractor.

  1. Providers file claims with Medicare first.
  2. Medicare processes and pays their portion of your claims.
  3. Then, Medicare forwards your claims to the TRICARE For Life contractor.
  4. Finally, the TRICARE For Life contractor processes and pays the TRICARE portion of the claims.

If you have Medicare due to a disability, you can continue your TRICARE Prime enrollment (if you qualify). If you have a disability:

  • Your Prime enrollment fees are waived.
  • You can get a refund for any Prime enrollment fees that you paid.
  • You can contact your regional contractor for more details.

If you choose not to enroll in TRICARE Prime or US Family Health Plan, you’ll automatically be covered by TRICARE For Life.

TRICARE For Life

When you have Medicare Parts A and B, you automatically receive coverage from TRICARE For Life. There are no enrollment forms or enrollment fees for TRICARE For Life.

 

  • Medicare is your primary payer.
  • TRICARE pays second to Medicare or last if you have other health insuranceHealth insurance you have in addition to TRICARE, such as Medicare or an employer-sponsored health insurance. TRICARE supplements don’t qualify as "other health insurance.".
  • TRICARE benefits include covering Medicare's coinsurance and deductible for services covered by Medicare and TRICARE.
  • When retired service members or eligible family members reach age 65 and are eligible for Medicare, they become eligible for TRICARE For Life and are no longer able to enroll in other TRICARE plans.

Prescription Drug Coverage

You must have Medicare Part B, unless you qualify for an exception listed above. You can continue to get prescriptions filled with no break in coverage as long as you have Medicare Part B when you first become eligible for Medicare Part A.

Medicare Part D, a prescription drug plan, is available to everyone with Medicare. You don't need Part D to keep TRICARE. If you meet certain income and resource limits, you may qualify for extra help from Medicare to pay Part D premiums. >>Learn more.

Has your medical or pharmacy claim been denied? You may still be covered. >>Learn more

How do I enroll in Medicare Part D if I’ve lost my TRICARE coverage?

You can enroll during Medicare Part D Open Enrollment. Each year, Medicare Part D Open Enrollment is from Oct. 15 through Dec. 7. Your coverage begins Jan. 1 of the following year. If you want to enroll in Medicare Part D outside of the open enrollment period, you’ll enroll through a special enrollment period. If you choose this option, Medicare might ask you for proof that you had TRICARE coverage. If you need this proof of creditable coverage, submit your request in writing to:

Defense Manpower Data Center/DEERS Support Office (DSO)
400 Gigling Road
Seaside, CA 93955-6771
Fax: 1-800-336-4416

Your request must include:

  • Sponsor's name and Social Security number
  • Name of person for whom the certificate is requested
  • Reason for the request
  • Name and address to whom and where the certificate should be sent
  • Signature of the requester

You can’t request this letter over the phone. You must request this letter in writing.

Questions? Call the Defense Manpower Data Center/DEERS Support Office at 1-800-538-9552. You can also visit milConnect for more information.

The TRICARE pharmacy benefit is considered creditable coverage. If you’re eligible for Medicare and go 63 continuous days or longer without creditable prescription drug coverageCoverage that pays at least as much as Medicare's standard prescription drug coverage., you may have to pay higher premiums for a Medicare drug plan.

Learn more about other Qualifying Life Events

Retiring Separating
Having a Baby Getting Married
Moving Getting Divorced
Going to College Child Becoming an Adult
Losing or Gaining Other Health Insurance Death in the Family
Moving When Deploying Injured on Active Duty
Activating Deactivating

 

 

Are you looking to see what tests, items, or services Medicare covers? >>Learn more.

Want to order a hard copy of the TRICARE For Life Handbook? Call Wisconsin Physicians Service (WPS) at 1-866-773-0404.

Last Updated 1/4/2023