TRICARE and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003

TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. TRICARE brings together the health care resources of the uniformed services and civilian health care professionals to provide better access and high quality health care service.

TRICARE beneficiaries entitled to Medicare Part A based upon age, disability, or End Stage Renal Disease, are required by law to enroll in Medicare Part B to retain their TRICARE benefits. TRICARE serves as a supplement to Medicare, paying the Medicare deductible and patient cost share. To take advantage of this program, individuals must be entitled to Medicare Part A and Part B. Family members of an active duty service member are NOT required to have Part B. However, when the active duty service member retires, family members with Medicare Part A only are required to enroll in Medicare Part B.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 makes two very important changes regarding enrollment in Medicare Part B for TRICARE beneficiaries.

Uniformed services retirees, their spouses (including eligible divorced spouses, and widows(ers)) and dependent children are affected by the new provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

The new law affects TRICARE-eligible beneficiaries in one of two ways:

• Beneficiaries who are entitled to Medicare Part A but are not enrolled in Medicare Part B may enroll in Part B without a premium surcharge during a special enrollment period that will continue through December 31, 2004.
• Beneficiaries whose current Medicare Part B entitlement began between January 2001 and December 2004 and who are paying a premium surcharge (more than $66.60 a month) for Medicare Part B, are eligible to have their Part B premium reduced to $66.60 beginning January 2004, or if later, their Part B entitlement date. These beneficiaries will receive a refund for any excess premiums they have paid in 2004.

The Social Security Administration (SSA) worked very closely with the Centers for Medicare & Medicaid Services and the Department of Defense TRICARE Management Activity to implement both provisions of the new Medicare law in a manner that required little, if any, action on the part of the Medicare beneficiary.

• Beneficiaries with Medicare Part A only were automatically enrolled in Medicare Part B effective September 2004. These beneficiaries also received a form in the mail, giving them the option of changing their Part B entitlement date to any other month in 2004, or refusing Part B altogether.
• Beneficiaries who were paying a higher premium (more than $66.60 a month) for their Medicare Part B received an automatic refund of all excess premiums paid in 2004. Most refunds were processed during September 2004.
• Beneficiaries who enrolled in Medicare Part B between January and March of 2004 (the Medicare General Enrollment Period) were given the option to retain their July 2004 entitlement date or change the entitlement date to any other month within 2004.

Additional information regarding the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (P.L. 108-173) is available at www.medicare.gov.