Retirement

Preparing for retirement? Select your current TRICARE plan to determine how your benefits will change upon retirement and steps you need to take to ensure your TRICARE eligibility.

TRICARE Prime

TRICARE Prime Remote

TRICARE Standard/Extra

As a retired beneficiary, you remain eligible for TRICARE pharmacy services and can now purchase dental coverage through the TRICARE Retiree Dental Program (TRDP).

If you are a dual-eligible beneficiary (eligible for Medicare and TRICARE), you may participate in TRICARE For Life , TRICARE’s Medicare wrap-around coverage. TRICARE for Life is not administered by TriWest. For detailed information, contact Wisconsin Physician Services (WPS) toll-free at

1-866-773-0404 or visit www.tricare4u.com.

TRICARE Prime

Once you enter retirement, you will experience the following changes to your TRICARE Prime plan:

• You must pay enrollment fees.
• The 20^th of the Month Rule may apply.¹
• Lock out rules apply.²
• You may or may not be assigned to the same provider you had when on active duty.
• You now pay co-pays for outpatient or inpatient care, unless you are enrolled in Prime at an MTF.
• Your catastrophic cap increases to $3000 per fiscal year per family.
• Medicare-eligible retirees and family members MUST have Medicare Part B to retain TRICARE eligibility.
• Family members no longer qualify for Extended Care Health Options (ECHO) benefits.
• You and your family are only entitled to an eye exam once every two years.

TRICARE Prime Checklist

• Check if Prime is available in the area you are planning to retire.
• Confirm that the doctor you want to see is a Prime network provider.
• Submit a new TRICARE Prime enrollment form with payment by the 20^th of the month before your official retirement date to avoid a lapse in coverage.
• Set up a process to pay your enrollment fees. You may pay by check or set up an automatic payment through an allotment, electronic funds transfer or recurring credit card.
• Research other programs or providers available to meet your family’s needs now that ECHO is no longer available to you.
• If you or your family members are entitled to Medicare Part A, purchase Part B to retain TRICARE eligibility.

TRICARE Prime Remote

• Once you retire, you will no longer be eligible for TRICARE Prime Remote (TPR), as the plan is only available for active duty and their family members.
• You will be disenrolled from TPR at the end of your active duty time; you and your family are then covered under TRICARE Standard/Extra
• If you later move to a TRICARE Prime Service Area, TRICARE Prime rules apply

TRICARE Standard and Extra

• Unless you reenroll in Prime, you will be disenrolled from Prime and will be covered by Standard or Extra.
• No enrollment required.
• You must use a TRICARE-authorized provider.
• Certain procedures require prior authorization; otherwise the claim will be denied.
• There is an annual outpatient deductible and inpatient/outpatient cost shares.
• You may be required to file your own claims.
• Your catastrophic cap is $3000 per fiscal year per family.
• Family members no longer qualify for ECHO benefits.
• Medicare eligible retirees and family members MUST have Medicare Part B to retain TRICARE eligibility.

TRICARE Standard/Extra Checklist

• Find a TRICARE-authorized provider in the area you’re retiring.
• Before having any procedure done, check to see if you need a pre-authorization. Ensure the authorization is in place before scheduling your appointment.
• If you or your family members are entitled to Medicare Part A, purchase Part B to retain TRICARE eligibility.

Footnotes

¹20^th of the Month Rule: If your retirement date is on a day of the month other than the 1^st of the month, and you do not submit your new form before your retirement date, then the 20^th of the month rule applies. This means you must submit your form by the 20^th of the month in which you retire for your Prime coverage to begin first day of the next month. Examples using retirement date March 1, 2008: If your application is received and date stamped March 3, 2008, your enrollment will take effect April 1, 2008. If the application is received and date stamped March 25, 2008, your enrollment will take effect May 1, 2008.

Applications received prior to the first of the month of the retirement date will be processed with an effective date the same as the retirement date (the 20^th of the month rule does not apply). Example using retirement date April 1, 2008: If your application is received and date stamped March 31^st, your enrollment will take effect starting on your retirement date, April 1, 2008.

²Lock out rules: If enrolled in TRICARE Prime, you are enrolled for a period of up to 12 months and remain enrolled unless you take an action to disenroll, lose your eligibility status, or, if retired, are disenrolled for failure to pay the required enrollment fees. If disenrolled, you may be subject to the 12-month lock out period. This means that you may not be eligible to re-enroll in Prime for a 12-month period from the effective date of disenrollment.