(TRICARE) TFL CRITERIA

TRICARE FOR LIFE REQUIRES THAT YOU MEET FIVE CRITERIA
By James E. Hamby Jr., Special to Navy Times, 2 May 2005 Issue
Forwarded by YNCS Don Harribine, USN (Ret.)

Q. In June, I will turn 65 and get Tricare for Life. My wife won't be 65 until November. Will she get Tricare for Life when I do, or does she have to wait until she is 65?

A. Your wife will not become entitled to Tricare for Life until she becomes entitled to Medicare at age 65.Tricare for Life entitlement is established by the law that created the program in 2001. To be entitled to Tricare for Life, each person must be all of the following:
(1) Legally eligible otherwise for Tricare;
(2) At least 65 years old;
(3) Entitled to Medicare;
(4) Enrolled in both Part A and Part B of Medicare; and
(5) Properly registered in the Defense Enrollment Eligibility Reporting System (DEERS) data base.

If a Tricare beneficiary is properly registered in DEERS and is enrolled in Part B of Medicare, the transition from “ordinary” Tricare eligibility to Tricare for Life entitlement is automatic and seamless one second past midnight on the last day of the month preceding the month of that person's 65th birthday. The beneficiary does not have to do anything to make it happen. This is true regardless of whether the beneficiary becomes entitled to Social Security payments at that time.

A beneficiary does not have to be entitled to Social Security payments to get Medicare at age 65. Medicare entitlement begins on the first day of the month of the person's 65th birthday, even if his Social Security payment entitlement will not start until later. Certain people become entitled to Medicare before they are 65 because of disability or kidney disease. They are called “dual eligible” if they are enrolled in Part B of Medicare. Their claims are processed and paid in exactly the same way as those of Tricare for Life beneficiaries. However, they are not Tricare for Life beneficiaries.

That's because the condition creating Medicare entitlement may not be permanent. If the condition improves enough, Medicare will terminate their entitlement. Then, they will no longer have dual eligibility. They will revert to their previous Tricare eligibility status. Medicare entitlement upon reaching age 65, and the resulting Tricare for Life entitlement, is permanent - lifelong. It requires only that the beneficiary's DEERS record and Part B enrollment be properly maintained.

There is a final caveat, of course: Divorce, or remarriage if widowed, will unfavorably affect the non-military member's entitlement in most cases.

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