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Medicare and TriCare - VERY IMPORTANT!

posted Jun 11, 2011, 3:17 PM by Info @NesloVentures   [ updated Dec 14, 2011, 6:27 PM by Neslo Ventures ]

Do I have to cancel employer’s policy to use Tricare for Life?

December 9th, 2011 | TriCare Help | Posted by Military Times

I will turn 65 later this year and become eligible for Medicare and Tricare for Life. I have another health insurance policy through my employer. I’ve heard that I have to cancel the other policy to use Tricare for Life, but my wife and children still need that coverage. I asked and was told that I can’t cancel just my own coverage and leave my family insured under my employer’s plan. What can I do?

You were misinformed. You do not need to cancel your other health insurance policy to qualify for Tricare for Life. The legal requirement regarding other health insurance is that Tricare must always be last payer to all other coverage, except welfare-related plans such as Medicaid.

When Tricare beneficiaries become entitled to Medicare and are enrolled in Part B, they are covered under Tricare for Life. If they have no other health insurance, Tricare Standard acts as a free Medicare supplement and last payer to Medicare.

After it processes a claim and makes whatever payment is due, Medicare automatically transfers the claim to Tricare electronically. In the vast majority of claims, Tricare pays whatever Medicare did not pay for Tricare-covered services — usually the beneficiary’s Medicare deductible and co-payment.

Your situation will be different because of your other health insurance. As you read the following, keep in mind that Tricare must always be last payer to all your other coverage, regardless of which plan is first or second payer.

Let me summarize the situation regarding your family:

Tricare for Life rules do not require you to cancel or alter your employer’s health insurance policy. You and your family may continue coverage under your employer’s plan. Regardless of decisions you make about your Medicare coverage, your family’s Tricare coverage as second payer to your employer’s plan will not be affected.

Now, the following pertains to you only, not your family:

When you become entitled to Medicare, you will be told that Medicare does not require you to enroll in Part B as long as you continue to work for the employer that provides the other health insurance. Also, for as long as you continue to work for that employer, your employer’s plan will be your primary coverage. Medicare will be second payer.

Although Medicare’s rules allow you to postpone Part B enrollment for as long as you continue to work, Tricare’s rules do not allow that.

According to law, retirees or their family members who become entitled to Medicare must enroll in Part B of Medicare in order to retain Tricare eligibility.

If you feel that Medicare Part A plus your employer’s plan is enough health insurance for you (yourself only) while you continue to work, you might want to postpone Part B enrollment during that period. That will allow you to avoid paying the monthly premium for Part B. But you will be ineligible for Tricare for Life until you enroll in Part B.

That’s a decision only you can make. Before you do, I suggest you contact Medicare for details about the kinds of health care services Part A covers.

You’ll want to enroll in Part B, however, as soon as you stop working. Your Tricare eligibility will be restored as soon as you do that and your Defense Enrollment Eligibility Reporting System (DEERS) record has been updated.

For as long as you continue to work, you must file claims with your employer’s plan first. Medicare Part A will be second payer to that plan. You will no longer have Tricare as a last-payer backup because you are not enrolled in Medicare Part B.

When you are no longer working, you will file claims with Medicare first. Your employer’s plan will be second payer to Medicare. If you have enrolled in Part B, Tricare will be last payer to your other coverage.

Depending on the extent of the other plan’s coverage, it will very likely pay what Medicare does not pay in much the same way that Tricare would. After Medicare and the other plan have both completed processing and you have the explanations of benefits from both, you may file a claim with Tricare for any amounts they left unpaid.

As I said earlier, regardless of decisions you make, your family members will continue to have your employer’s plan as their primary coverage and Tricare as second payer on their claims. Their Tricare coverage will not be affected by your Medicare entitlement or the decision you make about Part B enrollment.



Upon becoming disabled and the decision to sign up for social security benefits, information arrives in the mail about Medicare.  Hopefully you’ve read all the information sent.  Nowhere in the information does it state that if you accept Medicare what effect it may have on your current health insurance if in fact you have other health insurance.  DO YOUR HOME WORK!

Becoming Medicare Eligible - TriCare

Medicare is a health insurance program for people:

  • age 65 or older
  • under age 65 with certain disabilities
  • with end stage renal disease
  • with Lou Gehrig's disease

Medicare Part A is premium-free hospital insurance.  Medicare Part B is medical insurance, and you must pay Medicare Part B premiums to keep Medicare Part B coverage.  The Centers for Medicare & Medicaid Services manages Medicare.

