Q. What would happen if I defer taking my Social Security benefits until I am 67? Does that keep me from being able to enroll in Medicare Part B until I am 67? Do I have to enroll in Social Security when I am 65 so I can enroll in Part B and keep Tricare for Life eligibility?
A. The best source for clarification about Social Security and Medicare rules is the Social Security Administration. For official Tricare information, call your Tricare Service Center and ask for a free Tricare Standard or Tricare for Life Handbook. If you don’t know how to contact that office, call the Defense Enrollment Eligibility Reporting System support office, toll free, at (800) 538-9552.
That said, I’ll address some of the common issues that appear to concern you.
It used to be that Social Security benefit payments began at age 65. The law was changed several years ago. Now, entitlement to Social Security payments is determined by the year of the beneficiary’s birth. However, the age for Medicare entitlement did not change. If a person is entitled to Medicare, coverage still begins at age 65.
Even if a person won’t become entitled to monthly Social Security checks until, say, age 67, Medicare entitlement begins on the first day of the month when the beneficiary will be 65 years old. If the person was born on the first day of that month, Medicare entitlement will begin on the first day of the previous month.
There isn’t enough space in this column to discuss every rule and situation that can go into effect for every individual at that time, but here is some information that applies to several recent Tricare Help inquiries.
In effect, DEERS automatically reviews its database one second into the first day of every month. It looks for beneficiaries who are not active-duty family members and who will have their 65th birthday in that month.
The DEERS record for all those people must show that they are enrolled in Medicare Part B, or that they are not legally entitled to Medicare. In the absence of one or the other of those statements in the DEERS record, a person’s Tricare eligibility is automatically terminated.
To protect your Tricare eligibility, contact Social Security and apply for Medicare, Parts A and B, at least 90 days before your 65th birthday. If you don’t, you likely will lose your Tricare eligibility until you are enrolled in Medicare Part B and your DEERS record has been updated.
A few Tricare beneficiaries do not meet the legal requirements for Medicare entitlement. Medicare will deny their application and send them a notice of disallowance, which they must file with DEERS.
When DEERS is updated to show they are not entitled to Medicare, their Tricare eligibility will continue, unchanged, even if they are not enrolled in Part B.
A law enacted in 2001 allows retirees and their family members to combine Tricare Standard benefits with Medicare benefits if they are enrolled in Medicare Part B. The program created by that law, the combination of Medicare with Tricare Standard, is called Tricare for Life. It is not possible to become eligible for Tricare for Life until a person becomes entitled to Medicare and is enrolled in Part B.
Sponsor and spouse are seldom exactly the same age. If the spouse turns 65 before the sponsor, the spouse will get Tricare for Life first. The sponsor will have to wait until he gets Medicare at age 65 to get Tricare for Life.
If somebody refers to your status as “dual eligible,” instead of saying “Tricare for Life,” don’t worry. It means exactly the same thing — “dual eligible” is simply an earlier term.
James E. Hamby Jr. may be reached by writing to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or by sending e-mail to tricarehelp@atpco.com. In e-mail, please include the word “Tricare” in the subject line and do not attach files. If using regular mail, please include an e-mail address if possible to prompt a faster response.
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Saturday, August 30, 2008
Thursday, August 21, 2008
Medicare Advantage Program Abuses
Nationwide, enrollment in the private plans, known as Medicare Advantage plans, has soared, to more than 8.9 million in November, from 6.1 million at the end of 2005. The fastest growing type of plan, known as a private fee-for-service plan, is the one being sold most aggressively here.
The staff of the Medicare Payment Advisory Commission, an independent federal panel, said this month that it had found evidence of hard-sell tactics in interviews with a dozen groups of beneficiaries around the country. “In all 12 focus groups, at least one member mentioned horror stories about marketing abuses,” Jennifer Podulka, a staff member, told the commission at its meeting on Dec. 6. Insurance experts say the extent of the problem almost surely exceeds official data because many victims never file complaints or report their experiences.
