US Family Health Plan and Medicare Part B
US Family Health Plan does not require members to have Medicare Part B. In fact, since its inception, US Family Health Plan has been the principal program within the Military Health System providing comprehensive health care to people 65 and over, without requiring Medicare Part B.
However, we recommend that if you join the US Family Health Plan, you should also have Medicare Part B. Here are the reasons why:
- If you decline Medicare Part B when you first become eligible, and then choose to enroll at a later time, you may be subject to Medicare Part B's pre-existing condition clauses, exclusions, waiting periods and higher premiums. While you won't need Medicare Part B as long as you're in the US Family Health Plan, a time may come when you move out of a US Family Health Plan service area and you'll need to enroll in Medicare to get coverage from the military health system.
- If you are 65 or over and paying for Medicare Part B, there are no enrollment fees for the US Family Health Plan and no co-payments for medical services (except for prescriptions). Therefore, although you would pay the additional cost for the Medicare Part B premium, you'll save money by not paying the US Family Health Plan enrollment fee and most co-payments.
US Family Health Plan members who are 65 and over and who don't have Medicare Part B must pay the low annual enrollment fee and small co-payments for some services.
For more information about Medicare Part B, contact 800-MEDICARE or www.medicare.gov.
US Family Health Plan Members with Medicare Part A only
US Family Health Plan members who are 65 and over and who have Medicare Part A but do not have Medicare Part B continue to receive the same quality health care and member service from US Family Health Plan that they always have. In fact, since its inception, US Family Health Plan has been the principal program within the Military Health System providing comprehensive health care to people 65 and over, without requiring Medicare Part B. US Family Health Plan members who are 65 and over and who don't have Medicare Part B will continue to pay the small annual enrollment fee and co-pay’s they had as retirees without Medicare part B.
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US Family Health Plan and TRICARE For Life
Since its inception, US Family Health Plan has been the principle program within the Military Health System providing comprehensive health care to military beneficiaries regardless of age, including those ages 65 and over. In 2001, Congress passed legislation that authorized TRICARE For Life (TFL), which is supplemental medical coverage after Medicare for people 65 and over. The health care benefits provided by USFHP vs. Medicare plus TFL are similar but US Family Health Plan has the history and experience of providing health care to members throughout all stages of life.
Advantages of US Family Health Plan vs. TRICARE For Life:
- Family enrollment. Entire families may join US Family Health Plan, regardless of Medicare eligibility.
- Preventative care. Only US Family Health Plan covers preventative care, such as annual physicals and annual eye exams, to reduce the risk of illness in the future. These important preventative services are not covered under TFL.
- Guaranteed protection. US Family Health Plan pays for your healthcare, even in catastrophic illness cases.
- Hassle-free healthcare - No claim forms to fill out. US Family Health Plan is the entire payor for all services, which simplifies the payment process for members. Under TFL, the military beneficiary uses Medicare as the first payor and TFL as an additional supplement. With TFL, if Medicare does not cover a service but TRICARE does cover it, the person using TFL must satisfy a deductible and pay a percentage of the charges. US Family Health Plan members receive the full military benefit they earned from one comprehensive source of healthcare.
- Personal Choice- People who enroll in US Family Health Plan make a choice to receive their health services through an organized care program. A major value of enrollment in US Family Health Plan is that each individual member personally selects a primary care manager who works closely with the member to coordinate all aspects of care. That care is provided through a network of physicians, hospitals and other healthcare providers that must meet strict credentialing requirements to be in the US Family Health Plan network and agree to provide access to US Family Health Plan enrollees in a responsive, timely and convenient manner. Member response to the quality of care and the service US Family Health Plan offers has been overwhelmingly favorable, with satisfaction ratings.
The TRICARE For Life legislation also eliminated co-payments for US Family Health Plan members 65 and over with Medicare Part B, except for a small pharmacy co-payment. (The pharmacy co-payment, $3.00 for generic drugs, $9.00 for brand name drugs, and $22.00 for 3rd tier drugs is the same for US Family Health Plan members and people who use TFL.)
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