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Tricare Help: Uncertain times and the '20/20/20' rule

October 18, 2015 (Photo Credit: Thinkstock/Staff)

Q. I’ve been married 40 years. My husband was on active duty for 20 years and has been retired for more than 20 years. We were married for 18 of his active-duty years. I’m retiring soon and wondering whether to cancel my employer insurance and its high premiums, knowing that I could get Tricare if we divorced. We live in uncertain times and you never know what may happen.

A. Indeed we do live in uncertain times. But one thing is certain: You don’t meet the requirement of the last “20” in the 20/20/20 rule: The marriage and the service member’s active-duty time must overlap by at least 20 years; 18 years would not qualify you for lifetime post-divorce Tricare coverage.

A lesser-known corollary, the “20/20/15 rule,” requires only 15 years of marriage/ service overlap. But while coverage under 20/20/20 lasts indefinitely, as long as the spouse does not remarry, coverage under 20/20/15 lasts for only one year after divorce.

Q. Why is the cost of enrolling my spouse in Tricare so much higher than to enroll just myself? The monthly premium for sponsor-only coverage under Tricare Reserve Select is $50.75, but family coverage is $205.62. And you have to pay two months at enrollment!

A. This is the basic model for employer-provided health care — the price usually is relatively modest for the employee himself/herself, but it jumps considerably when family members enter the picture.

It may be scant consolation, but $205 a month for complete family health care coverage these days is not overly exorbitant.

Q. I’m a 52-year-old spouse of an Army retiree. I’ve been awarded Medicare for disability. I want to keep Tricare and cancel Medicare. Can I?

A. Technically, yes, but there are reasons to think long and hard before doing that.

For most people, the decision to cancel Medicare is irreversible. Its portals are tightly restricted; if you cancel, you may find it very difficult to get back into Medicare in the future if your life circumstances change.

That said, you still have Tricare coverage. But now that you’re on Medicare, you use Tricare for Life, in which Medicare is first payer and Tricare Standard is backup second payer. By law, Tricare must be last payer to all other health insurance.

You’re automatically enrolled in Medicare Part A inpatient hospitalization coverage, which carries no premiums. But to activate the Tricare portion of your Tricare for Life coverage, you must enroll in Medicare Part B outpatient coverage, which carries premiums of about $100 a month for most people.

Get more details from the Tricare for Life contractor, Wisconsin Physician Services, at toll-free 1-866-773-0404.

Email questions to tricarehelp@militarytimes.com.

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