Tricare help: Get my own coverage, or stay as wife’s dependent? - Military Health, Tricare programs - Military Times

Tricare help: Get my own coverage, or stay as wife’s dependent?

Q. I will soon turn 60 and qualify for retired pay and Tricare. My wife is on active duty, so I have Tricare now as her dependent. At 60, do I have to drop out of her coverage and adopt Tricare under my own Social Security number?

A. You may continue to use Tricare as an active-duty family member, as your wife’s dependent, for as long as you wish. There are a couple of benefits to doing this:

• You will have a smaller cost share: 20 percent, versus 25 percent for a retiree.

• You will have to meet only one Catastrophic Cap, and it will be $1,000 instead of $3,000. The Catastrophic Cap is the amount a family must pay in deductibles and cost shares in a single fiscal year before Tricare will withhold no more of those amounts from its payments, and instead pay 100 percent of the amount it allows on each claim for the remainder of that fiscal year.

Q. I’m a federal employee with government health insurance plus Tricare Standard. I’ll soon turn 65 and get Medicare, but I must keep my Federal Employees Health Benefits plan because my wife is only 57. In what order must I file claims? Do I file first with Tricare for Life and then with my FEHB plan? Also, Medicare says I do not have to enroll in Part B for as long as I continue to work. Tricare told me I must enroll in Part B as soon as I become eligible for Medicare. Who is right?

A. As far as the order of filing claims, remember one simple rule: By law, Tricare is always last payer to all other health insurance.

Your only issue then is whether to file first with Medicare or with your FEHB plan. Medicare’s rules say that depends on whether you still work for the employer who sponsors the other plan. So, for as long as you work for that employer, the FEHB plan is primary, Medicare is second and Tricare is last. When you retire, Medicare becomes primary, the FEHB plan second and Tricare last, as always.

As for enrolling in Medicare Part B, because you are a Tricare beneficiary who is retired from the military, the rule under Tricare law takes precedence over the Medicare rule.

Tricare law requires any retiree, retiree family member or survivor who becomes entitled to Medicare to be enrolled in Part B on the effective date of Medicare coverage. Failure to do that causes the immediate loss of all your Tricare eligibility. Note that this would have no effect on your wife’s Tricare eligibility.

Just remember to apply for Medicare Part A and Part B at least 90 days before the month of your 65th birthday.

___________________

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

Get Tricare advice anytime at www.militarytimes.com/tricarehelp.