How does Tricare work with Medicare Part D?
February 6th, 2010 | TriCare Help | Posted by Military Times
Q. I am retired military, age 65. I know Tricare pays last, but do you have to fill prescriptions with Medicare first and then submit to Tricare for any expenses not covered? Or can I use the Tricare mail order prescription service as my preferred prescription service?
All Tricare beneficiaries are automatically eligible for, and are automatically enrolled in, the free Tricare Pharmacy Program and are eligible for its complete benefits. It is recognized as one of the best pharmacy plans available. They do not need any pharmacy insurance other than the Tricare Pharmacy Program.
You can find detailed information about the Tricare Pharmacy Program online. If you want it, additional printed information is available from the Tricare worldwide pharmacy benefit administrator, Express Scripts Inc. The toll-free number is 877-363-1393.
Health Affairs does not recommend that Tricare beneficiaries enroll in the Medicare Part D Pharmacy Program. The only Tricare beneficiaries who are likely to derive any significant advantage from Medicare Part D are the few whose incomes are below the federal poverty level and who qualify for financial aid to pay their Medicare Part B monthly premiums.
Because you have other health insurance (Medicare Part D), you are not eligible to use TMOP. That is because of the way Tricare is required by law to coordinate its benefits with Express Scripts Inc. which, for TMOP services, is not only the plan’s administrator, but also the provider of the drugs under TMOP.
When you enrolled in Medicare Part D, you had several commercial pharmacy plans to choose among, depending on where you live. Each plan has its own rules for using its benefits. You must follow that plan’s rules for all your pharmacy services and use it first, before you may use your free Tricare pharmacy plan.
You may find that your commercial plan under Medicare Part D will not pay for certain drugs. Although Tricare has special rules for dispensing certain drugs, if your doctor can document the medical necessity of that particular drug in your particular case, Tricare will make it available for you without penalties.
If your Part D pharmacy plan charges you a co-payment or a deductible for your prescription services, you may file a claim with the Tricare Pharmacy Program for partial reimbursement of those expenses.
If you have to pay a premium for the Part D pharmacy plan, however, you may not file a claim with Tricare for the premium payment. Tricare will reimburse you only for your co-payment and deductible on the cost of the drugs, but not for any cost of the insurance plan.
You will probably need help to learn how to file a claim with Tricare as second payer for your prescription drugs. I suggest you call Express Scripts for that help. If you use the Tricare Pharmacy Program exclusively, there are no claims to file.
You may also want to discuss with Express Scripts your need, or the advisability, of continuing to be enrolled in Medicare Part D. Call Medicare if you choose to withdraw from your Medicare Part D enrollment. It is easy to do, and there is no penalty.
How can I get my hearing aid covered?
February 5th, 2010 | TriCare Help | Posted by Military Times
Q. Is there any coverage for hearing aids under Tricare for Life? I think the answer is “no,” but I’m just checking.
You are right that federal law doesn’t let Tricare pay for hearing aids, just like it can’t pay for glasses, either. But it’s not quite as bad as you might think.
There is a program called RACHAP (Retiree At Cost Hearing Aid Program) that allows retirees only (not their family members) to buy hearing aids at the government’s cost. It is not related to Tricare in any way.
I haven’t had any dealings with them or talked with anybody who has. In fact, I’d appreciate it if you tell me what happens when you contact them and whether it works to your satisfaction. Good hearing aids are expensive, so even with the government’s discount, you are going to have some pocket-book pain.
Did I lose coverage when I got married?
February 4th, 2010 | TriCare Help | Posted by Military Times
Q. I’m 17 and I just got married. My father is in the Air Force. Am I still covered by his Tricare?
No, at midnight of the day you married you automatically lost all the Tricare eligibility you had from your father’s service.
You can confirm that by calling the DEERS Support Office, toll-free, at 1-800-538-9552. You or your father must notify DEERS of your marriage.
Artificial insemination while husband is deployed?
February 4th, 2010 | TriCare Help | Posted by Military Times
Q. I am a Navy wife and we have been trying to conceive for two years. My husband is on a sub and leaves for three months at a time every three months. Would Tricare cover artificial insemination so that we can continue to try when he’s gone?
I sympathize with your problem, but I don’t have good news for you.
Tricare is not allowed to provide coverage for any kind of technical assistance with conception, including artificial insemination, even with your husband as sperm donor.
I have not heard of any exceptions being made, but you might want to write to the Tricare Headquarters, Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043, to inquire. Explain your situation and include a daytime phone number. Please don’t get your hopes up.
Are acupunture or chiropractic care covered?
February 3rd, 2010 | TriCare Help | Posted by Military Times
Q. Will Tricare pay anything for acupuncture or a chiropractor? I use them and they seem to work; I no longer take allergy meds. I still have a regular doctor too. I had the coverage when I had my employer’s insurance.
Tricare is currently forbidden by federal law and regulation to pay for chiropractic care or acupuncture. I am aware that there are people with strong feelings about the effectiveness of both of those treatment modalities, both for and against, and both have been the subject of considerable public dispute and debate.
Tricare is not a health insurance policy or an insurance company. It is a federal health benefits program created and governed by federal law, which determines who is eligible and when, which medical services Tricare may cover and which are excluded, the amounts it may pay for each medical service and the manner of payment, the portion of the costs of care that are the beneficiary’s responsibility to pay, and the like. Only Congress can change it.
