How TRICARE Changes When a Uniformed Services Member Retires
When an active duty sponsor retires from military service, he/she must re-enroll in TRICARE Prime by the 20th of the month of their last month of active duty, to be effective the first day of the next month as a retiree. This will allow TRICARE Prime benefits to continue without a break in coverage, if they wish to continue in TRICARE Prime. Retired service members and their family members may choose from the following options:
|Retired Service Member And Family Members|
|TRICARE Prime Remote (TPR)||
TRICARE Standard and TRICARE Extra
|Catastrophic Cap*||$3,000 per fiscal year|
|TRICARE for Life||Must be enrolled to premium-free Medicare Part A and have Medicare part B.Â No enrollment costs.|
* The catastrophic cap is the maximum out-of-pocket expenses per fiscal year. Only allowable charges for covered services apply toward the catastrophic cap.
**Rates are current for FY 2005; rates change every fiscal year.
Retirees may pay their TRICARE Prime enrollment fees through a monthly allotment only from their Service retirement pay.
Retired beneficiaries may visit their regional contractor's Web site or call them for information on Prime enrollment and fee payment options.
Use of Military Treatment Facilities (MTFs)
Retirees and their families who do not enroll in TRICARE Prime may continue to use MTFs on a space available basis. A priority system has been established for access to health care at MTFs:
1. Active duty service members
2. Active duty family members who are enrolled in TRICARE Prime
3. Retirees, their family members and survivors enrolled in TRICARE Prime
4. Active duty family members who are NOT enrolled in TRICARE
Prime (for the purpose of determining access priority, survivors of military sponsors who died on active duty who are NOT enrolled in TRICARE Prime are in this priority group)
5. All other eligible persons, including retirees and their families who are NOT enrolled in TRICARE Prime
TRICARE Plus is an MTF primary care enrollment program offered at some MTFs. All beneficiaries eligible for care in MTFs [except those enrolled in TRICARE Prime, a civilian health maintenance organization (HMO) or Medicare HMO] may enroll in TRICARE Plus at an MTF if enrollment capacity exists.
Becoming Entitled to Medicare
Medicare entitlement based on age usually begins on the first day of the month in which the beneficiary turns 65. If the 65th birthday falls on the first day of the month, Medicare Part A eligibility begins on the first day of the preceding month. If the Medicare beneficiary purchases Medicare Part B, he or she will remain eligible for TRICARE through a program known as TRICARE for Life (TFL). TRICARE acts as a second payer to Medicare for services covered by both Medicare and TRICARE. When a retired sponsor reaches age 65 and becomes eligible for TFL, his or her spouse remains eligible for TRICARE Prime or Standard until he or she (spouse) becomes entitled to Medicare Part A and B. At that time the spouse becomes entitled to TFL.
Persons under age 65 who become entitled to Medicare Part A and Part B because of a disability or End Stage Renal Disease (ESRD), maintain their eligibility for TRICARE Prime and become eligible for TFL. By law, TRICARE pays after Medicare for these dual-eligible persons. Beneficiaries who become eligible for Medicare due to a disability or ESRD should purchase Part B when notified they are Medicare eligible and present their Medicare card to the nearest Uniformed Services ID card-issuing facility on or after the date of eligibility.
Survivors of Retirees
Upon a retiree’s death, the surviving spouse remains eligible for TRICARE benefits at the retiree rate, unless he or she loses TRICARE eligibility through remarriage or failure to enroll in Medicare Part B when entitled to Medicare. The retiree’s surviving children remain eligible for TRICARE benefits until the age of 21 or, if the child is a full time student, he or she will remain eligible until the age of 23. For those beneficiaries who have aged out of TRICARE, please review the TRICARE Young Adult fact sheet below. Â If the surviving child is incapable of self support because of mental or physical incapacity, the child does not lose eligibility for TRICARE benefits at the age of 21 or 23.
For more information, beneficiaries may contact the Nurse Consultant or they may visit the TRICARE Web site at www.tricare.mil.