Ask Lacey: Should I Stay Signed Up for Medicare Part B?

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The front of a medical building appears with the sign "Clinical Annex."
The La Junta (Colo.) VA Clinic is part of the VA Eastern Colorado Health Care System. (Department of Veterans Affairs)

Q. I'm 65 and VA-disability-rated at 90%. Do I need to, or should I, stay signed up for Medicare Part B? I’m also on Tricare for Life, which requires me to be enrolled in Medicare Part B.

Thanks,

Charles

Thank you for your great question, Charles. I appreciate your writing in. If you're 65, disability rated at 90% by the federal Department of Veterans Affairs (VA), and already enrolled in Tricare for Life (TFL), you're in a situation in which Medicare Part B isn't just a "should I." It's a "you have to" if you want to keep your TFL coverage. The real question is probably whether you want to keep TFL if you have VA medical care available.

Related: What Is Tricare for Life?

Here are some things to consider in your decision.

Why Does Tricare for Life Require Medicare Part B?

For military retirees and their eligible family members, Tricare for Life works hand in hand with Medicare. Once you turn 65, TFL requires you to have both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) to stay covered. This isn't a suggestion. If you drop Part B, you lose your TFL coverage.

TFL isn't just "extra" insurance. It's what picks up most of the costs Medicare doesn't cover, making your out-of-pocket expenses extremely low or sometimes zero for covered services. The bottom line is, if you want to keep using TFL, you have to stay enrolled in Medicare Part B.

How Medicare Part B Works with Tricare for Life

Here's how the two work together:

  • Medicare pays first for Medicare-covered services.
  • TFL pays second, covering the remaining costs that Medicare didn't pay, such as deductibles, coinsurance and copayments.
  • You typically owe nothing out of pocket for Medicare-approved services.

It's a powerful combo. You get access to civilian providers through Medicare and backup coverage through TFL, without all the huge medical bill worries.

About VA Health Care

You mentioned your VA disability rating is 90%, which means you have access to VA health care. VA care is great for many veterans, but it works differently from Medicare and TFL:

  • VA health care can only be used at VA facilities or for VA-approved care such as Community Care.
  • VA and Medicare don't coordinate benefits; if you see a non-VA provider, the VA generally won't pay, even if Medicare would.
  • While the VA often does well for annual checkups, preventive care and prescriptions, it can take longer to get an appointment, especially for urgent needs.
  • For acute issues such as injuries or sudden illnesses, having Medicare and TFL means you can use your civilian doctor or urgent care to get seen quickly.

If you drop Medicare Part B and lose TFL, you could rely solely on the VA, but you'd give up the flexibility of seeing civilian providers quickly.

Why It Matters Even More if You Have Dependents

If you have eligible dependents, TFL also helps cover your health-care costs in coordination with Medicare (if you’re eligible) or as your primary Tricare coverage if you're younger than 65. Dropping Part B and losing TFL would affect not only your access to civilian care but also your family's coverage options. That's an important consideration for anyone supporting a spouse or dependents who may need care outside the VA system.

The Cost Side of the Equation

The main reason people consider dropping Part B is the monthly premium. In 2025, the standard Medicare Part B premium is $185 per month, though it could be higher if your income is above a certain level.

Here's how to think about it:

  • It's an ongoing cost, yes, but it also gives you the ability to see virtually any provider, with TFL covering what Medicare doesn't.
  • Without Part B, you lose TFL entirely. If you later re-enroll in Part B, you could face late enrollment penalties and long waits before coverage starts.

Given the high cost of medical care, most retirees find the premium is worth the peace of mind and the access it provides.

When You Might Reconsider

Suppose you had other equivalent employer coverage (not VA health care, but actual civilian employer insurance) that allowed you to delay Medicare Part B without penalty. In that case, you can postpone Part B temporarily. But for most people in your situation -- retired, on TFL, with VA care -- dropping Part B would mean giving up TFL, which is probably not worth it.

Since you're on Tricare for Life, it's probably best to stay enrolled in Medicare Part B to keep your TFL coverage. Doing so ensures you have:

  • Access to civilian care when and where you need it.
  • Minimal out-of-pocket costs for covered services.
  • The flexibility to use VA health care when it works best for you and civilian providers when you prefer or need them.

Think of it as three layers of protection: VA health care, Medicare and TFL. Together, they create one of the most comprehensive health coverage packages available to anyone in the U.S., and those are benefits you've earned.

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