Turning 65 with USFHP

How do I confirm that I am a Non- Grandfathered Member of the US Family Health Plan?

Please call Member Services at 888-674-8734 to determine if you are a Non-Grandfathered Member of the US Family Health Plan.

How is my prescription coverage handled when I transition to TRICARE for Life (TFL)?

a. A retail network pharmacy may be used to fill prescriptions (30-day supply or first-time fill).

b. Mail-Order Pharmacy (Express Scripts) is used for maintenance medications.

c. Contact Express Scripts to get established in their system. Once established, ask your provider to send your maintenance prescriptions to Express Scripts.

d. Wait until at least the first week of your birthday month to contact Express Scripts, as eligibility may not show until files sync between Medicare and Express Scripts.

e. Your copays for prescriptions will remain the same as you currently pay because all TRICARE beneficiaries pay the same copays.

When I transition to TFL, can I continue my vision and dental coverage through Benefeds?

Turning 65 does not impact your current coverage with BENEFEDS/FEDVIP programs.

When do I need to sign up for Medicare Part B?

Medicare’s initial enrollment period allows you to sign up for your Medicare Part B three months prior to your birthday month. If you use this 90-day enrollment window, it will ensure that Medicare Part B and, therefore, TFL eligibility will be in place the first day of your birthday month. This also allows time for you to update your military ID card.

Is Medicare Part B required for TRICARE for Life?

Yes. Medicare Parts A and B are mandatory in order to have TRICARE for Life; therefore, it is best to obtain your Medicare Parts A and B in a timely fashion to be effective on the first day of your birthday month.

Do I need to update my military ID card and when should I do this?

Yes, you will need to update your military ID card. Present your Medicare card to the DEERS operator as DEERS will reflect your immediate eligibility for TFL. We recommend that you contact your local ID facility to determine the best timing to schedule an appointment.

How do I pay my Medicare Part B premium?

If you are already drawing Social Security benefits, the premium is deducted monthly from this benefit. If you are not drawing Social Security, the Social Security office will provide you with information about your payment options. The initial payment required will be three months.

How do I know if my current US Family Health Plan network providers accept Medicare and TRICARE for Life?

If your provider accepts Medicare, then they are obligated to accept TRICARE for Life. If you have any concerns about this, you should speak with your provider’s office.

Why would I consider a Medicare Advantage plan?

There are additional benefits offered with Medicare Advantage plans that are not covered under traditional Medicare or TRICARE for Life. Many plans are available depending on your location. We suggest you reach out to a Medicare Advantage expert to explore what type of plan, if any, may work best for you.

Can I use the VA if I I’m enrolled in Medicare Part B and TFL?

You are always able to use the VA for any health care needs that you may qualify for. The VA is a separate earned benefit. For example, many service members use the VA to get their prescription medications as they may be less expensive than the TRICARE copays.

How is the coverage for my other family members affected when I turn 65?

Family members remain enrolled in their current plan until such time as their eligibility changes. If they are enrolled in the US Family Health Plan, the monthly premium will drop to a single rate.

With TRICARE for Life, what is my out- of-country coverage?

Medicare does not cover out-of-country services. However, your TRICARE coverage would apply.

Visit https://tricare.mil/Plans/HealthPlans/TFL and navigate to “Does TRICARE for Life work overseas?”

What steps do I need to take when transitioning to Tricare for Life?

a. Obtain your Medicare Parts A and B.

b. Update your military ID card and present your Medicare card to the ID operator.

c. Update your providers with your TRICARE for Life information. Present your Medicare card and your military ID card when seeking medical care.

How do I confirm that I am a Grandfathered Member of the US Family Health Plan?

Please call Member Services at 888-674-8734 to determine if you are a Grandfathered Member of the US Family Health Plan.

How is my coverage affected if I move out of state?

