Turning 65: TRICARE and Medicare
Posted on March 03, 2015
If you are entitled to premium-free Medicare Part A, you must also have Medicare Part B to keep TRICARE, regardless of your age or place of residence (some exceptions are discussed in the Delaying Part B Enrollment section below). Once you have both Part A and Part B, you automatically receive TRICARE benefits under TRICARE For Life (TFL). Keeping your information in the Defense Enrollment Eligibility Reporting System (DEERS) up to date is key to ensuring effective, timely delivery of your TRICARE benefits.
Signing up for Medicare
The month you were born determines when you become Medicare-eligible and when you should visit a Social Security Administration (SSA) office to sign up for Medicare Part A and Part B. See the guidelines that follow and avoid late- enrollment premium surcharges:
- If you were born on the first day of the month, you become eligible for Medicare on the first day of the month before you turn 65. Sign up for Medicare between two and four months before the month you turn 65. Your TFL coverage begins on the first day you have both Medicare Part A and Part B coverage.
- If you were born after the first day of the month, you become eligible for Medicare on the first day of the month you turn 65. Sign up for Medicare between one and three months before the month you turn 65. Your TFL coverage begins on the first day you have both Medicare Part A and Part B coverage.
If you live in the United States or U.S. territories (American Samoa, Guam, the Northern Mariana Islands, and the U.S. Virgin Islands) and you already receive benefits from the SSA or the Railroad Retirement Board, you will automatically receive Medicare Part A and be enrolled in Part B at age 65.
In Puerto Rico, Medicare Part A is automatic for those already receiving benefits from SSA; however, Medicare Part B is not. Individuals must sign up for Medicare Part B in Puerto Rico.
If you live outside the United States and U.S. territories, you must apply for Medicare even if you already receive benefits from SSA or the Railroad Retirement Board.
Premium-free Medicare part A
You are eligible for premium-free Medicare Part A if you worked and paid Social Security taxes for at least 10 years (40 quarters total). If you are not eligible through your own work history, you may be eligible for premium-free Part A through your current, divorced, or deceased spouse. If you are not eligible for premium-free Part A through your own or your spouse’s work history, please contact TRICARE to learn how to remain TRICARE-eligible after you turn 65.
Already enrolled in Medicare
If you are already entitled to Medicare due to a medical condition or disability, your Medicare coverage will continue without interruption after you turn 65. If you are paying a premium surcharge for late enrollment in Medicare Part B, it will be removed when you reach age 65. If you are entitled to Medicare Part A, but do not have Medicare Part B, you will be automatically enrolled in Medicare Part B.
Delaying Part B enrollment
If you have group health plan coverage based on current employment, you can sign up later for Part B during a Medicare special enrollment period within the eight months following either (1) retirement or (2) the end of group health plan coverage, whichever comes first. However, without Medicare Part B, you are ineligible for TRICARE.
If you are entitled to premium-free Medicare Part A, you must also have Part B to remain TRICARE-eligible, even if you have group health plan coverage based on current employment. Sign up for Part B before you stop working or lose group health plan coverage to avoid a break in TRICARE coverage. Your TFL coverage begins on the first day you have both Medicare Part A and Part B.
Under TFL, you can get care from Medicare-participating, nonparticipating, and opt-out providers. Medicare- participating providers agree to accept the Medicare-approved amount as payment in full. Medicare nonparticipating providers do not accept the Medicare-approved amount as payment in full. They may charge up to 15 percent above the Medicare-approved amount, a cost that will be covered by TFL. Providers who opt out of Medicare and enter into private contracts with patients are not allowed to bill Medicare. Therefore, Medicare does not pay for health care services you receive from opt-out providers. When you see an opt-out provider, TFL pays the amount it would have paid (normally 20 percent of the allowable charge) if Medicare had processed the claim; you are then responsible for paying the remainder of the billed charges.
Veterans Affairs (VA) providers cannot bill Medicare, and Medicare cannot pay for services received from VA. If you are eligible for both TFL and VA benefits and elect to use your TFL benefit for non-service connected care, you will incur out- of-pocket expenses when seeing a VA provider. By law, TRICARE can only pay up to 20 percent of the TRICARE-allowable amount. If you receive care at a VA facility, you may be responsible for the remaining liability. If you want to seek care from a VA provider, check with Wisconsin Physicians Service (WPS) to confirm coverage details and to determine what will be covered by TRICARE by calling (866) 773-0404 or visiting www.TRICARE4u.com.
TFL beneficiaries can receive care at military hospitals and clinics on a space-available basis. You may also be able to participate in TRICARE Plus, a program that allows certain beneficiaries to enroll at military hospitals or clinics and have priority access to primary care.
Under TFL, Medicare is the primary payer in areas where Medicare is available (the United States and U.S. territories), and TRICARE pays last. TRICARE is the primary payer for care received overseas unless you have other health insurance and Medicare pays nothing.
Prescription drug coverage
There is usually little or no benefit to purchasing a Medicare have TRICARE. As long as you remain TRICARE-eligible, you do not need Medicare Part D.