Medicare and TRICARE
TRICARE beneficiaries who have Medicare Part A, must have Medicare Part B to remain TRICARE-eligible. The only exceptions are if:

  • Your sponsor is on active duty
  • You're enrolled in the US Family Health Plan
  • You're enrolled in TRICARE Reserve Select

If you fall into one of these categories, you are not required to have Medicare Part B to remain eligible for TRICARE. However, we strongly encourage you to get Medicare Part B as soon as you become eligible for Medicare Part A to avoid any future loss of TRICARE coverage. For specific details about your Medicare-eligibility requirements, please enter your profile.

Forced Into Medicare - MARCH 24, 2011

A federal judge tells seniors to take it or lose Social Security.

This week marks the first anniversary of ObamaCare, and if you are wondering where that coercive law is headed, we'd point to a case in federal court. That's where Judge Rosemary Collyer has ruled that Americans have a legal obligation to accept sub par government health benefits.

It remains a remarkable fact that America obliges most citizens over the age of 65 to take that rickety government health plan known as Medicare. Judging by today's growing number of health-savings options (HSAs, medical FSAs), some Americans would prefer to maintain private coverage upon retirement, rather than be compelled into second-rate Medicare. (To read more log in to The Wall Street Journal online).

The above article applies to civilians, per my conversation with TriCare Eligibility on 06/13/2011.  However, once you've seen the title and subtitle you probably cringed.  Nonetheless, even if that ruling was meant for only civilians, why/what/who would make such an obnoxious law?  If the civilians maintain their own insurance, why should they be forced to take Medicare when their insurance most likely pays much better?

Once a veteran is receiving social security disability, they are then “eligible” for Medicare.    Upon the 25th month of receiving SSD (Social Security Disability) payments, the SSA (Social Security Administration) will automatically sign you up for Medicare Part A and offer you Medicare Part B without your knowledge.  Medicare Part A is hospitalization payments and is free to the disabled.  Just so you know, Part A just means you can have a bed at the hospital.  It doesn't cover anything else.  Medicare Part B pays for outpatient healthcare and doctors’ fees.  The Veteran does not have a choice to accept or deny Medicare.  Once you are eligible the SSA reports this information to the DoD (Department of Defense) and TriCare.  TriCare then sends you a letter that your benefits are about to change.  The Veteran is then required to purchase Medicare Part B at the rate of $115 per month or TriCare will not pay any claims or provide you with further coverage if Medicare Part B is not taken.  This means the Veteran lose all TriCare benefits.  However, the Veteran is still eligible to seek health care with the VA, but this does not apply to the Veteran’s beneficiaries.  If the Veteran has beneficiaries (spouse and/or children), they too lose all TriCare benefit coverage.


(Click to read documents)

You Can't Opt Out of Medicare without Losing Social Security, Judge Rules

Elder Law Answers Last Updated: 3/22/2011 12:01:30 PM

Retirees cannot dis-enroll from Medicare Part A without also losing their Social Security benefits and refunding all the money paid to them, a federal judge has ruled.

The judge dismissed a case, Hall v. Sebelius, brought by three retired federal employees who have reached age 65 and are receiving Social Security Retirement benefits, but who would like to drop their Medicare Part A coverage, which pays for care in institutions like hospitals.

Anyone who has reached age 65 and who is entitled to Social Security benefits is also automatically entitled to Medicare Part A without charge. However, the three plaintiffs, one of whom is former Republican House Majority Leader Dick Armey, wanted to drop their Medicare coverage because they claimed it threatened their coverage under the Federal Employees Health Benefit (FEHB) program, which they said was superior. They argued that the Medicare law allows them to drop out of the program without losing their Social Security benefits.

In her March 16, 2011, ruling, Judge Rosemary Collyer of the U.S. District for the District of Columbia acknowledged that the three retirees had a legitimate point that the law does not specifically say that avoiding Medicare Part A means losing Social Security benefits. But in examining the law that Congress enacted in 1965 creating the Medicare program, Judge Collyer found that "[requiring] a mechanism for Plaintiffs and others in their situation to 'disenroll' would be contrary to congressional intent, which was to provide 'mandatory' benefits under Medicare Part A for those receiving Social Security Retirement benefits." [emphasis in original]

The judge also pointed out that the plaintiffs would not gain much by renouncing their Medicare coverage. Even if they were to fore go and repay all Social Security benefits, under the law "their FEHB-paid benefits would be no more, and no less, than what Medicare Part A would provide," Collyer wrote.