If you move to another state that offers the US Family Health Plan, you will not lose your Grandfathered status. You will want to “port” your coverage to the new service area. If you move outside the US Family Health Plan service area, you can explore your new options under the Regional Contractor and decide on the best coverage available for you and your eligible family members. If you move outside of the US Family Health Plan coverage area and decide to return in the future, you will have lost your grandfathered status and may not rejoin the US Family Health Plan.

If I stay with the US Family Health Plan, can I continue my vision and dental coverage through Benefeds?

Turning 65 does not impact your current coverage with BENEFEDS/FEDVIP programs.

Can I switch from the US Family Health Plan to TRICARE for Life (TFL) anytime?

As a Grandfathered Member of the US Family Health Plan, you may choose to disenroll at any time and use TRICARE for Life, as long as you are enrolled in Medicare Part B. If you are NOT enrolled in Medicare Part B, you will have to wait for the Medicare Annual Enrollment Period. If you are married, your spouse does not have to make the change at the same time if they have no reason to. If you choose to leave the US Family Health Plan, you may not re-enroll.

If I stay with the US Family Health Plan, do NOT enroll in Medicare Part B, and then move out of the area later, will I incur a penalty for not enrolling in Medicare Part B?

Medicare will penalize you 10% for every 12-month period you were not enrolled in Medicare Part B, from when you were first eligible. Medicare can tell you what your monthly cost will be at the time you enroll. This higher rate will be the amount you pay for the rest of your life. This is why Martin’s Point highly encourages you to enroll in Medicare Part B when you first become eligible.

If I am traveling outside the area, what services am I covered for?

As a Grandfathered Member of the US Family Health Plan, you are covered for urgent and emergency care anywhere in the world. For any other non-urgent or emergent services, the point of service benefit will apply.

Do I need a new military ID when I turn 65?

Yes. Please plan to bring your new Medicare card with you when you renew your military ID card and show it to the DEERS operator who will make sure it is reflected in DEERS.

Am I required to enroll in Medicare Part B if I stay with the US Family Health Plan?

If you are continuing your membership with the US Family Health Plan, you are not required to enroll in Medicare Part B. However, we strongly recommend you consider enrolling in Medicare Part B as soon as you are eligible for the following reasons:

• Delay in accessing Medicare Part B and TRICARE benefits: If you ever disenroll from the US Family Health Plan, you will not be able to access other TRICARE benefits until you are enrolled in Medicare Part B. You will only be able to enroll in Medicare Part B during the General Enrollment Period (January through March each year), with coverage starting on July 1 of the year you sign up. You could be left without medical insurance coverage for an extended period of time should you decide to disenroll from the US Family Health Plan at a later date.

• Penalty in Medicare Part B premiums: If you wait to enroll until after you're first eligible, your Medicare Part B premium will increase by 10% for each 12-month period that you were originally eligible to enroll.

• Limited coverage for long-term care facilities: Long- term-care facility residents are not eligible for the US Family Health Plan in most cases. Without Medicare Part B, your coverage will be limited to Medicare Part A and you will be responsible for the costs of medical services provided by physicians, labs, etc.

Will my Martin’s Point enrollment premium change if I decide to stay with the US Family Health Plan?

If you are a Grandfathered Member of the US Family Health Plan and you enroll in Medicare Part B, you will need to send us a copy of your Medicare card. Your monthly premium will go to $0 per month and all copays for medical services will become $0 (in network). The only copays you will have will be for prescription drugs. If you have a spouse or other eligible family members enrolled, their monthly premium will go to a single rate, and they will continue to have copays.

Can I use the VA if I stay enrolled with the US Family Health Plan?

You are always able to use the VA for any health care needs that you may qualify for. The VA is a separate earned benefit. For example, many service members use the VA to get their prescription medications as they may be less expensive than the TRICARE copays. You will need to retain a civilian Primary Care Provider in our network.

If I disenroll from the US Family Health Plan now, can I reenroll in the future?

If you choose to disenroll from the US Family Health Plan for any reason, you will not be able to re-enroll in the US Family Health Plan.