TRICARE is a regionally-managed health care program serving active duty and retired members of the uniformed services, as well as their families, and survivors. TRICARE brings together the health care resources of the uniformed services and civilian health care professionals to provide better access and high quality health care service.
For service members who are entitled to Medicare Part A and B, TRICARE provides Medicare “wrap-around” coverage. Medicare is the primary payer for these beneficiaries. TRICARE serves as a supplement, paying the Medicare deductible and patient cost share.
The law requires TRICARE beneficiaries who are entitled to Medicare Part A based upon age, disability, or End Stage Renal Disease (ESRD) to enroll in Medicare Part B to retain their TRICARE benefits. Beneficiaries lose TRICARE coverage for any period in which they could have been covered by Medicare Part B, but chose not to enroll.
Yes. The National Defense Authorization Act for Fiscal Year 2010 changed the law for individuals determined to be eligible in October 2009 or later for retroactive disability or ESRD benefits. Those individuals do not have to enroll in retroactive Medicare Part B to retain TRICARE.
Individuals awarded retroactive disability insurance benefits may also become entitled to Medicare Part A for months before they receive the disability award notice. Generally, disabled individuals are entitled to Part A and eligible to enroll in Part B effective with the 25th month of disability benefits. Individuals who receive a letter that disability benefits are retroactive for 25 months or more in the past would be retroactively entitled to Part A and eligible to enroll in Part B.
Before the change in the law, all TRICARE beneficiaries awarded retroactive disability benefits or ESRD Medicare had to enroll in Part B for any month in the past for which they were entitled to Part A in order to keep their TRICARE coverage. This meant paying Part B premiums for that entire prior period. If they refused enrollment in Part B, they were ineligible for TRICARE coverage and had to repay any TRICARE payments for claims paid during those months.Because of the change in the law, effective October 2009, TRICARE beneficiaries awarded retroactive disability benefits or ESRD Medicare do not have to enroll in Part B for those months in the past and can keep their TRICARE coverage as long as they enroll in Part B prospectively.
Yes. The Affordable Care Act, as amended by the Medicare and Medicaid Extenders Act of 2010, makes an important change regarding enrollment in Medicare Part B for TRICARE beneficiaries. This change, effective March 28, 2010, affords TRICARE beneficiaries who are entitled to Medicare Part A due to disability or ESRD, and who previously declined Medicare Part B during their initial enrollment period (IEP), the option to enroll in Medicare Part B during a special enrollment period (SEP). These individuals will not have to pay the 10 percent per year premium surcharge for late enrollment in Part B.
As noted above, individuals awarded disability benefits are usually entitled to Medicare Part A, and eligible to enroll in Part B, beginning with the 25th month of disability benefits. The IEP is the 7-month period that begins 3 months before, and ends 3 months after, the 25th month of disability benefits.
Under the new law, disabled TRICARE beneficiaries who declined to enroll in Part B during their IEP can enroll during the new SEP. The SEP is the 12-month period following:
- the last day of their IEP, or if later,
- the month of notification of eligibility for Part B.
Their Part B coverage will be effective the first day of the month during which they enrolled, or at their option, the first month after the end of the IEP. If they elect to enroll in Part B for prior months, they must pay the retroactive Part B premiums for those months. But because of this change in the law, they will not have to pay the monthly premium surcharges usually required of beneficiaries who did not enroll during their IEP.
Yes. The Affordable Care Act tasked the Department of Defense with coordinating with the Department of Health and Human Services and Social Security Administration to identify and notify individuals affected by the change in the law. Our agencies are currently working together to identify all affected individuals.
As additional information becomes available, we will post it to this site.