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Turning 65 / Medicare Eligible

65 and over

Q: I am turning 65 next month. What do I need to do to keep my Johns Hopkins US Family Health Plan coverage?

A:  If you are a member who joined the Plan effective September 30, 2012 or earlier, you don’t need to do anything to remain in the Plan after you turn age 65.  As long as you pay your US Family Health Plan premium, your coverage remains in effect. You may want to find out more about enrolling in Medicare.  US Family Health Plan members enrolled in Medicare Part A and B do not pay premiums or copays for office visits. They pay only TRICARE-designated copays for prescriptions. You don’t have to enroll in Medicare but you should understand all your options and associated costs.

If you enrolled in the Plan with an effective date of October 1, 2012 or later, you will be required to transition to TRICARE for Life and enroll in Medicare when you reach age 65. You should contact TRICARE for more information.

You membership effective date is printed on the front of your membership card.

Q: I am over 65 and have TRICARE for Life. Can I enroll?

A: Beginning October 1, 2012, military retirees and their beneficiaries are only eligible to be members of the Johns Hopkins US Family Health Plan until they reach age 65. When military retirees and their beneficiaries turn age 65, they will transition to TRICARE for Life and Medicare for health care coverage. You should contact TRICARE for more information if you have questions about your health care choices at age 65 and beyond.

Q: Do I lose TRICARE for Life if I enroll in Johns Hopkins US Family Health Plan?

A: If you joined the Plan effective September 30, 2012 or earlier, you do not lose your eligibility for TRICARE for Life but you will not be covered by TRICARE for Life because you can only be in one TRICARE plan at a time. You remain eligible for TRICARE for Life so long as you are enrolled in Medicare Part B.    

If you joined the Plan with an effective date October 1, 2012 or later, you will be required to transition TRICARE for Life and enroll in Medicare when you reach age 65. So you won’t lose your TRICARE for Life coverage but will begin using it when you reach age 65.

You membership effective date is printed on the front of your membership card.

Q: When I go to my doctor, do I show my Johns Hopkins US Family Health Plan member card or my Medicare card?

A: Only your Johns Hopkins US Family Health Plan member card is needed.  The Johns Hopkins US Family Health Plan is the primary coverage so you don’t need to show your Medicare card. If you have questions about coverage, please call Customer Service at 1-800-808-7437 before you seek medical services.

Q: Which Medicare plan do I need to enroll in to get your Plan?

A: Medicare enrollment is not a requirement to be a member of the US Family Health Plan.

When you are enrolled in Medicare prior to age 65 (due to a disability or ERSD), your portion of US Family Health Plan premium as well as office visit copays will be waived and the only copay will be for prescriptions.

For current members who joined the Plan prior to September 30, 2012, if you enroll in Medicare Part B, you do not pay premiums or co-pays for doctor visits. You will still be responsible for pharmacy co-pays, which are set by DoD standards.

You membership effective date is located on the front of your membership card.

Q: Can I keep my doctor? Can I choose any doctor or practice I want?

A: The Johns Hopkins US Family Health Plan is a managed care plan, which means you must choose your primary care doctor from our network of providers.

Q: Do I need to send a copy of my Medicare card to you?

A: No, as long as your information is listed in DEERS that you are enrolled in Medicare.

Q: I am a Plan member who has Medicare Part B. How does Medicare and Johns Hopkins US Family Health Plan work?

A:  If you are enrolled in Medicare and the Johns Hopkins US Family Health Plan, your Medicare coverage remains in effect.  However, as a condition of membership, you have agreed not to use Medicare Parts A and B or to enroll in a Medicare-sponsored managed care plan (HMO) such as Medicare Advantage plans while enrolled in the Plan. You are expected to receive all health care services through the Plan.  Using Medicare benefits while a Plan member may result in disenrollment.

However, you may use Medicare for certain benefits that are not covered by the Plan. Contact Customer Service prior to using Medicare for non-covered benefits to ensure that such use does not compromise your membership in the US Family Health Plan. Members with current Medicare Part A and B are not required to pay their portion of the USFHP premium or copays for office visit or facility visits, but will pay pharmacy copays.

It is important to remember:
  • Medicare must not be billed for services covered by the Plan
  • Members filing Medicare claims or who have claims filed on their behalf are in violation of the conditions of participation for the Plan and may be disenrolled
  • Members who have coverage under both the Plan and Medicare may only use Medicare benefits for services not covered by the Plan such as chiropractic care or end-stage renal disease (ESRD)
  • For all medical services, Medicare will be billed (as primary) for members with ESRD

·         Medicare is a health insurance program for:

    People age 65 or older

    People under age 65 with certain disabilities

    People with ESRD

    People with Lou Gehrig's disease

    People with Mesothelioma, who live or previously lived in Libby or Troy, Montana

Still have questions?

Johns Hopkins US Family Health Plan Customer Service: 1-800-808-7347
TRICARE: www.tricare.mil
Medicare Eligibility: Medicare FAQs

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