How TRICARE changes when a uniformed services member retires

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Subject: How TRICARE changes when a uniformed services member retires

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How TRICARE changes when a uniformed services member retires

August 25, 2005


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:


TRICARE Prime

Enrollment fees apply - $230 for individuals, $460 for families; Outpatient care -$12 per visit; Inpatient care - $11 per day, $25 minimum; Inpatient mental health - $40 per day and Emergency care - $30 per visit. TRICARE Prime Remote (TPR)

- Not eligible. TRICARE Extra

Annual outpatient deductible-$150 for individuals, $300 for families; Inpatient care-$250 per day** or 25 percent of hospital's negotiated charges, whichever is less, plus 20 percent of negotiable professional fees; Outpatient care-20 percent of the negotiated fee and Inpatient mental health-20 percent of the negotiable fees.

TRICARE Standard

* Annual outpatient deductible-$150 for individuals, $300 for families; Inpatient care-$512 per day** or 25 percent of hospital's billed charges, whichever is less, plus 25 percent of allowed professional charges; Outpatient care-25 percent of allowed charges; Inpatient mental health-lesser of $169 per day* or 25 percent of allowable fees and the Catastrophic Cap* is $3,000 per fiscal year. Entitled to Medicare [based on age, disability or end-stage renal disease (ESRD)] Retired service members and their family members must enroll in Medicare Part B to remain eligible for TRICARE.

* 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. Enrollment fees and allotments Retirees may pay their TRICARE Prime enrollment fees through a monthly allotment only from their Service retirement pay.

This retirement pay allotment may be deducted from one of the following pay agencies: Defense Financial Accounting System (DFAS), U. S. Coast Guard or U. S. Public Health Service. To start an allotment, a retired beneficiary must: Fill out an Enrollment Fee Allotment Authorization Letter, which is used to stop, start or change monthly allotment payments from a retirees pay account.

Send the letter to the regional contractor (North, South or West) along with an initial quarterly payment. Beneficiaries will not need to send a quarterly payment when transferring from one region to another once the allotment process has already been set up.

After the contractor receives the allotment authorization letter and initial quarterly payment, the contractor forwards a payment request to the designated pay agency. The pay agency sets up a monthly payment to the regional contractor on the retiree's behalf. Retired beneficiaries may visit their regional contractor's Web site or call them for information on Prime enrollment and fee payment options.

Beneficiaries who receive survivor benefits from either retired or active duty sponsors are paid through a separate pay account and may not set up an enrollment fee allotment. 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: Active duty service members; active duty family members who are enrolled in TRICARE Prime; retirees, their family members and survivors enrolled in TRICARE Prime; 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); finally 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 looses 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 more information on TRICARE college student benefits, beneficiaries may view the College Students and TRICARE fact sheet. 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 a local health benefits advisor, beneficiary counseling and assistance coordinator, TRICARE service center or they may visit the TRICARE Web site at visittricare's site.