Small Increase to TRICARE Pharmacy Copays
Posted on March 02, 2015
New copayments for prescription drugs covered by TRICARE went into effect February 1, 2015. The Fiscal Year 2015 National Defense Authorization Act (NDAA) requires TRICARE to increase most pharmacy copays by $3. Drugs from military pharmacies and generic drugs from TRICARE Pharmacy Home Delivery still cost beneficiaries $0.
TRICARE pharmacy copays vary based on the class of drug and where beneficiaries choose to fill their prescriptions:
- TRICARE Pharmacy Home Delivery copays for formulary brand name drugs are going from $13 to $16, and for non-formulary from $43 to $46. Beneficiaries can get up to a 90-day supply of drugs through Home Delivery.
- At the retail pharmacy network, copays for generic formulary drugs go from $5 to $8, brand name formulary go from $17 to $20 and non-formulary from $44 to $47. Beneficiaries can get up to a 30-day supply of drugs at retail pharmacies.
Some pharmacy copays are not changing in 2015. Military pharmacies remain the lowest cost option for beneficiaries, with no cost for drugs, and generic formulary medications at Home Delivery remain $0. Home Delivery is a low-cost, safe and convenient way for TRICARE beneficiaries to get their maintenance medications. Copays at non-network retail pharmacies will also change, based on the changes to retail copays.
For more details, visit the TRICARE pharmacy costs page.
These changes in the NDAA overrule previous rules passed by Congress in 2013 that connected TRICARE pharmacy copays to the retiree cost of living adjustment (COLA).
Gold Star Family volunteers requested for survey
Posted on February 27, 2015
The Clearinghouse for Military Family Readiness is looking for Gold Star Family members to participate in a short survey. Initiated by the Office of the Secretary of Defense, the survey asks about the programs and services made available to surviving family members following the death of their Soldier, including if the Soldier died after retiring from the military.
Questions are designed to learn the needs of surviving family members and to assess how well those needs are being met by existing programs and services. Participation is completely anonymous.
What is good for your heart is also good for your head
Posted on February 26, 2015
Whether you are an active duty service member looking to retire soon or you are already a military retiree, the lifestyle choices you make now can make a big difference on the activities you are able to enjoy in the future. A ground-breaking 35-year study funded by the Medical Research Council, the Alzheimer's Society and the British Heart Foundation has shown how a healthy lifestyle ultimately pays off in old age. In 1979, 2,235 men aged between 25 and 49 in Caerphilly, South Wales, were asked to follow this simple health regimen -- eat well, work out, drink less, keep their weight down and never smoke. This simple lifestyle appears to be the secret of a fit and happy old age for the 25 seniors who managed to stick to the plan for the last 35 years. These 25 seniors are all far fitter and healthier than the other volunteers who gave up living according to these healthy lifestyle recommendations.
The recommended physical activity was to walk two or more miles each day, cycle 10 or more miles each day, or engage in regular "vigorous" exercise, and drink in moderation. The volunteers gave regular reports of their physical activity, alcohol consumption, and diet; and every five years the men were re-questioned and their medical records re-examined by researchers to identify new cases of diabetes, heart disease and strokes. The researchers found the seniors who were non-smoking, at a healthy weight, ate a diet high in fruit and vegetables, achieved regular physical activity, and consumed a low to moderate amount of alcohol were associated with low incidence of certain chronic diseases. Initially the study focused on heart disease, but as time passed it was found that those who stuck to the plan had dramatically cut their risk of cancer, diabetes, heart-attack, stroke and dementia. Deciding to follow healthy life choices made an impact on preventing illnesses from developing in older age. Would these choices not be worth it in order to stave off disease and premature death, and spend a more satisfying life in old age?
Professor Peter Elwood, the study leader from Cardiff School of Medicine, said "We must wake up to the preventive power of living a healthy life. Healthy behavior was far more beneficial than any medical treatment or preventative procedure. Following these steps did not give them complete protection against disease, but the development of heart disease was delayed by up to 12 years, and up to around an additional six years before dementia took its grip.” Living according to these steps reduced the chances of dementia by up to 60 percent, with exercise having the single biggest influence on dementia levels. Professor Elwood stressed that while physical activity had more impact on certain illnesses, the emphasis of the study was on an overall healthy lifestyle. "Exercise happens to be the most important, but the other factors come in very close behind. We should all live a more active lifestyle,” he added.
Dr. Doug Brown from the Alzheimer's Society said, “We have known for some time that what is good for your heart is also good for your head, and this study provides more evidence to show that healthy living could significantly reduce the chances of developing dementia.”
Do the tenants of the healthy lifestyle in this study sound familiar? They should since it includes two of the key components of the Performance Triad of sleep, activity and nutrition. The DOD Healthy Base Initiative also focuses on improving two of the tenants in the Cardiff study – reducing tobacco use and improving nutrition. It is important to recognize that the extent to which someone is able to prevent illness lies in a person's own hands. Following a healthy lifestyle is the responsibility of the individual. Unfortunately, few people commit to following a fully healthy lifestyle. To learn more about how the military health system can support your personal choices to live a healthy lifestyle, visit the Performance Triad and the Healthy Base Initiative.
