How Will SSA Assist TRICARE Beneficiaries?

One of the provisions of the Medicare Modernization Act of 2003 affects Medicare beneficiaries who are also eligible for TRICARE. In order to retain TRICARE Health Benefits, these beneficiaries are required, in most cases, to enroll in Medicare Part B. Beneficiaries already enrolled in Part B are eligible to receive a refund of any excess premiums (amounts above $66.60 per month) they paid in 2004.

A fact sheet that further explains these provisions is available at: http://www.socialsecurity.gov/legislation/tricare.html. This supplemental fact sheet provides information about the Part B enrollment process, refund amounts, and what individuals should do if they think they might be eligible to enroll in Medicare or to receive a premium refund under the new law.

SSA worked with the Centers for Medicare & Medicaid Services (CMS) and the Department of Defense (DOD) to identify the military retirees (and their dependents) who are potentially affected by the new law – approximately 48,000 in all, eligible for either the Part B enrollment or a premium refund. See the attached document for a breakdown of affected beneficiaries by state.

SSA enrolled these individuals in Part B (or provided premium refunds, as appropriate) automatically in early September 2004. This auto enrollment process provided combined Medicare and TRICARE coverage without requiring the beneficiary to take any action. Refunds of excess premiums also required no direct action by the beneficiary.

The identified beneficiaries received a notice from SSA in mid-September, explaining either their automatic enrollment in Part B or their premium refund. Copies of sample notices can be found below.

• Automatic Enrollment Letter
• Premium Waiver Letter

The enrollment letter explained that TRICARE beneficiaries have been automatically enrolled in Medicare Part B effective September 2004. It also explained that the Part B premium amount of $66.60 will be deducted from the beneficiary’s Social Security check each month. Because Part B premiums are withheld one month in advance, the Social Security payment received in October will be reduced by $133.20, to pay for 2 months worth of premiums (September and October). Most beneficiaries were also given the option to select a different Part B enrollment month (any month in 2004) or to refuse Part B altogether. They were advised, however, that refusal of the Part B coverage may affect TRICARE eligibility.

Shortly after the SSA notices were sent, DOD also sent its own notices to potentially affected individuals about this Medicare enrollment and refund process. Thus, all of the individuals identified by CMS, DOD, and SSA received two notices about their rights and responsibilities under the provision. (Some DOD notices mention that individuals would receive a notice from CMS regarding auto enrollment. Those notices actually came from SSA, not CMS).

• The percentage amount of excess premiums paid by the beneficiary. For every 12 months in which an individual could have been enrolled in Part B, but did not do so, the monthly premium increases by 10%. In 2004, the regular Part B premium is $66.60, so a beneficiary with an existing 10% premium increase would be paying $73.30, or $6.70 extra per month. Likewise, a beneficiary with a 20% increase would be paying $79.90, or $13.30 extra per month.
• The number of involved months. The refund of excess premiums is effective for months in 2004, so most beneficiaries will have 9 months of excess payments refunded (January through September). Since premiums are withheld one month in advance, beneficiaries receiving the premium refund would already have had the premium for September deducted from the August check (payable in September). Thus an individual who formerly paid an excess premium of 10% would receive a $60.30 refund (9 x $6.70).

Any premium refund payable will be provided by a separate check (or direct deposit, as applicable) to the beneficiary. Those beneficiaries who are billed for their Medicare Part B premiums can expect to have the refund amount applied against any premium due.

For months remaining in 2004, the Part B premium deducted from such individuals’ Social Security checks will be the regular premium amount of $66.60. This premium is adjusted every January, and may increase in the future.

For more information, beneficiaries can call SSA at 1-800-772-1213.

Although SSA, CMS and the DOD attempted to identify all potentially eligible beneficiaries, there may be some eligible individuals who were inadvertently omitted. SSA has developed processing instructions to address such situations. Beneficiaries who think they may be affected by the new law who do not receive a letter by November 1st, should contact their local Social Security field office. Eligible individuals will be protected for the Part B enrollment or premium refunds just as if they had been initially identified. We will work with these individuals on a case-by-case basis to verify their TRICARE eligibility, and to enroll them in Medicare Part B or to refund excess premiums as appropriate.