The House of Representatives recently approved the National Defense Authorization Act (HR 1540). Implementation of this Act will impact eligible non-members of the US Family Health Plan. The Act specifically prohibits Medicare eligible retirees from enrolling in a managed care such as the US Family Health Plan after Sept. 30, 2012.
Current US Family Health Plan members, or those who join the plan before September 30, 2012, are not affected by the legislation. Those members can remain in the plan for life, regardless of age.
Military family members and retirees under age 65 who become members of the US Family Health plan after September 30, 2012 will lose their eligibility to participate in the Plan upon reaching age 65. They will be required to transition to Medicare. Retirees who are 65 or older will no longer be permitted to join the US Family Health Plan, after the September 30 deadline.
Important dates to remember:
- The NDAA does not impact current US Family Health Plan members. Members with an effective date on or before September 30, 2012 regardless of age are grandfathered in the Plan and retain their eligibility.
- Through September 30, 2012, the US Family Health Plan is able to accept new members regardless of age as long as the effective date for coverage is on or before September 30, 2012.
- After September 30, 2012, the Plan is only able to accept new members under age 65.
- Eligible military beneficiaries who enroll with an effective date after September 30, 2012 are required to transition to TRICARE for Life at age 65.
US Family Health Plan continues to be the highest rated health care plan in the military health system, with 91% of members reporting high satisfaction, 45% higher than the national average of health plans.
As we have done over the entire 30-year history of our program, we will continue to be advocates for all of the military families and retirees we proudly serve through our longstanding focus on high-quality health care, access and superior customer service.
How will the NDAA affect you? Click here to find out.
Q&A for New Legislation
Current USFHP Members
Q. I am already a member of JH USHFP and over 65/not yet 65, am I still eligible?
A. Because you are already a member, you are grandfathered, which means that you can remain a member of the Plan as long as you'd like, regardless of age.
Q. What does the new legislation mean?
A. The 2012 National Defense Authorization Act has a provision that basically says an eligible military beneficiary that is not already a member of the US Family Health Plan with an effective date on or BEFORE September 30, 2012 and turns 65 is no longer eligible to enroll in the US Family Health Plan.
Q. What do I have to do?
A. No action is required if you are current member of the US Family Health Plan. The legislation allows members effective as of September 30, 2012 to remain in the Plan.
Q. My spouse is not yet 65. Can he/she stay in the Plan if already a member?
A. Yes. And we encourage your spouse to remain in the Plan so that he/she will be grandfathered and able to remain a member at 65.
Q. What do I have to do?
A. If you're not yet 65, you should become familiar with the US Family Health Plan and determine if you want to enroll BEFORE SEPTEMBER 30, 2012.
If you're currently 65 or over and would like to join USFHP, you must enroll BEFORE September 30, 2012, or you will not be eligible to join after that date.
Q. I am enrolled in Medicare but not yet 65. Can I still enroll?
A. Yes. You must be enrolled in the USFHP with an effective date on or BEFORE September 30, 2012. If you turn 65 on or after October 1, 2012 and you have not yet joined the Plan, you're no longer eligible to enroll in the USFHP.
Q. I turn 65 next week. Can I still enroll?
A. Yes, as long as you are eligible in DEERS. (So long as "next week" doesn't include the September 30, 2012 cutoff.)
You should have received a DoD/TMA letter about three to four months prior to the 1st of the month in which you turn 65 alerting you to enroll in Medicare Part B in order to retain your TRICARE eligibility. However, if you become a member before turning 65, you can remain a Plan member after turning 65 with or without Medicare Part B.
Also, if you're already drawing Social Security benefits, you should have received a letter from SSA, at least three months prior to the 1st of the month in which you turn 65, with your Medicare Card enclosed asking you to reply if you DO NOT want to enroll in Medicare.
Q. I submitted my application last week but don't have my member card yet. Am I enrolled?
A. If you are currently enrolled in TRICARE Prime, we would have processed your application within 24 hours of receipt and you enrollment is effective that date. Within about a week, you should receive a welcome packet with Member Handbook and ID cards for each family member enrolled.
If you're NOT enrolled in TRICARE Prime, and we received your application before the 20th of the month, your effective date of enrollment is the 1st of the very next month. In plenty of time prior to the 1st, you should receive a welcome packet with Member Handbook and ID cards for each family member enrolled.
Q. How is your plan different than TRICARE for Life?
A. The US Family Health Plan is a TRICARE Prime Plan, that is, it's the managed care plan. This means you must select a specific primary care practice and a specific primary care doctor to be your care manager. You'll receive all your general health care from that doctor and he/she will refer you (with an referral authorization) to specialty providers. You'll receive all your care within the Plan network and you'll get all your prescriptions filled ONLY through Rite Aid Pharmacy. If you enroll in the USFHP, we become your primary coverage and Medicare is secondary, and is typically used only for medical services NOT covered by the USFHP. Since the DoD/TMA says you can only be in one TRICARE plan at a time, you will not be using/accessing TFL at all. You do not lose your eligibility for TFL so long as you remain enrolled in Medicare Part B. If you disenroll from the USFHP and remain enrolled in Medicare, Medicare again becomes your primary coverage and you again have TFL as a supplement to Medicare.
TRICARE for Life (TFL) is a TRICARE Standard-type Plan which is intended to be a Medicare supplement. You must enroll in Medicare Part B in order to be eligible for TFL. You are your own care manager; no one doctor is centrally managing your care. Medicare and TFL allow you to go to any doctor anywhere who accepts Medicare and/or TFL. You do not need referrals for any medical services. Medicare is always the first payer and providers can then submit claims to TFL to see if they will further reimburse for medical services.