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TRICARE Operations Manual 6010.62-M, April 2021
TRICARE Medicare Eligible Program (TMEP)
Chapter 20
Section 20
Other TMEP Requirements
Revision:  C-12, August 14, 2024
1.0  General
The TMEP encompasses the processing of all TRICARE claims for services rendered within the 50 United States (US) and the District of Columbia, as well as Puerto Rico, Guam, the US Virgin Islands, American Samoa, and the Northern Mariana islands, to individuals who have dual eligibility under both TRICARE and Medicare.
2.0  Dual Eligibles
There are six general categories of beneficiaries who have dual eligibility under both TRICARE and Medicare and whose claims will be the contractor shall processed under TMEP:
2.1  TRICARE beneficiaries, who are 65 or older and who are entitled to premium-free Medicare Part A and who have Medicare Part B;
2.2  TRICARE beneficiaries who are 65 or older and who are not entitled to premium-free Medicare Part A on their own record or the record of their current, former, or deceased spouse but have Medicare Part B;
2.3  Active Duty Family Members (ADFMs) who are 65 or older and who are entitled to premium-free Medicare Part A only;
2.4  TRICARE beneficiaries who are entitled to premium-free Medicare Part A because of a disability or End Stage Renal Disease (ESRD) and who have Medicare Part B;
2.5  ADFMs who have a disability or ESRD and are entitled to premium-free Medicare Part A only (while those with Medicare based on disability get a special enrollment period and therefore are not subject to the Part B premium surcharge, the special enrollment period does not apply to those with ESRD. ESRD patients who do not keep Medicare Part B when first eligible may have to pay a surcharge of 10% for each 12 month period that they could have enrolled in Part B but did not); and
2.6  TRICARE beneficiaries, who are entitled to premium-free Medicare Part A because of a disability, where Social Security Disability Insurance (SSDI) is awarded on appeal. These beneficiaries will who have a Medicare Part B effective date of October 1, 2009, or later and a six-month minimum gap between their Medicare Part A and Medicare Part B effective dates will remain TRICARE eligible for the period where only Part A was effective. If a beneficiary declines Part B coverage, he or she will be ineligible for TRICARE from the original Part B effective date until Part B coverage is established.
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