Medicare or Tricare? Which Do You Need?

If you or your family is or has been an active-duty member of the military close to retirement, you may have been hearing about the need to switch from Tricare to Medicare for your health coverage.  

There are plenty of terms and definitions that can make this issue confusing, and you want to be sure you don’t have a lapse in healthcare coverage and end up paying unnecessary costs and fees.  

Thus, it pays to educate yourself on all things Tricare, Medicare, and Tricare for Life, so you make sure all your bases are covered.  

Medicare or Tricare? Which Do You Need? 1

What Is Tricare?  

Tricare is the healthcare coverage for active-duty members of the military, military retirees, and some of their family members.  

In general, Tricare is coverage for those under the age of 65, at which point coverage will shift to a Medicare version of Tricare called Tricare for Life.  

Exception 

The exception to this rule applies to any active-duty military above the age of 65. Basically, if you have reached “retirement age,” but have not retired yet, you are still covered by Tricare.  

This exception applies to both the active-duty military member and their spouse all the way up until the time of retirement.  

Tricare is essentially in place for all active-duty military and their spouses until retirement and for all retired military and their spouses until the age of 65.  

Tricare provides exceptional coverage and will do so for life, but you will have to file additional paperwork once you either retire or turn 65, depending on your circumstances.  

veteran child medicare

How to Keep Tricare 

To keep the Tricare benefits you earned as a member of the military, all you have to do is sign up for Medicare Part A and Medicare Part B before you turn 65 or, if you retire after 65, upon retiring.  

This applies to whether you are active duty military at 65 or working elsewhere at 65 and have health coverage from your current employer.  

You don’t need to sign up for Medicare benefits until you are 65 and retired.  

But your Tricare benefits will expire once you turn 65, so if you are insured through another employer, and have been using your Tricare benefits to supplement your coverage, those benefits will no longer be in effect until you sign up for Medicare Part A and Part B.  

So, it may behoove you to go ahead and sign up for Medicare Part A and Part B even if you are still employed and insured. Just to cover all bases.  

veteran american flag medicare

What Happens to Tricare When You Sign Up for Medicare?  

Now, once you sign up for Medicare Part A and Part B, your Tricare benefits will shift to Tricare for Life benefits, and you will be covered by both Medicare and Tricare.  

Medicare will cover your medical expenses first, as your primary coverage, and then anything not covered by Medicare will be supplemented by Tricare.  

Thus, while many people on Medicare must enroll in supplemental insurance, called Medigap, to cover out-of-pocket expenses, retired members of the military will already have Tricare for Life for this purpose and are unlikely to need that supplemental insurance.  

Another effect of having both is that some healthcare services are not covered by one but are covered by the other.  

For example, most chiropractic care is not covered by Tricare, but Medicare covers it. You will still have Medicare coverage for this service, though you will have to pay out of pocket whichever portion is not covered by Medicare.  

On the opposite side, if you need care that is covered by Tricare but not Medicare, like out-of-country healthcare, only Tricare will cover this service, and you will have to pay whatever deductibles and copays come up.  

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What About My Spouse?  

All coverage offered to members of the military is extended also to the spouse of that member.  

It is critical to understand, however, that the policies are individual policies; it is not a family policy.  

So each spouse, both the member of the military and the spouse, must file their own Medicare Part A and Part B forms in order to ensure full coverage from both Medicare and Tricare for Life at the appropriate time.  

Thus, if the spouse turns 65 before the retired member of the military, he or she must file the Medicare Part A and Part B forms in order to receive Tricare for Life and avoid gaps in coverage.  

medicare part d veterans

What About Prescriptions?  

Both Tricare and Tricare for Life cover prescriptions, so you do not have to worry about filing Medicare Part D to get prescription coverage, either for you or for your spouse.  

medicare enrollment veterans

You Must Pay Premiums 

Do be mindful that in order to receive your Tricare for LIfe insurance, you will have to pay the premiums for Medicare Part B, currently $164.90 per person in 2023.  

If you qualify as low-income, you may qualify for a Medicare Savings Program, which can help pay your premiums, deductibles, and copayments.  

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Contact Coverage 2 Care Today 

If you have any questions or concerns about any of this information or about your insurance coverage in general, please contact Coverage 2 Care today.

One of our licensed specialists will help you make sure you are fully covered and fully informed of your coverage.  We are here to help.

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