FALLS CHURCH, Virginia –
Will you be turning age 65 this year? You’re on your way to an important milestone in your life. You’re also a step closer to becoming eligible for Medicare and TRICARE For Life. or TFL. Once you have Medicare Part A and Part B, you’ll automatically have TFL. Of course, if you have family members—like a younger spouse or children—enrolled in a TRICARE plan, you may be wondering if your TFL eligibility may impact their coverage.
“One of the key things to know about TFL is that it’s an individual entitlement,” said Anne Breslin, TRICARE For Life program manager at the Defense Health Agency. “This means coverage is only for the beneficiary who is eligible for Medicare and TRICARE. Therefore, family members who aren’t eligible for Medicare remain eligible for TRICARE Prime or TRICARE Select.”
Here’s a look at what you need to know about TFL and what happens to your family’s TRICARE coverage once you become eligible for TFL benefits.
Who qualifies for TFL?
First, it’s important to understand how TFL works with Medicare and who’s eligible for it. TFL is Medicare-wraparound coverage. This means that Medicare pays first for health care services covered by both Medicare and TRICARE. TFL then pays the remaining amount. TRICARE processes your claim as the primary payer when you get care that’s covered only by TFL (for example, TRICARE-covered services received overseas).
To be eligible for TFL, your Defense Enrollment Eligibility Reporting System, or DEERS, record must reflect your eligibility for TRICARE and your entitlement to Medicare Part A and Part B. You may be eligible for Medicare if you’re:
You’ll need to sign up for Medicare a few months before the month you turn age 65. As stated in the TRICARE and Medicare Turning Age 65 Brochure, “Your birth date determines when you become entitled to Medicare and when you should sign up for Medicare Part A and Part B.”
Does your birthday fall on the first day of the month? If so, you become eligible for Medicare on the first day of the month before you turn age 65. You should sign up for Medicare between two and four months before you turn age 65.
If your birthday falls after the first day of the month, you become eligible for Medicare on the first day of the month you turn age 65. Sign up for Medicare between one and three months before the month you turn age 65.
Your TFL coverage begins on the first day you have both Medicare Part A and Part B.
What happens to my family’s coverage once I have TFL?
Nothing. The good news is your family’s existing TRICARE coverage doesn’t change. Your spouse can remain in his or her TRICARE plan. And if you have children, they remain in their current plan until they change plans or lose TRICARE eligibility.
Medicare and TFL are individual entitlements. However, becoming eligible for Medicare is one of many TRICARE Qualifying Life Events (QLEs) that apply to your family members. A QLE opens a 90-day period for you and your family to make eligible enrollment changes outside of TRICARE Open Season. For example, if your spouse wanted to switch from TRICARE Prime to TRICARE Select, this is the time to do so. You can learn more about QLEs in the TRICARE Qualifying Life Events Fact Sheet.
Keep in mind, there aren’t any enrollment forms or fees for TFL coverage. But you must pay Medicare Part B premiums to remain eligible for TFL. If you and your spouse had enrollment fees for your TRICARE Prime or TRICARE Select coverage, your spouse’s enrollment fee will be reduced when you have TFL.
“Your spouse’s enrollment fee changes from the family rate to the individual rate once you have TFL,” said Breslin. “However, if you and your spouse have one or more children who are also enrolled in a TRICARE plan, the enrollment fee stays at the family rate.”
Do you have questions about enrollment fees? You can check out the TRICARE Compare Cost Tool or contact your TRICARE contractor to learn more.
As you or a family member becomes eligible for Medicare and TFL, it’s important you know how TFL works. The TRICARE For Life Handbook, TRICARE and Medicare Turning Age 65 Brochure, and TRICARE and Medicare Under Age 65 Brochure are useful resources to help you learn more about eligibility, costs, what’s covered, and more.