By Matt Scherer
Introduction
At a recent town hall, the Fort Sam Retired Affairs Council invited representatives from the Defense Health Agency, TRICARE, Medicare, and Social Security to brief on medical benefits. More than 300 retirees attended, eager for clarity on their promised care. Some answers addressed retirees’ concerns to a satisfactory level.
To cut through confusion, our team compiled a list of the most common questions and found official policy sources that provide precise answers in detail. We hope that this interactive article will give military retirees and their spouses straightforward guidance on transitioning to Medicare at age 65.
A PDF copy of this 34-page article, featuring an interactive table of contents, can be downloaded here.
Brig. Gen Bud Day: the officer who caused the current medical benefits program
In 1997, retired Brig. Gen. Bud Day, an Air Force Medal of Honor recipient and Vietnam POW, filed a lawsuit against the federal government to contest the Medicare payments expected from him at his 65th birthday.
General Day, a Hanoi Hilton roommate of Senator John McCain, brought legal action on behalf of William O. Schism and Robert Reinlie. Like the Medal of Honor recipient, both military retirees had been billed for their Medicare benefits when they reached their 65th birthday. Like General Day, both had promises from their recruiters about the “lifetime of free medical payments.”
According to a 1997 U.S. Naval Institute article written by Tom Philpot, the general’s federal lawsuit in Pensacola, Florida asked for restoration of in-service medical care for those over the age of 65. It also asked for reimbursement of monies deducted from their Social Security payments. The court ruled that collecting Medicare benefits was a “breach of promise” given to veterans like Schism and Reinlie.
In 2002, the U.S. Court of Appeals ruled that whatever military recruiters had promised was not binding. Veterans like General Day, once they had reached their 65th birthday, still had to pay for their medical benefits. As a result of this legal action, Congress enacted afterwards a TRICARE For Life program and a senior pharmacy program.
TRICARE For Life charges the veteran and his family for basic health insurance. Veterans can opt out of this program by not paying their monthly premium and hope to obtain “space available” at a DHA military treatment facility. Depending on their disability rating, they can also receive medical care at a nearby VA facility.
For veterans with limited income, understanding the official policies of Social Security, Medicare, TRICARE and the VA can help get medical coverage is not straight forward. The veterans and their spouses at the Fort Sam Houston town hall meeting had some great questions, but sometimes, the answers, especially with the supporting graphics, were not too clear.
What’s the difference between Medicare and Medicare Advantage plans?
When he turned 65, Mark Goode, a retired Army special forces noncom, said he didn’t choose a Medicare Advantage plan as he had TRICARE For Life as his supplemental insurance.
“To me, those Medicare Advantage programs are a scam,” he told me recently.
Goode made his decision after reviewing YouTube videos like this one featuring Tricia Sandiego, an AARP Medicare advisor and Matthew Claassen, the CMT and CEO of Medigap Seminars.
According to Sandiego, Medicare Advantage plans have the “medical necessity” clause. That means that they can deny treatments depending on their policy.
If veterans make a lot of trips outside their primary home, Sandiego noted in her video that veterans may have limited treatment with a Medicare Advantage plan.
“The goal of Tricare and Medicare is to cover everything that is medically necessary,” said Matthew Claassen, CMT and CEO of Medigap Seminars in this article. “No insurance company can stall or prevent medical treatment based on their internal rules.”
Sure, Medicare Advantage plans provide complimentary access to local gyms and other benefits. Yet, the medical necessity clause makes it difficult for veterans to obtain medical care.
“Medicare Advantage plans may offer additional benefits and services, but they also come with network restrictions and potential delays in care approval,” Claassen added in one recent article.
Veterans can also visit the www.medicare.gov website to obtain this chart.
How Much will I pay in Medicare?
Congrats on your retirement, here is a monthly bill for your future medical services.
After more than 40 years of military and civil service, Air Force CMSgt. Marco Aldaz decided to officially retire, not recognizing he now needed to pay $480.90 per month for his medical insurance.
Aldaz retired as an Air Force senior enlisted manager with 28 years of active-duty experience. He then spent nearly two decades as a GS-15 civil service worker.
The retired Air Force chief master sergeant got a bill from Medicare informing him that once he began collecting his Social Security payment, he now had to pay a higher monthly stipend.
His new bill was based on his retirement income as an Air Force senior noncom and a civil service executive. His income was over the Income-Related Monthly Adjusted Amount. The government also added the income from his wife’s position as a C-level executive.
For most veterans, a payment of $185 per month will be deducted from their Social Security benefit payments. Aldaz’s payments were higher because he and his wife had a higher level of annual income.
