Medicare And Tricare

As a retired military service member or their spouse, you will likely have Tricare as your medical and prescription coverage. Prior to becoming eligible for Medicare, you have been using this as your main coverage. But, when you become eligible for Medicare at age 65, this changes. When you start Medicare it becomes your primary medical insurance and Tricare your secondary. Tricare also continues to provide you with prescription coverage. As a Tricare For Life recipient, it’s important to know that you must enroll in Medicare to maintain your Tricare benefits. You can enroll in Medicare 3 months before the month that you turn 65 and it starts that month. Here is what your coverage looks like when this transition occurs.

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Facts To Know

  • When you’re eligible, Medicare A & B will become your primary medical coverage for doctors care, treatment, and hospitalization.
  • Tricare becomes secondary insurance to Medicare and will cover all medical costs not paid by Medicare, essentially giving you 100% coverage (For Medicare A & B services).
  • Tricare continues to provide you with prescription coverage.
  • With Medicare, you have two main choices as to how you are covered. You can choose to get Medicare directly through the government (Original Medicare) or through private health plans known as Medicare Advantage.
  • Tricare can be billed as your secondary insurer for copays with either Original Medicare or private Medicare Advantage.

Need To Know

To maintain your Tricare benefits, you must enroll in Medicare when you become eligible.

The Parts Of Medicare

Medicare has 5 parts, with the main ones being Parts A & B. Medicare Part A covers inpatient hospitalization, skilled nursing facility, and home health care. Medicare Part B covers doctors, outpatient treatment and testing.

The Other 3 Parts

  • Part C – More commonly known as Medicare Advantage, these are private insurance plans. You have the choice of being covered directly through Medicare or a Private Insurer.
  • Part D – Medicare prescription pharmacy benefits. Medicare does not provide coverage directly but instead through private insurers.
  • Supplements – Medicare Supplements are insurance plans that supplement Medicare A & B. They are offered by private insurers and help cover medical costs. CHAMPVA provides the same function, so in most cases, Medicare Supplements aren’t needed by CHAMPVA recipients.

Medicare Advantage

How Tricare Recipients Get The Most Medicare Benefits For The Lowest Cost

With Medicare you have the choice of getting your benefits directly through the government (Original Medicare) or through a private insurer (Medicare Advantage). Both Original Medicare and Medicare Advantage include Part A coverage for hospitalization and Part B for doctors & outpatient care. Tricare can be billed as your secondary insurance for either option. Original Medicare is “one size fits all” and the same for everyone in the country. Medicare Advantage, however, gives you various choices that may be a better fit for your unique situation.

The “Advantage” in Medicare Advantage is that they include more benefits than Original Medicare, at the same or lower monthly cost. The additional benefits you can get with Medicare Advantage include;

  • Dental, Vision, and Hearing Aid coverage.
  • Silver Sneakers – Gives you free access to exercise facilities and online exercise videos.
  • Part B Giveback – This is a benefit included with some plans that gives you a monthly dollar amount to help you pay your Medicare cost.
  • Prescription – There are Medicare Advantage options that include pharmacy coverage and some that do not. You have choices.

If you will continue to use Tricare for medication coverage, you will not need prescription benefits with Medicare. This can allow you to be covered by a Medicare Advantage plan without prescription coverage, which has it’s own unique benefits.

Tricare As Secondary

Tricare can be your secondary insurance whether you have Original Medicare or Medicare Advantage. You have a choice.

Medicare Advantage Vs. Original Medicare Comparison

To get a better idea of how Medicare Advantage and Original Medicare compare, here is a comparison chart of the different features.

FeatureOriginal MedicareMedicare Advantage
Total Monthly Cost$148.50 In 2021$64.60 – $148.50 In 2021
Hospitalization & DoctorsYesYes
Doctor NetworksNo NetworksYes: PPO & HMO Options
Rx IncludedNoOptions With & Without
Dental & VisionNoYes
Hearing AidsNoYes: Often Included
Fitness / Health ClubNoYes

Part B Giveback

Part B giveback is a monthly rebate offered by some Medicare Advantage plans that can reduce your overall monthly cost for Medicare, even with the additional coverage included with the plan.

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Medicare Frequently Asked Questions

When will I start Medicare? If you are turning 65, you are eligible to start Medicare the first day of the month that you turn 65. If you are over 65 and have or are leaving employer insurance; you are eligible to start Medicare anytime. If you are disabled you will typically start Medicare 24 months after being awarded disability. If you have End Stage Renal Disease or ALS, you are usually awarded Medicare immediately.

What Costs Are Associated With Medicare? Medicare has 2 types of costs; Monthly premiums and medical cost sharing. A premium is the cost you pay to have the coverage, typically monthly or quarterly. Cost sharing is what you pay when you have medical care. If you have secondary insurance such as Tricare, it can cover your medical cost sharing. These are items such as deductibles and copay’s. The standard monthly premium most people pay in 2021 is $148.50. There are ways to lower your monthly premium such as Part B giveback and state programs.

When should I apply for Medicare? First, if you are already receiving Social Security payments when you become eligible for Medicare, you don’t need to apply. You will be automatically enrolled in Medicare. If you are turning 65 and need to apply, you can do so 3 months before the first day of the month that you turn 65. If you are over age 65 and have insurance through your employer; you can apply anytime and your coverage can begin as soon as the first day of the next month. If you are receiving disability

How do I enroll in Medicare? 1. Apply Online through the Social Security website. 2. Call the Social Security Administration at 1-800-772-1213 and schedule an appointment to enroll by phone. Instead of calling the main Social Security 800 number, you can call your local office to schedule a phone enrollment. To find your local office click here.

What is the benefit of working with Lone Star Medicare? Medicare can be confusing and the government doesn’t directly provide you with all benefits. So, you have choices to make and things to do. As a top independent agency, we are a one stop guide and resource to help make your life easier. We can help you get the coverage you need and save money. There are also no fees or costs for you, it’s a win win.

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