Friday, December 2, 2022

Do I Need Medicare Part B If I Have Tricare

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Is Part B Worth It

TRICARE for 65 And Over

Another mistake we see is people who thought they didnt need Part B because they are healthy. Ive seen a number of individuals who said they didnt get sick often so they opted to only enroll in Part A. Every one of these people assumed that Part A Hospital benefits cover everything in the hospital. So they decided to skip Part B thinking that they didnt mind paying out of pocket for an occasional doctor visit. They didnt realize Part B covers many things that occur in a hospital.

Usually they discover their error when they are sent for an MRI or a surgery and find out they now owe thousands or tens of thousands of dollars. Be sure you dont make the same mistake. If you are unsure, ask your insurance agent: Do I Need Medicare Part B?

If he or she tells you no, be sure you get a full explanation on why you are able to delay your. Get a second opinion if you are unsure, and never rely on Social Security to give you the right answer. Weve seen too many people get wrong answers from inexperience government employees.

Related Article: 7 Medicare Mistakes That Could Cost You

How Do Tricare For Life And Medicare Process Claims

Typically, your provider will file claims with Medicarefirst. After Medicare calculates its share, it will forward the claiminformation to TFL.

If you have other health insurance, Medicare will submitclaims to that insurance company first. Afterwards, you can send a claim to TFLfor any outstanding amount not covered by Medicare or the other insurer. Forinstance, if you also have a Medicare Supplement and TFL, Medicare would payfirst, and the supplement would pay second. Afterwards, TFL would payremaining, eligible expenses.

Learn More About Your Medicare Advantage Plan Options

For information about Medicare eligibility, benefits and the Medicare Advantage plan options available in your area, speak with a licensed insurance agent by calling 1-800-557-6059TTY Users: 711 24 hours a day, 7 days a week.

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.

Where you’ve seen coverage of Christian’s research and reports:

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Are Medicare Rules Different If I Have Fehb Coverage

Most people who have retiree coverage must enroll in Medicare Part A and Part B when first eligible. If they dont enroll, their retiree plan may pay only a small amount or nothing at all for their care. Medicares rules for you are different, however, if youre a federal retiree. As a federal retiree, if you dont enroll in Medicare, your FEHB plan will act as your primary insurer and wont pay less because you qualify for Medicare.

I Am Retiring From The Military And I Will Become Eligible For Health Coverage Under The Tricare For Life Program How Does This Fit In With Medicare And How Does It Affect My Spouse

TRICARE For Life and Medicare
  • You must pay Medicares Part B premiums. But you dont pay any premiums for TFL.
  • TFL pays the other out-of-pocket costs of Medicare your deductibles and copays so that you get comprehensive coverage at minimal cost. You dont need Medigap supplemental insurance.
  • TFLs prescription drug coverage is better and less expensive than Medicare Part D drug coverage, so you dont need to enroll in a Part D drug plan.
  • When you use a medical service that is covered by both Medicare and TFL, Medicare pays first. The provider bills Medicare, which pays its share, and the rest of the claim is sent to TFL. TFL pays the remaining share of the bill directly to the provider.
  • If you use a medical service thats covered by Medicare but not by TFL , TFL wont pay Medicares deductible or copay or anything else toward the bill.
  • If you use a service thats covered by TFL but not by Medicare , TFL pays at the same rate as the TRICARE Standard program, and you pay its deductibles and copays.

See official information on the TRICARE For Life program.

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Does Medicare And Tricare Pay For Nursing Home

Skilled nursing care is covered by TRICARE in the U.S. and U.S. Territories within skilled nursing facilities if you have a hospital stay of three or more days. TRICARE and Medicare do not cover assisted living facilities or long term care, which is needed if you can no longer perform everyday tasks by yourself.

How Does Tricare For Life Work With Medicare

Tricare for Life is intended to reduce your out-of-pocket health care costs, including prescription drug expenses and some copayments and deductibles for Medicare. It also helps pay if you need health care while traveling overseas.

With both Medicare and TFL, you can seek care at any Medicare participating provider. You can seek care through a non-participating provider as well, but Medicare will only cover the Medicare approved cost. You can also seek care at any military hospital, but on a space-available basis only.

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How Tricare Works With Medicare

Home / FAQs / General Medicare / How TRICARE Works with Medicare

Beneficiaries eligible for both TRICARE and Medicare should understand how the two medical insurance programs work together. Medicare consists of a few different parts. If youre familiar with these parts, you might be wondering how each works with TRICARE, and if additional supplemental insurance is necessary for those who are dual-enrolled in both Original Medicare and TRICARE.

TRICARE For Life is the health insurance program available to U.S. military retirees who qualify, as well as their beneficiaries, for no cost. Its different and separate from Medicare. Medicare is the U.S. national health insurance program for individuals 65 years of age and older or who are disabled. Its crucial for those who are dual-eligible to understand their coverage options.

