Military Health, Tricare programs - Military Times

Tricare Help: To get Tricare, most Medicare beneficiaries must enroll in Part B

There is an application of a Tricare rule about Medicare Part B enrollment that’s so important, and so frequently overlooked, that I must repeat it often to readers of Tricare Help.

Medicare and Tricare have totally different rules about Part B enrollment. Medicare’s rules concern other health insurance and the penalty on the Part B premium for late enrollment.

Tricare’s Part B enrollment rule, which affects hundreds of families each year, is completely different.

It applies to all Tricare beneficiaries except active-duty family members. All other beneficiaries who get Medicare, at any age, must be enrolled in Medicare Part B on the same day their Medicare Part A coverage takes effect or they immediately lose Tricare eligibility.

The beneficiaries most often caught in this trap are family members who got Medicare for disability while their sponsor was on active duty. Others include retirees and their family members who confuse Medicare’s Part B enrollment rules with Tricare’s.

Active-duty spouses or children may get Medicare Part A for disability months, or even years, before the sponsor retires. They usually don’t enroll in Part B and pay its monthly premium because it’s not required as long as the sponsor remains on active duty. They are likely enrolled in Tricare Prime, and also may use Part A.

Months or years pass, and everybody forgets about Part B.

Then the sponsor retires, and overnight, disabled spouses or children become retiree family members with Medicare Part A and a legal requirement, effective on that date, to also be enrolled in Part B. Without it, they are ineligible for Tricare.

If they depended on Tricare Prime enrollment to get military hospital care, they no longer have that priority access. If they are enrolled in Tricare Standard and go to a civilian doctor, that claim will be denied for “not eligible on DEERS.” With Part A, but without Part B, they have no Tricare coverage — none.

The only remedy is to go to the Social Security office and beg, if necessary, to be enrolled in Medicare Part B immediately.

Their Tricare eligibility cannot be restored until Social Security officially notifies the Defense Enrollment Eligibility Reporting System that their Medicare Part B enrollment is in effect. Until then, their only coverage is Medicare Part A, and use of the military hospital if its commanding officer will allow it without their being enrolled in Tricare Prime.

To avoid this disaster, any family member with Medicare Part A only must contact Social Security at least 90 days before an active-duty member’s retirement to enroll in Part B effective on the first day of the sponsor’s retirement.

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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.