Compounding the problem, many agents sell Medicare Advantage plans for two or more insurance companies, and some work for independent marketing organizations, so the lines of responsibility may be blurred.
“Medicare has a pile of new rules, but the rules are not making a heck of a lot of difference,” said L. Darriel Pulliam, an insurance agent in Columbus for more than two decades.
Under the Medicare Advantage program, the government pays insurers an average of $9,000 a year for each person enrolled in a private plan. Agents say they typically receive commissions of $350 to $600 for each person they enroll. Agents can buy the names of prospective customers from marketing organizations like the Premier Agent Group in Dallas, which offers “100 red-hot Medicare Advantage leads” for $1,000, according to the company’s Web site.
The staff of the Medicare Payment Advisory Commission, an independent federal panel, said this month that it had found evidence of hard-sell tactics in interviews with a dozen groups of beneficiaries around the country. “In all 12 focus groups, at least one member mentioned horror stories about marketing abuses,” Jennifer Podulka, a staff member, told the commission at its meeting on Dec. 6. Insurance experts say the extent of the problem almost surely exceeds official data because many victims never file complaints or report their experiences.
Compounding the problem, many agents sell Medicare Advantage plans for two or more insurance companies, and some work for independent marketing organizations, so the lines of responsibility may be blurred.
“Medicare has a pile of new rules, but the rules are not making a heck of a lot of difference,” said L. Darriel Pulliam, an insurance agent in Columbus for more than two decades.
Under the Medicare Advantage program, the government pays insurers an average of $9,000 a year for each person enrolled in a private plan. Agents say they typically receive commissions of $350 to $600 for each person they enroll. Agents can buy the names of prospective customers from marketing organizations like the Premier Agent Group in Dallas, which offers “100 red-hot Medicare Advantage leads” for $1,000, according to the company’s Web site.
Medicare Basic Payments
HOW IS MEDICARE FINANCED AND WHAT ARE
MEDICARE’S FUTURE FINANCING CHALLENGES?
Funding for Medicare comes primarily from payroll tax
revenues, general revenues, and premiums paid by
beneficiaries.
Medicare is funded as follows:
Part A, the Hospital Insurance (HI) Trust Fund, is financed
largely through a dedicated tax of 2.9 percent of earnings paid
by employers and their employees (1.45 percent each). In
2007, these taxes are estimated to account for 86 percent of the
$216 billion in revenue to the Part A Trust Fund.
Part B, the
Supplementary Medical
Insurance (SMI) Trust
Fund, is financed
through a combination
of general revenues
and premiums paid by
beneficiaries.
Premiums are
automatically set to
cover 25 percent of
revenues in the
aggregate. In 2007,
Part B revenue is estimated to be $194 billion.
Part C is not separately financed.
Part D is financed through general revenues, beneficiary
premiums, and state payments for dual eligibles eligible for drug
coverage under state Medicaid programs prior to 2006. In 2007,
Part D revenue is projected to be $64 billion, 78 percent of
which will be from general revenues.
MEDICARE’S FUTURE FINANCING CHALLENGES?
Funding for Medicare comes primarily from payroll tax
revenues, general revenues, and premiums paid by
beneficiaries.
Medicare is funded as follows:
Part A, the Hospital Insurance (HI) Trust Fund, is financed
largely through a dedicated tax of 2.9 percent of earnings paid
by employers and their employees (1.45 percent each). In
2007, these taxes are estimated to account for 86 percent of the
$216 billion in revenue to the Part A Trust Fund.
Part B, the
Supplementary Medical
Insurance (SMI) Trust
Fund, is financed
through a combination
of general revenues
and premiums paid by
beneficiaries.
Premiums are
automatically set to
cover 25 percent of
revenues in the
aggregate. In 2007,
Part B revenue is estimated to be $194 billion.
Part C is not separately financed.
Part D is financed through general revenues, beneficiary
premiums, and state payments for dual eligibles eligible for drug
coverage under state Medicaid programs prior to 2006. In 2007,
Part D revenue is projected to be $64 billion, 78 percent of
which will be from general revenues.
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