What Are My Tricare For Life Costs

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When you use TRICARE For Life, you don’t pay any enrollment fees, but you must pay Medicare Part B monthly premiums. Your Part B premium is based on your income. For more information visit or call Social Security at 800-772-1213 or 800-325-0778 .

What you pay out of pocket for care depends on how it’s covered. Your out-of-pocket costs are determined by the service you receive and whether or not it’s covered by Medicare and TFL. View your Health Care Plan Costs.

How the service is covered What you pay

*Medicare pays first

*TRICARE For Life pays second

*You pay nothing

*TRICARE For Life pays first

*Medicare pays nothing

*You pay the TRICARE For Life calendar year deductible and cost-shares

* Medicare pays first

* TRICARE For Life pays nothing

* You pay the Medicare deductible and coinsurance

Not covered by

Medicare or TRICARE For Life

* Medicare pays nothing

* TRICARE For Life pays nothing

* You pay the entire bill

What is covered?

TRICARE For Life and Medicare cover proven, medically necessary, and appropriate care. TRICARE has special rules and limitations for certain types of care, and some types of care are not covered at all. Tricare policies are very specific about which services are covered and which are not. It is in your best interest to take an active role in verifying coverage.

Exclusions

Also Check: Do I Need Medicare Part C

What Happens If A Provider Opts Out Of Medicare

If your provider opts out of Medicare, Medicare will paynothing. TFL would cover up to 20 percent of allowed TRICARE amounts forservices, and youd be responsible for the remaining bill. This rule applies toany care received from a U.S. Department of Veterans Affairs for injuriesor illnesses not related to your military service. You can read more about theVA and associated care and costs at www.va.gov/healthbenefits/apply/veterans.asp.

Tricare And Medicare Advantage

Medicare Advantage, also known as Medicare Part C, is an alternative to traditional Medicare.

These extras may include prescription drug, vision, dental, and hearing coverage, depending on the policy.

When you have TRICARE for Life, you can certainly choose a Medicare Advantage policy. However, its important to know how having both policies may impact you. These considerations include:

  • Prescription drug coverage. TRICARE for Life offers prescription drug coverage. So do many Medicare Advantage plans. If you dont want dual coverage, you may choose a Medicare Advantage plan that doesnt offer prescription drug benefits, which will likely make the monthly premium cheaper.
  • Provider networks. Youll usually experience the greatest cost-savings in Medicare Advantage if you use in-network providers. This is usually a smaller network than you would have with original Medicare or TRICARE for Life.
  • Costs. Some Medicare Advantage plans are premium-free, others are not. Most plans will require you to pay a copayment when you see in-network doctors. Often, TRICARE for Life will pay the costs of these copayments.

The answer to this question depends if you are or arent on active duty. Well explain the details of both situations next.

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Do I Need To Enroll In Medicare Part B

If you are continuing your membership with the US Family Health Plan, you are not required to enroll in Medicare Part B. However, we strongly recommend you consider enrolling in Medicare Part B as soon as you are eligible for the following reasons:

  • Delay in Accessing Medicare Part B and TRICARE Benefits: If you ever do disenroll from the US Family Health Plan, you will not be able to access other TRICARE benefits until you are enrolled in Medicare Part B. You will only be able to enroll in Medicare Part B during the General Enrollment Period , with coverage starting on July 1 of the year you sign up. You could be left without medical insurance coverage for an extended period of time should you decide to disenroll from the US Family Health Plan at a later date.
  • Penalty in Medicare Part B Premiums: If you wait to enroll until after youre first eligible, your Medicare Part B premium will increase by 10% for each 12-month period that you were originally eligible to enroll.
  • Limited Coverage for Long-Term-Care Facility: Long- term-care facility residents are not eligible for the US Family Health Plan in most cases. Without Medicare Part B, your coverage will be limited to Medicare Part A and you will be responsible for the costs of medical services provided by physicians, labs, etc.
  • Tricare And Medicare Eligibility

    Veterans Benefits &  Medicare

    In order to enroll in TRICARE For Life, you must be eligible for and enrolled in both Medicare Part A and Part B and be eligible for TRICARE.

    TRICARE eligibility is available to:

    • Military members and their families
    • National Guard/Reserve members and their families
    • Survivors
    • Some former spouses
    • Medal of Honor recipients and their families

    There is no cost to join TRICARE For Life or to maintain coverage. You will, however, have to pay your monthly premium for Medicare Part B.

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    Fehb Medicare And Tricare For Life

    Q. Can FEHB suspension be done only in retirement? How can suspension be done working as an active federal employee with Medicare and Tricare for Life? One may want to keep working for the government but not have to pay FEHB fees and use Medicare Part A with its fees along with Medicare Part B free and TFL benefits included due to being a military retire. Why would one want to have such overkill in health care benefits and costs? Could you explain the process in a scenario such as this, and could either a continuing active employee or a retiree reclaim their FEHB in the event the Medicare or TFL benefit degrades or goes away?