Jason Garza, a public affairs specialist with the Social Security Agency said some veterans like Aldaz can expect to pay more for their monthly Medicare insurance. Known as the Income-Related Monthly Adjustment Amount or IRMAA, Medicare will base their monthly bill on the income taxes reported two years ago.
The chart below details the cost structure veterans can expect when they turn 65 years of age.
The SSA-44 form
When a military professional experiences a life-changing event, he or she can submit this form. This includes categories such as marriage, divorce/annulment and the death of a spouse. It can include work stoppage, work reduction, loss of income producing property, loss of pension income, or an employment settled payment.
A professional accountant can assist a military professional with getting the financial documentation to submit this form. The SSA-44 pdf can be downloaded here. When Chief Aldaz completed this form, he had his monthly bill lowered to the $185 per month.
Garza said the adjustment is good for only one year.
Where can I find a Medicare Doctor near me?
Where are my online resources to find a Medicare provider?
Don’t expect DHA representatives to help find alternatives to a military treatment facility. The federal government can’t officially recommend any medical providers. “No federal or DoD endorsement implied” is a phrase commonly shared by those who serve in our government patient affairs departments when asked for an opinion on a veteran’s medical options with their Medicare coverage.
At the Fort Sam conference, a Medicare representative said veterans and their spouses should go to Medicare.Gov. The website’s search feature will help veterans, and their families locate medical providers near them that accept Medicare payments.
While the Medicare website provides a list of doctors who practice close to a home or apartment, it’s important to use a little customer service recon as well. As I turned 65, I used zocdoc.com to find my first primary care manager.
These websites provide a starting point to begin the transfer from a military provider. The next step is to call their office to speak to their customer care team.
Customer Service Recon
Another option is to personally visit the medical provider’s office to evaluate the customer outreach provided to patients. I found after nine months my first doctor didn’t have enough administrative staff to handle the influx of phone calls concerning their patient’s appointment setup and medical prescription issues. It sometimes took 30 minutes to reach a medical administrative specialist because the doctor didn’t have enough staff to handle their patient communications.
Based upon this poor customer experience, I transferred to another primary care manager. To me, that’s one of the benefits of using Medicare. While on active duty, I didn’t have the option of choosing an alternative provider for poor customer service. Now, I have the opportunity to pick another provider who can work with me on my care.
Finding a Medicare provider is not that easy
Four months before a military retiree turns 65, a retired military professional will get a letter from the Defense Health Agency, advising them that coverage at their nearby military treatment facility is no longer available.
In June 2020, I got that DHA letter advising me that future treatment with my primary care manager at Camp Bullis would end.
I found it ironic that Jackie, my wife who was two years older than me, did not get a letter before her 65th birthday. She still gets her primary care from Camp Bullis.
Calls to the DHA patient affairs were such that I could not get a straight answer on my future medical coverages. My Camp Bullis medical provider was not aware that I would soon be leaving her care.
That made me want to send an email to Senator Ted Cruz to get clarification on why the DHA kept my wife on their rolls while advising me to look for alternative medical care.
“Unfortunately to our understanding, Tricare for Life does not guarantee access to the military treatment facility (MTF). MTFs have always treated retirees on a space-available basis. With space-availability, retirees in some areas might have to seek care at civilian providers,” Jacob Chamblin, Senator Cruz’s Texas constituent services liaison responded to my email.
How do I transfer my Military Health Records?
As one leaves military medical practice, it’s time for a veteran to transfer their medical records to their new provider. This gives the Medicare provider a chance to learn about their new patients’ specific ailments and treatments. Depending on the military treatment facility, this can take a couple of weeks for a routine transfer of records.
Every military retiree can obtain one’s medical records once a year through the MHS Genesis program.
Combining the best of both worlds with the VA and TRICARE For Life
Retired Air Force CMSgt. Jason David said he continues his treatment for his military injuries from both the VA and TRICARE.
“To me, it’s like owning two cars. I used both to take care of my medical issues,” David, a Purple Heart recipient, said. The retired Air Force noncommissioned officer gets his medications through the VA. He also receives acupuncture and chiropractor services through his VA primary care manager.
Through his TRICARE For Life plan, he gets ongoing surgical care for his hip from Johns Hopkins.
Will the VA EHR System improve my healthcare?
Yes it will, but it will take some time to fully implement it.
The VA says that all of its medical facilities will have this system in place by 2031. When the work is completed, veterans and their medical providers can have full access to their medical records taken from a military treatment facility.
There’s more at this VA.gov website.
As a military retiree, do I need Medicare’s Part D?
No!
Military retirees have several options to obtain pharmaceuticals. Through the VA.gov/my-health portal, they can get an appointment with a primary care manager to obtain their pharmaceuticals. The VA will also mail every veteran a 90-day supply of their medications.
