Getting out, military health issues - Air Force Times

Tricare help: For TFL, Medicare eligibility comes first

Q. My wife won’t have enough work credits to get Medicare on her own. Except for her age, 59, she will qualify based on my work history when I get Medicare next year. In the same way, her Tricare eligibility is based on my military service. Although she will not be old enough for the Medicare part of the plan, can she get the rest of Tricare for Life when I do?

A. No, because there is no “rest of Tricare for Life.” There are only two parts to Tricare for Life: The Medicare part is Medicare Parts A and B, and the Tricare part is Tricare Standard.

There is nothing special about either: It’s the same Medicare Parts A and B everybody gets, even civilians, and the same Tricare Standard that younger beneficiaries get. The only difference under Tricare for Life lies in some of the processing details.

A retiree or a retiree family member must be enrolled in Medicare Parts A and B to qualify for Tricare for Life. So your wife will get Tricare for Life when she enrolls in Medicare Parts A and B at age 65. If she happens to be enrolled in Tricare Prime at the time, it will convert to Tricare Standard under Tricare for Life.

Q. Medicare offers a number of supplemental plans called Medigap A through L, each with benefits in addition to Medicare. Which of them is Tricare for Life equivalent to?

A. Original Medicare consists of Medicare Parts A and B only. After satisfaction of its deductible, Medicare pays 80 percent of the amount it approves for covered services. The patient’s share is the deductible plus the remaining 20 percent of the amount approved.

Tricare for Life consists of full benefits under Medicare Parts A and B plus full benefits under Tricare Standard.

Unlike Medigap plans, Tricare for Life provides no services in addition to Parts A and B, but it does pay part of the costs for many things not covered by Medicare. Tricare Standard pays the patient’s 20 percent share of the costs of covered Part A and B services, plus any Medicare deductible that applies to those charges.

Members of each Medigap plan pay a graduated premium in addition to the premium charged for Part B. Tricare Standard is free.

Although Tricare does not provide services in addition to Medicare, it will pay for many services Medicare does not cover.

The Tricare deductible and cost share are waived on its payment for Medicare- and Tricare-covered services. All Tricare processing rules, including the Tricare deductible and cost share, apply when it pays for a service covered by Tricare alone.

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Write to James E. Hamby Jr. at Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or e-mail tricarehelp@atpco.com. In e-mail, include the word “Tricare” in the subject line and do not attach files.