The ruling could have implications for the current court cases challenging the new health reform law. A central basis of these challenges is that the "individual mandate," the reform law's requirement that all Americans have health coverage, is illegal because the government can't compel citizens into economic activity. Judge Collyer's ruling suggests that the government may already have been doing this in the area of health care for the past 46 years. Indeed, the Washington Times notes in an editorial that on February 22, "D.C. federal district Judge Gladys Kessler cited preliminary rulings in Hall v. Sebelius to conclude that the [individual] mandate is allowable."

The plaintiffs plan to appeal the decision.

To read the court's decision, click here.

Medicare Part D Prescription Drug coverage Creditable Coverage

Veterans Administration Retrieved 6/10/11

If the Veteran is eligible for Medicare Part D prescription drug coverage, you need to know that the enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes.  This means that VA prescription drug coverage is at least as good at the Medicare Part D coverage.  Since only Veteran may .enroll in the VA health care system, dependents and family members do not receive credible coverage under the Veteran’s enrollment. 

However, there is one significant area in which AV health care is NOT creditable coverage:  Medicare Part B (outpatient healthcare, including doctors’ fees).  Creditable coverage for Medicare Part B can only be provided through an employer.  As a result, VA health care benefits to Veterans are not creditable coverage for the Part B program.  So although a Veteran may avoid the late enrollment penalty for Medicare Part D by citing VA health care enrollment, that enrollment would not help the Veteran avoid the late enrollment penalty for Part B.

VA does not recommend that Veterans cancel or decline coverage in Medicare (or other health care or insurance programs) solely because they are enrolled in VA health care.  Unlike Medicare, which offers the same benefits for all enrollees, VA assigns enrollees to priority levels, based on a variety of eligibility factors, such as service-connection and income.  There is no guarantee that in subsequent years Congress will appropriate sufficient medical care funds for VA to provide care for all enrollment priority groups.  This could leave Veterans, especially those enrolled in one of the lower-priority groups, with no access to VA health care coverage.  For this reason, having a secondary source of coverage may be in a Veterans’ best interest. 

In addition, a Veteran may want to consider the flexibility afforded by enrolling both VA and Medicare.  For example, Veterans enrolled in both programs would have access to non-VA physicians (under Medicare Part A or Part B) or may obtain prescription drugs that are not on the VA formulary if prescribed by non-VA physicians and filled at their local retail pharmacies (under Medicare Part D).

Additional information on Medicare Part D prescription drug coverage can be found online at http://www.va.gov/healtheligibility/costs/MedicareDEligibility.asp or health and Human Service Medicare website at www.medicare.gov. 

Per my conversation with TriCare Eligibility on 06/13/2011, if the disabled person who is on SSD has TriCare and uses ExpressScripts, your prescription coverage will remain unaffected.

It is important to note that VA health care in NOT considered a health insurance plan.

Unfortunately, I found out the hard way by being disabled and a retired, service-connected disabled Veteran’s wife.  I am in the same boat as thousands of disabled Veterans and their families.  Because I have been determined by the SSA to be disabled, I am forced to pay for health coverage that I am otherwise entitled to  by being married to a service-connected disabled veteran. This is not a political soap box, merely a lightning bolt to cause unsuspecting disabled Veterans to see what’s in the future. 

What will you do?  How will you react when your life is turned upside down and ordered by the government to pay for something you don’t want. Then to have had the well deserved and earned benefits of a service member take a backseat to government required sub par healthcare that you need to pay for?  

Per my conversation with TriCare Eligibility on 06/13/2011,TriCare's stance and rules regarding Medicare with TriCare has been in effect for many years.  The bill was written and has been sitting on a desk just waiting to be passed.  The only coincidence is that the bill was signed into legislation during Obama's term.  So if you want to blame someone for this issue, blame TriCare.  The president just inked the deal.

(The opinions expressed here are not those of the organizations, people or companies in this commentary)


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