The National Defense Authorization Act for fiscal year 2001 expanded TRICARE benefits for eligible beneficiaries who are age 65 and over and enrolled in Medicare Part B. If you are not already enrolled in Medicare Part B, the open season for enrollment is Jan. 1 to March 31 each year.
Benefits for TRICARE for Life became effective October 1, 2001. Under TRICARE for Life, TRICARE becomes the second payer to Medicare for medical care that is a benefit under both Medicare and TRICARE. Medicare Part B covers doctors' services, outpatient hospital care, blood, medical equipment and some home health services. It pays for other medical services such as laboratory tests, physical and occupational therapy, and some preventive health care, such as mammograms and flu shots. Medicare will pay the allowable amount for the care, and TRICARE will pay the amount that is the Medicare cost share, as well as the Medicare deductible. Eligible beneficiaries who have Medicare Part B may keep their current Medicare provider and use TRICARE to pay cost shares and deductibles not covered by Medicare.
When a benefit is covered only by Medicare (for example, chiropractic care), you may be responsible for any remaining costs after Medicare has paid the provider. When a benefit is covered only by TRICARE (for example, prescriptions), you may be responsible for only the TRICARE cost-shares and deductibles.
During any period when beneficiaries are without Medicare Part B coverage, they lose all eligibility for TRICARE benefits, except for those who turned age 65 before April 1, 2001 and qualify for the Senior Pharmacy benefit. However, beneficiaries will remain eligible for care in military treatment facilities on a space-available basis. Medicare does not cover health service delivered outside the United States. However, to use TRICARE, all eligible beneficiaries, including those who reside or travel overseas, must be enrolled in Medicare Part B. TRICARE will be their only payer for care, and beneficiaries will have the same co-payments as all other TRICARE retired beneficiaries.
Medicare Costs and Enrollment
For 2001, the Medicare Part B premium is $50 per month. Once beneficiaries enroll, their coverage begins on July 1. Beneficiaries who declined to enroll in Medicare Part B when they first became eligible (at the time of Medicare Part A eligibility) may enroll only during the general enrollment period. They may also face a penalty and pay more than the $50 premium should they decide to enroll now or in the future.
The Social Security Administration allows beneficiaries age 65 and over to delay their Part B enrollment under certain circumstances without having to pay higher premiums. You can delay your Part B enrollment if you are either age 65 or older and have group health insurance based on your own or your spouse's current employment. You may also delay your Part B enrollment if you are disabled and have group health insurance based on your own or other family member's current employment. These beneficiaries are extended a "special enrollment period," and have the option of enrolling anytime as long as they are still covered by an employer or union group plan based on current employment status. They may also delay enrollment for up to eight months after the month that group health coverage or employment ends (whichever is first).
Without Medicare Part B coverage, beneficiaries in this category are no longer eligible for the TRICARE program except the pharmacy benefit.
For additional information on Medicare enrollment, beneficiaries can contact the Social Security Administration (SSA), toll-free at 1-800-772-1213, TTY/TDD: 1-800-325-0778 for the hearing and speech impaired. Additional information is also available on the Medicare Web site.
Update DEERS Information
To ensure eligibility for TRICARE benefits, beneficiaries 65 and older must have their current address on file with the Defense Enrollment Eligibility Reporting System (DEERS). Update change of addresses on the TRICARE Web site.Beneficiaries can also update their DEERS address by:
- Visiting the nearest military personnel office that has an ID card facility.
- Calling the Defense Manpower Data Center Support Office (DSO) telephone center at 1-800-538-9552.
- Mailing the address change to DSO, Attn: COA, 400 Gigling Road, Seaside, CA 93955-6771.
- Faxing your change of address to DSO, Attn: COA at 831-655-8317.
- Sending an e-mail message to . Messages sent should be lower case only and include: the sponsor's name, social security number and telephone number, name(s) of family members affected by the address change, and the start date for the change.
Senior Pharmacy Program
On April 1, 2001, military retirees, their family members and survivors of any age, including those over 65, gained access to prescriptions drugs at military treatment facilities, network and non-network civilian pharmacies and the National Mail Order Pharmacy. You must be enrolled in DEERS to use the Senior Pharmacy Program, but there is no enrollment fee for the pharmacy program.
Military beneficiaries who were age 65 before April 1, 2001, automatically qualify for the pharmacy benefit whether or not they have purchased Medicare Part B.
Military beneficiaries who turn 65 after April 1, 2001 must be enrolled in Medicare Part B. (Open enrollment for Medicare Part B is Jan. 1 through March. 31, each year.)
Military Treatment Facilities:
Present your prescription to the pharmacist and follow procedures established by the MTF.
Prescriptions by Mail:
Mail your health care provider's written prescription and payment and receive a 90-day supply of you medication. Register with the National Mail Order Pharmacy by calling 1-800-903-4680. Prescriptions are $3 for a 90-day supply of generic medications, or $9 for a 90-day supply of brand name medications. Credit card payments are accepted.
TRICARE Network Pharmacies:
These are pharmacies that have contracted with TRICARE to serve military beneficiaries. For a list, contact the TRICARE Service Center, 1-800-444-5445 or visit. You can receive up to a 30-day supply at one time. You pay $3 for a 30-day supply of generic drugs or $9 for brand name drugs.
Eligible beneficiaries can be reimbursed 80% of the full retail price after meeting the TRICARE annual deductible ($150 per person/$300 per family). You must pay full retail price than file a CHAMPUS Claim.
The Delta/Select Retiree Dental program is a new dental program available to retirees of all ages, both under and over 65 and their spouses. The program is low-cost, and covers diagnostic and preventive procedures. To enroll, call 1-888-838-8737. Credit cards are accepted. (Learn more about the TRICARE Retiree Dental Program on our site and at the TRICARE Dental web site.
SOURCES OF INFORMATION
Fore more information on Medicare Benefits, call 1-800-MEDICARE (1-800-633-4227) or check on the Internet.
For more information on the Senior Pharmacy benefit, call 1-877-DoD-MEDS (1-877-363-6337), or visit the TRICARE web site.
For more information on TRICARE for Life, visit the web site..
For more information or assistance, visit the TRICARE Service Center, building 36023, across from Darnall Army Medical Center's front parking lot, or call 254-288-8155 or 1-800-444-5445.
page last modified on: 5/7/2013