MOAA Answers Your Health Care Transition Questions

MOAA Answers Your Health Care Transition Questions
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More than 2,800 MOAA members registered for an April 17 webinar where MOAA experts helped navigate retirees through two health care transitions – from military service to retirement, and from TRICARE to Medicare and TRICARE for Life.

MOAA regularly hosts webinars as a way to empower its members, as well as the broader military audience. You can watch the health care webinar here, or search past webinars here.

MOAA Life and Premium members have access to financial and benefits experts Capt. Paul Frost, USN (Ret), and Lt. Col. Shane Ostrom, USAF (Ret), who presented the webinar; they can email beninfo@moaa.org with any questions. To become a MOAA member, join here.

After the webinar, Frost and Ostrom compiled answers to six frequently asked questions on the topic:

Q. I’m the retiree and I’m older than my spouse. When I turn 65, does my spouse remain in TRICARE, or must he/she follow me into Medicare/TRICARE for Life?

A.
The spouse remains in their selected TRICARE program until turning 65 him/herself. Each TRICARE eligible beneficiary ages out of TRICARE individually when he or she reaches age 65.

In order to enroll, bring your Medicare cards to the nearest ID card office to get a new ID card and activate your TRICARE for Life benefit.

Q. I plan to continue working after turning 65. I know I lose TRICARE, but can I use my company-sponsored health care plan and delay enrolling in Medicare?

A. Yes, you can delay enrolling in Medicare without penalties by enrolling in employer-sponsored health care plan. However, you will not have TRICARE for Life as your supplemental coverage until you enroll and begin paying for Medicare Part B. Once you stop working, you have eight months to enroll in Medicare before incurring a late penalty.

A spouse covered under the working spouse’s employer plan can also delay enrolling in Medicare during employment. 

Q. How is my Medicare Part B premium computed, and what is IRMAA?

A. Medicare Part B & D premiums are income-based.

IRMAA is an acronym for Medicare’s income-related monthly adjustment amount. For most Medicare beneficiaries, the government pays about 75 percent of the Part B premium, and the beneficiary pays the remaining 25 percent. If you’re a higher-income earning beneficiary, you’ll pay a larger percentage of the total cost of Part B based on the income you report to the IRS.

To determine whether you’ll pay higher premiums, Social Security uses your most recent federal tax return on file; this is typically the return from two years prior. The first IRMAA increase occurs when modified adjusted gross income (total adjusted gross income plus tax-exempt interest income), for those filing as “married, filing jointly,” exceeds $170,000. A detailed explanation of IRMAA and premium tables can be found here (PDF).  

Military retirees do not need Medicare Part D (prescription/pharmacy coverage) because TRICARE for Life provides the same pharmacy benefit as TRICARE beneficiaries.

Q. What are the differences between the two TRICARE programs?

A. TRICARE Prime is the Health Maintenance Organization (HMO) option. It assigns you to a Primary Care Manager-facility if you live within a 40-mile radius (or out to 100 miles if you waive the distance limit). It charges an annual premium and a co-pay per visit

TRICARE Select is the Preferred Provider Organization (PPO) option. It allows you to select your own doctor, hospital, or clinic as long as the provider accepts TRICARE Select. There is no annual premium, but there is an annual deductible and co-pays. In 2021, an annual premium will be added on top of the current charges.

Both plans limit your total out-of-pocket costs with a catastrophic cap of $3,000. Learn more about the plans at www.Tricare.mil.


Q. How does TRICARE cover my children?

A.
Dependent children are covered under your program until they age out at 21, or at 23 if they are enrolled in higher education.

The TRICARE Young Adult plan allows you to cover children under TRICARE until age 26. The child must be single. TRICARE Young Adult is not subsidized by DoD, so the price can be an issue. Find more information here.

In addition to TRICARE Young Adult, college my offer student health plans. Check here for other options.

Q. Can I change my TRICARE plan after I enroll?

A. You will enroll in a Tricare plan during your retirement processing.  Should you want to change plans in the future, you must wait for the Tricare Open Season that occurs in November and December every year. There are some exceptions to the Open Season window called Qualifying Life Events. These are major life events that cause you to modify your plan or when you lose your private/employer health plan.

(NOTE: Have TRICARE Pharmacy Program questions? Experts from TRICARE will tackle questions on filling prescriptions, pharmacy services, and costs during a webinar on April 25 at 1 p.m. Eastern. Register here.)  

Amanda Dolasinski is MOAA’s staff writer. You can reach her at amandad@moaa.org. Follow her on Twitter @AmandaMOAA.

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