Between VA and Tricare for Life, I think I’m paying too much
May 24th, 2012 | TriCare Help | Posted by Military Times
I am a retiree enrolled in Medicare Parts A and B, and I also have Tricare For Life. I do not use Medicare; instead, I use a VA Medical Center near my home. I an in VA enrollment priority category 8, the lowest priority, so I am billed co-payments for my visits. The VA hospital will not bill TFL and as a result I’m not receiving any benefits from my TFL, even though I am paying $100 a month in premiums for Medicare Part B, which I need to be eligible for TFL. VA hospitals in other parts of the country do bill TFL. Mine won’t do it because they say they have no Tricare agreement. I don’t think it’s fair that I have these co-pays.
As you note, in certain areas of the country, VA medical facilities may become authorized Tricare network health care providers. But there is no requirement for a VA facility to do that. However, I believe the reason you were given for having to pay costs shares – that your particular VA facility is not part of a Tricare agreement – is incorrect. According to the Veterans Health Administration Handbook, TFL-eligible beneficiaries using VA medical facilities may receive all Tricare covered services, but VA services provided through TFL are always subject to cost-sharing requirements, such as applicable annual deductibles and cost shares.
“The amount of the required cost-share payment assessed to the DoD TFL beneficiary depends on the status of the VA facility as a Tricare network or non-network health care provider,” but VA cannot, in either instance, waive TFL beneficiary out-of-pocket cost shares, the handbook states. In other words, the co-pay may vary depending on the VA facility’s Tricare status, but there would be some co-pay either way. Here is the relevant section of the VHA Handbook.
All that said, I don’t think it’s fair to say that you’re getting no benefit from TFL. While you may have co-pays, those charges are far lower than the actual costs of the medical services you receive through your VA facility. What you’re not getting any benefit from is Medicare, for which you are paying $100 a month in Part B premiums. Since you are in VA’s Category 8, the lowest-priority category for care, and are already paying for Medicare Part B, you may want to consider simply using Tricare For Life. To do that, you need to find a Medicare provider. Under TFL, in most cases, Tricare will pay for whatever Medicare does not, fully covering your medical costs on the vast majority of your claims.
If I already have Medicare at 60, can I start using Tricare for Life?
May 22nd, 2012 | TriCare Help | Posted by Military Times
I am a “gray area” Army Reserve retiree. My wife and I are both on Medicare. I will soon turn 60 years old. Can we purchase Tricare For Life at that time?
Military retirees become eligible for Tricare For Life when they become eligible for Medicare. In the vast majority of cases, that happens at age 65. However, people with certain disabilities may qualify for Medicare earlier than age 65, which is apparently the case for you and your wife.
The basic eligibility requirement of Tricare For Life is that beneficiaries be enrolled in Medicare Parts A and B. The fact that you and your wife are already on Medicare means that when you cross the initial threshold to become eligible for military health care as a retired reservist at age 60, you will also become eligible for Tricare For Life at that time.
There is no need to “purchase” TFL coverage; the program charges no enrollment fees or deductibles. However, in addition to your Medicare Part B premiums of about $100 a month, retirees also pay some out-of-pocket costs for prescription drugs under TFL.
A couple of months before you reach your 60th birthday, I suggest you call the Defense Enrollment Eligibility Reporting System (DEERS) support office at 1-800-538-9552 and tell them about your imminent change in status. They will help set you up to use TFL.
Why does Tricare need my original bill when it’s the second payer?
May 18th, 2012 | TriCare Help | Posted by Military Times
I have other health insurance, and when I file with Tricare as second payer, I always have a problem getting copies of the original bills from my doctor’s office. The other plan’s EOB says what medical services I got and the amounts it paid, so why isn’t that enough for Tricare’s use? Why are copies of the original bills required?
The way services are listed on the other plan’s EOB may not report a detailed description of the medical services you actually received. For example, there may be several different services labeled simply as “office visit” on the other plan’s EOB. Tricare and the other plan likely allow different amounts for each service, so the words “office visit” and the amount allowed by the other plan does not tell Tricare exactly what kind of medical service the patient received.
Tricare must know exactly what services you received in order to determine the amount it would have allowed for each of them if Tricare had been your primary coverage. If, as I suspect, the problem arises between you and the office staff, perhaps explaining it to your doctor will remedy the situation.
What happens to wife’s coverage if my death isn’t service-connected?
May 16th, 2012 | TriCare Help | Posted by Military Times
My wife is eligible for Tricare because of my military service. What will happen to her eligibility if I die because of a condition that is not service-connected?
Your death, or the reason for it, will have no effect on your wife’s Tricare eligibility. Under current law, she can remain eligible for Tricare for the rest of her life unless she remarries. If she remarries, she will immediately lose her Tricare eligibility under your sponsorship.
If her second marriage is ended by divorce or death, her eligibility under your sponsorship cannot be restored.
Could mother still be eligible for Tricare for Life?
