Haris Ashley
If you have Medicare and Tricare, Medicare is your primary insurance, and Tricare pays last after Medicare and any other health insurance. However, if you lose your Medicare coverage, Tricare becomes your primary payer. If you have Tricare for Life, Tricare becomes the second payer after Medicare. You can change your Tricare plan from Tricare Prime or Remote to Tricare Select or vice versa, and you can also change your primary care manager if you move to another Prime Service Area.
| Characteristics | Values |
|---|---|
| If you lose your other health insurance | TRICARE becomes your primary payer |
| If you have TRICARE For Life | TRICARE becomes the second payer |
| If you have any health insurance other than TRICARE | It's called "other health insurance" |
| If TRICARE gets your claim before your other health insurance processes it | TRICARE will deny it |
| If TRICARE pays first and then discovers you had other health insurance | TRICARE will take back any payments made |
| If you lose other health insurance | TRICARE becomes your primary payer |
| If you gain other health insurance | TRICARE becomes the second payer after Medicare |
| If you move to another Prime Service Area | Change your primary care manager |
| If you move to a remote area | Call your regional contractor to transfer to TRICARE Prime Remote |
| If you are enrolled in the USFHP | You may have a PCM or primary care provider |
| If you are a retiree enrolling family members in different plans | You must perform a separate enrollment process for each plan |
| If you meet the criteria | You can change your plan during open enrollment or after a QLE |
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What You'll Learn
Understanding the process of changing primary insurance
However, if you lose your OHI, TRICARE becomes your primary payer. In this case, you must inform your doctors and contractors by completing and returning the necessary forms. This is a crucial step, as failure to do so may result in TRICARE denying your claims. It's important to note that gaining or losing OHI is considered a Qualifying Life Event (QLE), which allows you to make changes to your TRICARE coverage.
Changing your TRICARE coverage typically involves selecting a plan that suits your needs and the region in which you reside. TRICARE offers various plans, such as TRICARE Select, TRICARE Prime, and TRICARE Prime Remote. The process of changing your plan may vary depending on your specific circumstances and eligibility. For example, if you are enrolling family members, you may need to perform a separate enrollment process for each plan. Additionally, beneficiaries changing to a TRICARE Prime or Remote plan must choose a Primary Care Manager (PCM), while those changing to a Select plan do not.
It's important to keep your address information up to date during the process of changing your primary insurance. This is because TRICARE plans are often specific to certain regions, and your address must be accurate and in the same region as your enrollment. Verifying your address is typically part of the process of changing your medical plan. Additionally, if you move to another Prime Service Area or a remote area, you will need to change your PCM or transfer your enrollment to TRICARE Prime Remote.
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Knowing the difference between Medicare and Tricare
Medicare and Tricare are both health insurance programmes, but they cater to different groups. Here are the key differences between the two:
Medicare
Medicare is a federal health care programme for US citizens aged 65 and older, or those under 65 with certain disabilities or end-stage renal disease. To remain eligible for Tricare, you must enrol in Medicare Part A and Part B when you turn 65. Part A is paid from payroll taxes while you are working, and your Part B premium is based on your income. You do not need Medicare Part D to keep Tricare, but if you meet certain income and resource limits, you may qualify for extra help from Medicare to pay Part D premiums.
Tricare
Tricare is a health care programme that serves uniformed service members, retirees, and their families worldwide. It is important to note that Tricare pays after all other health insurance plans, except for other federal government programs identified by the Director, Defense Health Agency. This means that if you have Medicare and Tricare, Medicare will be the primary payer in the US and its territories, and Tricare will pay its portion directly to the provider for the services it covers. However, in overseas locations, Tricare is the primary payer and you are responsible for paying Tricare's annual deductible and cost shares.
Changing Primary Insurance from Medicare to Tricare
It is not possible to change your primary insurance from Medicare to Tricare, as Medicare is always the primary payer when you have both insurances. However, you can change your Tricare plan from Tricare Prime or Remote to Tricare Select, or vice versa. To do this, you must ensure that your address is accurate and in the same region as your enrollment.
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Eligibility for Tricare Prime Remote
Tricare is a federal health insurance program for military service members and their families. Tricare Prime Remote is a managed care option available in remote areas in the U.S. and provides healthcare coverage through civilian providers for members and their families on remote assignments.
