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Medicare and the military: understanding your coverage

By The Health News Team | December 6, 2019
Medicare and the military: understanding your coverage

There are over 100,000 active-duty service members in San Diego, and more than 240,000 veterans. That adds up to the largest concentration of military personnel in the nation.

As many of these individuals and their spouses near age 65, they are facing choices about their health care coverage. Many are looking for clarity in the intersecting seas of Medicare and what is offered to them by the military.

To help you understand coverage paths and options, we've broken down a few key points:

  1. Medicare-eligible military members can face penalties for late enrollment, and their enrollment in Medicare isn't automatic.
    For many who become Medicare eligible at age 65, the threat of late enrollment penalties can be intimidating. Active military and spouses are subject to this same penalty risk. Like civilians who are still covered by insurance from an employer or a spouse's employer, active military and family have the option to delay enrollment in Medicare Part B. But before their active-duty health plan ends, they must enroll in both Parts A and B to make sure they're covered.

  2. There's a difference between Tricare and Tricare For Life.
    Tricare is the health care program for the U.S. military and their families. Tricare For Life is Medicare wraparound coverage for Tricare beneficiaries who have Medicare Part A and Part B. In simpler terms, Tricare For Life is a way for Medicare-enrolled Tricare members to continue their coverage. When it comes to coverage, Medicare is charged first for Medicare-covered services. Then, for deductibles and coinsurance, Tricare For Life benefits are applied. Some services not covered by Medicare are also picked up by Tricare For Life.

    A big advantage of Tricare For Life is that it eliminates the need for most Medicare supplements. While civilians may need gap coverage for things like prescriptions, most standard expenses are covered by Part A, Part B and Tricare For Life. However, every situation is different, and some military members may need or want to sign up for extras.

  3. Veterans Affairs (VA) health coverage can be paired with Medicare supplements.
    Some military members choose VA health coverage over Tricare. While Tricare is more comprehensive and offers more choice, VA coverage does have compatibility with private plans. The trick is being eligible, as the government has strict criteria on who can apply, such as length of service.

    If you have VA coverage and would like to continue your plan into retirement, know that your insurance will continue to cover a large portion of your care. For services outside the VA umbrella, you will need additional Medicare coverage. For many, a Medicare Advantage plan that includes prescription drug benefits can offer the extended coverage you need.

    While the VA does cover many prescriptions at a low cost, private prescription drug coverage can close the gap and ensure you're not forced to pay high drug prices.

  4. Insurance is confusing, but there's help if you need it.
    Medicare is not always easy to understand. Add military exceptions and options, and the water may seem even murkier. At Sharp, we understand the importance of getting your questions answered so you can choose the coverage best for you. That's why we offer help with Medicare through in-person classes, online resources and expert advice over the phone.

    You can also contact military offices directly. For VA benefits, visit the U.S. Department of Veterans Affairs. For Tricare or Tricare For Life questions, visit their contact page.

Still have questions about Medicare?
Sharp hosts free online seminars, where you'll learn more about enrollment periods and how Medicare works. Sign up for the "Understanding How Medicare Works" seminar or the "Understanding Your Medicare Open Enrollment Options" seminar.

These classes are also available in Spanish. Please visit Entienda Cómo Funciona Medicare and Entienda Sus Opciones de Medicare Durante la Inscripción Abierta for more information.

This story was updated February 4, 2021.

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