What about hair implants?
February 3rd, 2010 | TriCare Help | Posted by Military Times
Q. Will Tricare cover and pay for hair implant surgery? I’m male, and I had a thick head of hair prior to joining the military. I’m now showing signs of baldness. It’s not hereditary in my family. I feel that lack of sleep, nutrients, stress, missions and shots received while in the military have caused my hair to thin.
I’m sorry, but Tricare is not allowed to pay for medical, surgical or other services performed solely for cosmetic purposes or psychological reasons. Tricare benefits are determined by federal law and regulation.
If you believe your hair loss is a result of your military service, you may want to file a claim with the Department of Veterans Affairs.
Tricare News Alert: Download the new Tricare Standard Handbook
February 2nd, 2010 | TriCare Help | Posted by Military Times
The new handbook for Tricare Standard is here. Read the Tricare Management Activity’s official news release, or download your own copy of the new handbook here.
If Tricare pays less than Medicare, how does it work with TFL?
January 27th, 2010 | TriCare Help | Posted by Military Times
Q. I’ve read stories about Tricare and it seems less reliable than most commercial plans. It pays 5 percent less than Medicare does, so how will it help pay my Medicare claims under Tricare for Life?
Medicare and Tricare allow the same, or almost the same, amount for identical services because, by law, they must use the same, or almost the same, methods and databases to determine that amount.
Even when the amount allowed is the same, however, you are correct. Medicare pays 80 percent of the amount it approves or allows, whereas, for retirees, Tricare pays only 75 percent.
But Tricare’s allowance under Tricare for Life is seldom considered.
For Tricare for Life beneficiaries whose only health insurance is Medicare and Tricare Standard, and have no additional coverage from, say, a civilian job, Medicare is their primary health insurance, and Tricare Standard is secondary.
Tricare for Life beneficiaries must get all their civilian care from providers who will file a Medicare claim. On the vast majority of those claims, both Medicare and Tricare cover all the services on the initial Medicare claim. Tricare’s payment is determined by the amount Medicare pays, not by the amount Tricare allows.
When both programs cover every service on a claim, Medicare first pays 80 percent of the amount it allows on the charges after satisfaction of the Medicare deductible, if applicable, on that claim. Tricare pays the patient’s share — the Medicare deductible and copayment.
The patient owes the provider only what Medicare does not pay. When Tricare pays that amount, the Medicare claim and the provider’s bill are paid in full. The patient owes nothing more.
Therefore, on most TFL claims, Tricare’s allowable charge is not a factor.
Your transition to Tricare for Life
January 26th, 2010 | TriCare Help | Posted by Military Times
Q. I will be 65 this year and become eligible for Tricare for Life. My wife, daughter, and I have been under Tricare Prime for several years and it has met our health care needs in almost every respect.
But now, as soon as I get Tricare for Life, I will become ineligible for Tricare Prime and be switched to Tricare Standard against my will. Not only will I have the additional expense of Medicare Part B, but under Tricare Standard, we will start incurring deductibles and cost shares that we don’t have under Tricare Prime. Is there any way we can keep Prime when we get Tricare for Life?
Your loss of Tricare Prime eligibility and automatic transfer to Tricare Standard can’t be avoided — it’s part of the legal requirements for Tricare for Life.
Under Tricare for Life, Tricare Standard acts as a free Medicare supplement. You cannot choose to keep Tricare Prime.
Reading between the lines in your letter, however, leads me to believe you expect your transition to Tricare for Life and Tricare Standard to affect other members of your family. Not so.
Your transition to Tricare for Life and transfer from Prime to Standard will have no effect on your family’s Tricare Prime enrollment. You will be the only one affected.
Your daughter may continue under Tricare Prime until she loses Tricare eligibility at age 21 (age 23 if she is a full-time college student), or until she marries, whichever comes first.
Your wife may continue under Tricare Prime until she becomes entitled to Medicare and Tricare for Life at age 65. At that time, she’ll lose her Tricare Prime eligibility and transfer to Tricare Standard under the Tricare for Life program, just as you were.
Why does my doctor keep billing me?
January 25th, 2010 | TriCare Help | Posted by Military Times
Q. My doctor charged $268. Tricare allowed $192.50 and sent me a check for 75 percent, or $144.38. I paid the doctor $192.50 plus the 15 percent surcharge, for a total of $221.38. Now the doctor is demanding another $46.62, making the total the amount of his original bill, and says he’ll turn my account over to a collection agency if I don’t pay. It’s my understanding that federal law doesn’t allow him to do that. What should I do?
You are correct. The doctor may not charge you more than 15 percent over the amount Tricare allowed. If he sees Medicare patients, he is aware that the Limiting Charge law applies to Medicare claims; he needs to learn that it applies to Tricare claims also.
You should send a report to the Tricare office that processed your claim. The address is on the Tricare Explanation of Benefits form. Include a copy of the EOB and any “balance due” notices from the doctor. If the doctor persists, report him again.
It is unfortunate that the law will not allow Tricare to do more than write to the doctor and explain the federal law. Beyond that, all it can do is threaten to discontinue his status as a Tricare-authorized provider and threaten to cancel his ability to participate in other federal programs such as Medicare.
The doctor may be unaware of what his billing clerk is doing. You might consider writing or talking with him about it.