To be eligible for Tricare Prime Remote, members must live and work more than 50 miles or approximately one hour's drive time from the nearest MTF (Military Treatment Facility). Active-duty family members are eligible to enrol if they reside with their sponsor in a TPR location and the sponsor is eligible for TPR. The service member must be eligible for TPR for family members to be eligible. Guard/Reserve members are eligible for TPR if activated for more than 30 consecutive days.
Guard/Reserve family members' eligibility requires that they and the service member "reside with" one another in a TPR ZIP code. If the sponsor is deployed, the family members remain eligible unless they move. It is important to register your residence address in DEERS (Defense Enrollment Eligibility Reporting System).
You can check if you are eligible for a Tricare Prime Remote plan by entering the sponsor's current work zip code in the Sponsor Work Zip section of the website. If the zip code qualifies for Tricare Prime Remote and the family meets all other qualifying conditions, family members can be enrolled in a Tricare Prime Remote plan.
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Enrolling family members in Tricare
To enrol your family members in Tricare, you must first ensure that they are eligible for the plan based on their status and location. The beneficiary's address must be accurate and in the same region as their enrolment.
If you are enrolling family members in different plans (Prime and Select), you must perform a separate enrolment process for each plan.
To enrol your family members, follow these steps:
- Go to the "Enrol in Tricare - Select Enrolling Family Members" page.
- Select one or more family members to enrol in Tricare medical benefits.
- Click "Continue."
- Select a reason for the plan change. If it is during the open enrolment period, select the "Annual Open Season" option. If you are changing the plan due to a Qualifying Life Event (QLE), select the QLE, the effective date, and any other required information.
- Verify the addresses for each family member whose plan you want to change on the "Enrol in Tricare - Address Verification" page.
- On the "Enrol in Tricare - Select Plan" page, select a plan for the first family member listed under "Enrolling Family Member(s)."
- Click "Continue."
- If applicable, read the instructions on the "Command Sponsored for Prime Plans" page and select the "Family member is command-sponsored" checkbox.
- Click "Continue" again.
- The following pages may vary depending on the selections for each family member. If beneficiaries are changing to a Select plan, they do not need to choose a Primary Care Manager (PCM). If beneficiaries are changing to a Prime or Remote plan, they must choose a PCM.
- Verify that the information is correct on the "Enrol in Tricare - Verify Selected Plan" page.
- Click "Continue" again.
- Repeat the process for any additional family members listed.
Note that you must make any enrolment changes within 90 days following a QLE and pay any applicable enrolment fees or premiums during that period. A QLE for one family member means that all family members may make eligible enrolment changes.
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Informing doctors and contractors about the change
It is important to inform your doctors and contractors when changing your primary insurance from Medicare to Tricare. This is because Tricare will only pay after your other health insurance has processed your claim. If Tricare pays first, it will take back any payments made and reprocess your claim only after your other health insurance has paid.
If you lose your other health insurance, Tricare becomes your primary payer. In this case, you must inform your doctor and contractor by completing and returning a form. Failure to do so may result in Tricare denying your claims. You can find this form on the Tricare website. You can also contact your Tricare regional or overseas contractor for additional information.
If you are changing your medical plan, you must ensure that your beneficiary's address is accurate and in the same region as their enrollment. You can change your plan from Tricare Prime or Remote to Tricare Select, or vice versa. If you are enrolling family members in different plans, you must perform a separate enrollment process for each plan.
If you are a Tricare Prime enrollee, you can search for a new Primary Care Manager (PCM) in your region's provider directory. You can change your PCM at any time by phone, online, or by mail. However, you should call the provider first to see if they are accepting new patients. If you are overseas and stationed at a military installation with a military hospital or clinic, you will be assigned a PCM there.
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Frequently asked questions
If you have Medicare and Tricare, Medicare is your primary insurance and Tricare pays last after Medicare and your other health insurance. If you lose your other health insurance, Tricare becomes your primary payer. You can change your medical plan for a beneficiary who is currently enrolled in Tricare Select, Tricare Prime or Tricare Prime Remote and is eligible for a different plan based on their status and location.
You can change a plan from Tricare Prime or Remote to Tricare Select or from Tricare Select to Tricare Prime or Remote. If you are changing your plan because of a Qualifying Life Event (QLE), select a QLE, the effective date, and any other required information. If it is during the open enrollment period, the page shows the Annual Open Season option.
A QLE is when you lose or gain other health insurance through your employer or a private insurance program.
If you move to another Prime Service Area, simply change your PCM. If you move to a remote area, call your regional contractor to transfer to Tricare Prime Remote. You can begin your enrollment transfer before you move.
