Why can’t I keep using Tricare Prime? - Off Duty, Military Health and Fitness - Air Force Times

Why can’t I keep using Tricare Prime?

We are enrolled in Tricare Prime, which we will lose this summer when my husband gets Tricare for Life. Tricare Prime is good for us because we can use a military treatment facility for our medical care, which is much cheaper and more convenient. Why do we have to lose Tricare Prime?

When your husband becomes eligible for Tricare for Life, federal law makes him ineligible for Tricare Prime. His coverage will be Medicare parts A and B plus Tricare Standard, which acts as a free Medicare supplement.

Your husband can ask permission to continue to use the military treatment facility for his care, but that is unlikely to be granted. He’ll be expected to seek civilian care from Medicare providers.

Your Tricare Prime enrollment and priority access to the military treatment facility, however, will not be affected by your husband’s transition to Tricare for Life and loss of Tricare Prime eligibility. You may continue to be enrolled in Tricare Prime until you become entitled to Medicare when you are 65.

When I get Medicare, I know I’m required to enroll in Medicare Part B. But I know Medicare starts with Part A, which is free. What am I supposed to do with Part A? Why do I have it?

The program called Original Medicare, which is what most Tricare for Life beneficiaries enroll in, consists of Part A and Part B, which pay for different kinds of medical services.

Part A is called hospital insurance. Although it covers a few other things, it mainly helps pay for hospital bills. These are things the hospital itself provides — room and board, special diets, general nursing services, use of hospital facilities and personnel such as X-ray equipment and technicians, laboratory services, and use of the operating room.

The hospital files a claim with Part A for those charges. Your hospital bill does not include your doctors’ bills, even for services you receive while in the hospital.

Part B is called medical insurance. Its primary purpose is to pay providers of professional services, such as your physician, surgeon, the radiologist who interprets X-rays, and the pathologist who interprets the lab results. Those providers all bill Medicare Part B whether you receive their services in or out of the hospital.

For a more complete description of things paid by parts A and B, look in your Medicare Handbook or go to www.medicare.gov.