Veterans with PTSD claims may apply for discharge upgrades
Posted on February 25, 2015
Veterans with post-traumatic stress disorder (PTSD) who were discharged under "other than honorable" conditions may now submit requests to the Army Board for Correction of Military Records to have their discharge reconsidered for an upgrade if it was due to PTSD.
The Army launched a new webpage where veterans can get information and to ultimately enable these individuals to apply for the change in discharge status. According to the Secretary of Defense’s supplemental guidance, all Boards for Correction of Military Records are empowered to implement liberal consideration of evidence of PTSD symptoms in the service record or in a diagnosis provided by civilian providers and special consideration of Department of Veterans Affairs diagnosis of PTSD or PTSD-related conditions.
"Army veterans are Soldiers for Life. I want to encourage our veterans out there to apply,” said Col. Matthew B. Coleman, Special Assistant to the Deputy Assistant Secretary of the Army at the Army Review Boards Agency.
"Discharge upgrades are very important because they are linked to benefits these individuals could receive through the Department of Veterans Affairs, as well as being able to get medical treatment -- that's probably most important with those who are suffering from invisible injuries of PTSD or PTSD-related symptoms," Coleman added.
Veterans who were previously denied an upgrade can reapply. The Army Board for Correction of Military Records will consider such an application as a new case. However, the guidance only applies to veterans with "other than honorable" discharges.
“PTSD was not recognized as a diagnosis at the time of service in past conflicts such as the Vietnam War,” Secretary of Defense Chuck Hagel wrote in his memorandum, dated Sept. 3. “In many cases,” Hagel wrote, “diagnoses were not made until decades after service was completed.”The memorandum provided guidance to the military departments’ Boards for Correction of Military/Naval Records, as they considered the upgrades. The memorandum seeks to ease the application process for the veterans.
The Army is committed to making sure the veterans receive fair consideration of their service and the conditions that may have mitigated the misconduct that led to their discharge, according to Coleman.
"We inculcate the core values of the agency, which are justice, equity and compassion -- and those are the merits by which we look at each and every case,” he emphasized.
Americans unite to thank and honor Vietnam veterans and their families
Posted on February 24, 2015
The Vietnam Veterans Memorial in Washington, D.C. is an arresting reminder to its four million annual visitors of the service and sacrifice of the 58,300 Americans whose names are on "The Wall." On Memorial Day 2012, a poignant ceremony was held there to symbolize the beginning of a Congressionally authorized national commemoration; its primary focus: to thank and honor all Vietnam veterans and their families for their service, valor and sacrifice on behalf of a grateful nation.
During the ceremony, President Obama said "one of the most painful chapters in our history was Vietnam -- most particularly, how we treated our troops who served there. You were often blamed for a war you didn't start, when you should have been commended for serving your country with valor. You were sometimes blamed for misdeeds of a few, when the honorable service of the many should have been praised. You came home and sometimes were denigrated, when you should have been celebrated. It was a national shame, a disgrace that should not have happened. And that's why here today we resolve that it will not happen again."
The ceremony's genesis began in 2008. Congress passed Public Law 110-181§589 authorizing the Secretary of Defense to commemorate the 50th anniversary of the Vietnam War and establish The United States of America Vietnam War Commemoration.
Key to the Commemoration's plans to accomplish its primary objective is its hometown-centric Commemorative Partner Program. To date, approximately 7,000 organizations at the local, state and federal levels have committed to conducting events and activities in their local communities that recognize and honor Vietnam veterans and their families.
There are no costs associated with becoming a commemorative partner, and we heartily invite organizations to join the mix of dedicated local and national businesses, corporations, veterans and military organizations, associations, educational institutions, community groups, towns, cities and many others who have committed to assist the nation in this noble effort. Please visit VietnamWar50th.com or call (703) 697-4893 for more information about the Commemoration and the Commemorative Partner Program.
As veterans and Retired Soldiers, we encourage you to share this article and our contact information with organizations you believe might be interested in joining our Commemorative Partner Program. Additionally, as you connect with your circle of friends, please convey the thanks and gratitude of our nation to those who served during the Vietnam War.
New U. S. Army Retired Lapel Buttons are now available
Posted on February 20, 2015
The new U. S. Army Retired Lapel Button (at left) is now available at Exchange stores and on their their website. The lapel button is $5.80 online; the larger Retired Service Identification Badge, worn by Retired Soldiers on the Army Service Uniform, is $12.25.
The Army logo in the middle of the new U. S. Army Retired Lapel Button and Retired Service Identification Badge is slightly different than the official Army logo, due to manufacturing requirements.
Soldier for Life window stickers, which incorporate the official Army logo, will be available this summer.
About Army Echoes
Army Echoes informs Retired Soldiers, surviving spouses, and their Families on changes to their benefits and entitlements, developments within the Army, and how they can continue to support the Army.