Q. In a response to a Tricare Help question a while back, you used the phrase, "If you're willing to pay the Medicare Part B monthly premium ..." As a retired Army Reserve officer with a retired Army Reserve wife, both of us over age 65, our understanding is that you must pay the Part B premium to be eligible for TFL. Is that not the case? You also mentioned that a beneficiary could use a third insurance plan, such as Humana, if you pay the Part B premium. If my wife and I were to go that route — having coverage from Medicare, TFL and Humana — which would be the primary coverage? Could we choose Medicare as primary and Humana as secondary?
A. On your first question about Part B, you 're right — you cannot use Tricare for Life if you do not sign up for Medicare Part B outpatient insurance. That said, no one is forced by law to sign up for Medicare Part B. Also worth noting: Beneficiaries who are no longer working at age 65 and who do not sign up for Part B when they first become eligible, but decide they want to sign up later, likely will face a "late enrollment" penalty equal to about 10 percent of the Part B premium for each year they could have signed up but for whatever reason did not.
Your second question is really a Medicare issue, not a Tricare issue. When Medicare and other health insurance are both in the picture, either may be considered the "primary payer," based on "coordination of benefits" rules that in turn depend on a number of variables. One of the biggest such variables is whether the beneficiary intends to continue working past age 65 and has access to employer-provided group health plan coverage.
In those situations, the number of company employees can determine whether Medicare or the employer-provided OHI pays first. If the other insurance is group coverage and the company has 20 or more employees, the group plan generally pays first, Medicare second. But if the company has less than 20 employees, Medicare generally pays first, the employer coverage second.
That's only one of many potential variables that can come into play. Yes, it can get confusing. Below are two online sources for more information on your question. The first link is to a Medicare Web page that's a basic primer on who pays first, while the second link is another Medicare web page that goes into a bit more detail with information tailored to various beneficiary scenarios:
* militarytimes.com/medicare-other
* militarytimes.com/medicare-whopays
If you'd prefer to speak with a live human about the above as it relates to your own circumstances, you can call Medicare's Benefits Coordination & Recovery Center at 855-798-2627. The one unalterable constant in the above discussion is that Tricare, by law, is always last payer to any and all other health insurance coverage.
Questions? Send an email to tricarehelp@militarytimes.com