Retired veterans and their military spouses can also get their medications through TRICARE For Life. Tricare.Mil provides the military retiree and his spouse with a search option.
Prescriptions are also available at retail pharmacies, but retirees will have to pay a co-payment for these medicines.
How can I make a VA appointment?
The VA through its VA.gov website allows a veteran to enroll in their My HealtheVet program. This online portal allows veterans to check on appointments and to request additional services such as Eye Care or nutrition.
For veterans like Chief David, this allows a veteran to choose the right medical treatment options, based on their location and availability.
I’m still working and my 65th birthday is approaching. What should I do to enroll in Medicare?
According to Jason Garza, a public affairs specialist for the Social Security Agency, a retired military member should contact their human resources specialist to submit CMS 40B and the CMSL564 form.
Military veterans and their HR professionals can get these forms at SSA.gov. They can also schedule a phone appointment at 800-772-1213.
When do I use the VA for Medical Care?
TRICARE and the VA recommend that you get care for your service-connected disability at a VA facility. For all of your other care, consider all of your options, including using a Medicare-certified provider. When using Medicare providers, you typically have no out-of-pocket costs for services covered by both Medicare and TRICARE.
Retired Army Command Sergeant Major E.G. Mais, an accredited veteran service officer based in San Antonio, said veterans and retirees should get treatment for all service-connected disability conditions. He notes the VA disability program can review a veteran’s medical or mental health condition to ascertain if a person still has a service-related disability.
Does Tricare for life provide medical coverage if I live in germany or japan?
Yes, in certain countries. A veteran or his spouse can find more information at this link.
Medicare does not provide a military retiree living overseas with insurance coverage.
Can I drop Medicare if I have VA Care as a 100 Percent Disabled Veteran?
Both independent insurance and advisors are in full agreement on this topic. Their advice: Do not drop this coverage as you will face a penalty payment from Medicare. In a medical emergency outside of one’s home of residence, VA care may not always be available.”
How do i notify tricare of my change of address?
One’s TRICARE For Life and Medicare will change as someone moves to a new location. Both these coverages will travel with a veteran anywhere they reside in the United States.
The Defense Health Agency has a website search function. Same with Medicare and their search capabilities.
When changing doctors, a veteran should ask if their medical provider is a “participating provider.” According to reps at the Fort Sam Houston briefing “You will have providers who say, ‘Yes, I take Medicare,” but if they are not a participating provider, they can charge you whatever they want to charge you.”
Where do i get the government forms i need?
Where can I get the right forms to obtain or modify my benefits?
Here are the four official government sites we used for our research.
When military professionals search for claims forms at online search engines, other websites such as pdffiller.com, www.signnow.com or www.dochub will often appear to offer help with these forms. Be aware that these firms are known to share data to third parties.
Each government website has a search function to locate the forms needed to complete one’s enrollment.
What is the difference between tricare plus and tricare for life?
Some military hospitals and clinics offer TRICARE Plus on a space available basis. When services are not available, such as a heart or cancer issue, the military veteran and his spouse must use another medical option.
When hospitalization treatments occur outside of a military treatment facility, Medicare serves as the primary source of payment. TRICARE For Life picks up the remaining payment.
I just got a bill for three months of Medicare coverage. How can I change this to a monthly bill?
A qualifying veteran or family member can go to this Medicare Easy Pay link to update this payment form.
I am the widow of a deceased veteran who turned 65. What should I do to obtain Medicare benefits?
Widows and widowers of deceased military professionals should sign up for Medicare Part B two to four months before they turn 65. When they get their “notice of Award” based on the deceased spouse’s social security number, they should also make an appointment with an “Uniformed Services ID card issuing facility to update their DEERS record.
Where can I get a new DEERS Identification card?
Gone are the long waits at a military personnel flight office to obtain this card. Veterans can visit this Department of Defense link to obtain information on updating their ID card. This allows the veteran or family member to set up a specific time to get their ID card updated.
My wife was in the hospital for five days and she got a bill for $1,676. Does tricare for life pay this remaining bill?
Yes. It’s important to keep a copy of the payment and then send the DD2642 to the TRICARE regional claims department. The form’s link is available at this TRICARE claims page.
How do I get a VA clothing allowance?
“Most eligible veterans are unaware that they can file for an annual clothing allowance. However, here is the information so you can be informed about the allowance and how to apply for it,” posted Bruce Thompson in a recent LinkedIn post.
“If your clothing has been damaged by your prosthetic or orthopedic device (such as a wheelchair) or by the medicine you’re taking for a skin condition, you may be able to get money each year to help you buy new clothes. This is called an annual clothing allowance.”
The 2025 rate is $1,024.50.
Veterans can get more information at this VA link.