May 14th, 2012 | TriCare Help | Posted by Military Times
My mother got CHAMPUS through her second husband. He died in the 1990s, and she became eligible for Tricare as his widow. A few years later she got Medicare, and they canceled her military insurance. An officer friend thinks Tricare was wrong to cancel her insurance. Could she still be eligible?
It sounds like your mother turned 65, became entitled to Medicare, and thus, lost her Tricare eligibility prior to October 1, 2001, when Congress created Tricare for Life.
The best way for her to find out if she is still eligible is to call the Defense Enrollment Eligibility Reporting Service at 1-800-538-9552. They can explain to her exactly how the Tricare eligibility rules apply in her case.
Do Tricare benefits kick in at age 60 or 65?
May 11th, 2012 | TriCare Help | Posted by Military Times
You have said that retired reservists can begin receiving Tricare benefits at age 60. When I retired I was informed that the health benefits are free when you are eligible for Medicare at age 65. Which is correct?
Both statements are correct; you’re talking about two different things. When retirement-qualified reservists reach age 60, they become eligible for military health care benefits in the form of Tricare Prime or Tricare Standard. Tricare Prime charges an annual enrollment fee of $230 for an individual and $460 for a family for those enrolled before Oct. 1, 2011, and $260 for an individual and $520 for families for those enrolled after that date. Prime has no annual deductibles. Tricare Standard does not charge an annual enrollment fee, but retirees must pay annual deductibles of $150 for an individual and $300 for a family.
When retirees reach age 65 and become eligible for Medicare, they transition to the program known as Tricare for Life. At the moment, TFL charges no enrollment fees or deductibles, but the program does require retirees to have Medicare Part B, which carries a premium of about $100 a month.
Retirees also pay some out-of-pocket costs for prescription drugs under all Tricare programs.
Do we have to report insurance policy payments to Tricare?
May 9th, 2012 | TriCare Help | Posted by Military Times
My husband and I have an insurance policy that will pay us $100 for each day we are in the hospital for cancer treatment. Do we have to report that to Tricare when we file claims?
Policies that pay a specified and fixed amount directly to the beneficiary for each day of hospitalization and don’t specify that the payments are for medical bills are income protection policies. They are not health insurance and do not have to be reported to Tricare.
Can I switch from VA care to Tricare?
May 7th, 2012 | TriCare Help | Posted by Military Times
I am a retiree with a 100 percent disability. I have been getting all my medical care through the VA, but they are driving me crazy with delays. Plus, the nearest VA medical center is more than 200 miles away. How can I switch from VA care to Tricare?
The primary qualifying condition for a former uniformed service member’s Tricare eligibility is entitlement to retired, retainer, or equivalent pay. Many retirees with service-connected disabilities opt for equivalent pay in the form of a pension from the Department of Veterans Affairs in lieu of retired pay from their uniformed service. The amount of the VA pension is often greater.
To determine your Tricare eligibility, contact the DEERS Support Office at (800) 538-9552. Be prepared to tell them all the appropriate dates and numbers.
My understanding of the rules regarding a transfer of your coverage from Veterans Affairs to Tricare is that it is an administrative matter that you must resolve through the Department of Veterans Affairs. There may be special circumstances due to your 100 percent disability rating.
In essence, the rules say that a beneficiary must choose whether to receive care through Veterans Affairs or Tricare, but not both, for the same medical condition.
Getting care under Tricare may be more expensive than under Veterans Affairs auspices because of Tricare’s deductible and cost shares. Unless you have a Tricare supplement, or qualify for Tricare for Life by being entitled to Medicare, you could have to pay up to $3,000 out-of-pocket each fiscal year for those items.
Would Tricare pay for new wife’s nursing home care?
May 4th, 2012 | TriCare Help | Posted by Military Times
I retired from the Army in 1975 and I have Tricare for Life. My wife of 52 years passed away in 2010 and now I am thinking of getting remarried. I am concerned about how to protect my children’s inheritance if my new wife has to go to a nursing home for a long period of time. What benefits does Tricare offer?
Like Medicare, Tricare makes no provisions for long-term care such as in a nursing home.
While there is no upper age limit for active medical care designed to make a patient “well” and able to live more or less independently, Tricare cannot cover long-term care in a protected and secure environment with assistance with the activities of daily living, such as eating, dressing and bathing. That is called custodial care. Both Tricare and Medicare are specifically forbidden by federal law to cover that kind of care.
As a result, you must look to the private sector for such benefits.
Will Tricare cover my sister?
May 3rd, 2012 | TriCare Help | Posted by Military Times
I am currently on active duty in the Army. Is it possible to put my sister on my Tricare? She lives with me, is 18 years old and currently still in high school.
Parents, brothers and sisters, or other family members other than spouses and children are not eligible for Tricare, even if totally dependent on the military member.
For official confirmation of the above, please call the DEERS at 1-800-538-9552.