    A. Employees cant suspend coverage. However, they can cancel their coverage to use CHAMPVA, Tricare or Tricare for Life. If you dont participate in premium conversion, you can cancel your enrollment at any time. If you do, you can cancel during any annual FEHB Open Season. If you decide to return to FEHB coverage, you can do so during a future Open Season. On the other hand, if you then lose CHAMPVA, Tricare or Tricare for Life coverage involuntarily, you can immediately re-enroll in FEHB.

    When You Should Consider Enrolling In Medicare Part B

    If you qualify to delay enrolling in Medicare, deciding to do so is a personal choice.

    Some may choose to delay, and for others, it may still be a good fit for your health and lifestyle to enroll in Part B. Consider the following when trying to decide whether to enroll in Part B or delay while still working:

    • Is Medicare less expensive than your current health insurance?
    • Does Medicare offer better coverage than your current health insurance?
    • Do you want to keep your current insurance but also take advantage of Medicare benefits
    • Do you want to enroll in either a Medigap or Medicare Advantage plan?
    • Is your prescription drug coverage considered creditable by Medicare?

    Answering the above questions can help you decide whether or not to delay enrollment. Its important to carefully consider the last item regarding prescription drug coverage. While most employer coverage is considered creditable, you should still verify if it is or could end up facing a late enrollment penalty for Medicare Part D.

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    Sign Up: Within 8 Months After You Or Your Spouse Stop Working

    • Most people dont have to pay a premium for Part A . So, you may want to sign up for Part A when you turn 65, even if you or your spouse are still working.
    • Youll pay a monthly premium for Part B , so you may want to wait to sign up for Part B.

    Avoid the penalty & gap in coverageIf you miss this 8-month Special Enrollment Period, youll have to wait to sign up and go months without coverage. You might also pay a monthly penalty for as long as you have Part B. The penalty goes up the longer you wait to sign up. How much is the Part B late enrollment penalty?

    If I’m In The Fehb Should I Enroll In Part A

    Medical Plans for Retirees Entitled to Medicare

    Most people dont have to pay a premium for Part A. When combined with FEHB coverage, having Part A would limit your out-of-pocket costs for the expenses it covers . Having Part A means you cant contribute to a Health Savings Account , so youd want to delay enrolling in Part A if your FEHB coverage is HSA-qualified and you want to continue making contributions to your HSA.

    You can only delay Part A until you begin collecting Social Security at which point your Part A coverage will start automatically. The Office of Personnel Management , which administers the FEHB, recommends taking Part A if you dont have to pay a premium.

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    How Tricare For Life Works

    You may visit any authorized provider.

    • Your provider files your claims with Medicare.
    • Medicare pays its portion and sends the claim to the Tricare For Life claims processor.
    • Tricare For Life then pays the provider directly for Tricare-covered services.

    You can get care at military hospitals and clinics, but only on a space-available basis.

    What If I Have Specific Questions About A Tricare For Life Claim

    Contact a TRICARE for Life contractor. In the U.S. and U.S. Territories, visit the Wisconsin Physicians Service website. For all other overseas areas, visit the International SOS website.

    Lisa Eramo is an independent health care writer whose work appears in the Journal of the American Health Information Management Association, Healthcare Financial Management Association, For The Record Magazine, Medical Economics, Medscape and more.

    Lisa studied creative writing at Hamilton College and obtained a masters degree in journalism from Northeastern University. She is a member of the American Health Information Management Association, American Academy of Professional Coders, Society of Professional Journalists, Association of Health Care Journalists and the American Society of Journalists and Authors.

    Lisa currently resides in Cranston, Rhode Island with her wife and two-year-old twin boys.

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    Getting Started With Medicare

    Do your current medical providers accept Medicare? If not, shop for new ones.

    • Medicare Part B has a monthly premium based on income level, determined by the last reported tax filing two years before from the IRS.
    • Original Medicare works like TRICARE Select or preferred provider organizations : You can choose any providers, specialists included, if they accept Medicare.

    Where Can I Find More Information About Tricare For Life

    Do I Need a Referral to See a Specialist With Medicare ...

    Call 866-773-0404 or visit their website here. Be sure to click on and download the TRICARE for Life Handbook on the right side of the page for more detailed information. Also click on and download the TRICARE for Life Cost Matrix for additional details about costs you may incur for specific services.

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    I Want To Delay Part B

    If you qualify and decide you want to delay enrolling in Medicare Part B, you should not face any late enrollment penalties for Part B. When you lose your employer coverage, you will get an 8-month Special Enrollment Period during which to enroll in Medicare Part B, and Part A if you havent done so already.

    Youll also be able to enroll in a Medicare Advantage plan or Part D prescription drug plan in the first two months of this period. Note: if you enroll in Part C or Part D after the first two months of your Special Enrollment Period, you may face late enrollment penalties for Part D. Youll want to also ensure you provide proof of creditable coverage when you enroll in Part D.

    You do not need to notify Medicare that you will be delaying Part B unless you are already receiving Social Security or Railroad Retirement Board benefits.

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