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Veteran's wife asks about TRICARE for Life (TFL) coverage

February 19, 2013

Sgt. Shaft

Dear Sgt. Shaft:

Once a person turns 65, their TRICARE Prime or Standard coverage stops by law as TRICARE Prime and Standard have to stop after age 64. That means to continue TRICARE coverage, a person has to enroll in TRICARE for Life (TFL). TFL is a partnership between Medicare and TRICARE with Medicare acting as the primary payer and TRICARE acting as a Medicare Supplement. There is no need for a Medicare Supplement policy if a person has TFL. Before TFL, there was just Medicare at age 65 and beyond as TRICARE coverage stopped for all after that.

My husband is approaching his 65th birthday and with being priority “1” in the VA Heath Care System, I am wondering what your take is on Medicare B? The cost is six times more than TRICARE Prime, which I only paid for him since 2007, but he really seeks most of his health care at the VA hospital. He sometimes sees a private hematologist and heart doctor, but I am speaking with the VA regarding treating these conditions.

I know if there is an emergency, I can take him to our local hospital since Bay Pines VA Medical Center is two hours away. I can just call VA within 72 hours, and they will ask if I would transfer him.

I will turn 65 next year and must pay for Medicare again six times more than TRICARE Prime. It hardly seems fair they would do this to us at an age when I am his sole non-compensated caregiver and only get $300 from Social Security retirement. It is low because I have not been able to work as I was caring for my husband since 1969 and became ill myself.

I have been assisting my husband in his effort to increase his VA compensation for his service-connected disabilities.

I keep up with your columns whenever I can and value your advice.

Genevieve R.
Via the Internet

Dear Genevieve:

TRICARE is the health-care program for service members, retirees and their families. TFL requires enrollment in Medicare Parts A and B — only those two parts. They do not recommend TFL-eligible persons enrolling in Medicare Part D pharmacy coverage as TRICARE pharmacy coverage continues after age 64 for all TFL members.

For vets who are VA health-care eligible, they have the choice to enroll in TFL and have dual coverage with VA health care or just VA health care. Without the TFL, they will also do without the Tricare pharmacy coverage.

Consider these issues if you go VA health care alone. Are you sure that VA health care is all you’ll ever need in the future? Are you confident with the VA’s level of service and availability? A spouse would need to check for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) eligibility. Should you choose not to enroll in Medicare/TFL at age 65 and should you ever change your mind, you’ll pay a penalty to get into Medicare/TFL at a later date. The penalty being 10 percent additional monthly premium for each full-year enrollment is delayed.

Shaft notes

• Sen. Patty Murray, Washington Democrat, and Sen. Jon Tester, Montana Democrat, have introduced legislation to adjust current eligibility requirements for children who receive health care under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). Under the Patient Protection and Affordable Care Act, a child may stay on a parent’s health insurance plan to age 26. However, children who are CHAMPVA beneficiaries lose their eligibility for coverage at age 23, if not before. The legislation introduced recently by Ms. Murray and Mr. Tester would raise the maximum age for CHAMPVA eligibility to age 26 to bring eligibility under the VA program into parity with the private sector.

“As more and more service members return home from Afghanistan, CHAMPVA will continue playing a vital role in caring for veterans’ loved ones,” Ms. Murray said. “In our ongoing commitment to keep the faith with our nation’s heroes, this bill ensures CHAMPVA recipients — without regard to their type of coverage, student status or marital status — are eligible for health care coverage under their parent’s plan in the same way as their peers.”

“Allowing young folks to stay on their parents’ health insurance until they turn 26 gives them a chance to finish school or start their careers without worrying what happens if they get sick,” Mr. Tester said.”This bill makes sure that the children of our most selfless citizens have access to the same care as the rest of the country.”

Vice Admiral Norb Ryan (retired), president of the Military Officers Association of America (MOAA), said: “MOAA strongly supports VA-sponsored health coverage for eligible adult children of CHAMPVA beneficiaries. … Such coverage is mandated in law to be made available for every other qualifying adult child across the nation and only a technical adjustment to the VA statute is needed to extend it to the grown kids of our nation’s heroes who made the ultimate sacrifice for their country.”

• Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax 301/622-3330, call 202/257-5446 or email sgtshaft@bavf.org.