How can I make sure my son’s child – born out of wedlock – is covered?
October 30th, 2009 | TriCare Help | Posted by Military Times
Q. My son is currently deployed to Afghanistan. He will become a father in March or April. He is not married to the mother, but there is no question of paternity. I have his power of attorney, and I am trying to set up whatever is needed to secure benefits for his son when he is born. What needs to be done? Whom do I contact?
Those who wrote the law and regulation governing Tricare eligibility, fortunately, had the foresight to consider situations like your son’s. A uniformed service member’s child born out of wedlock may be declared eligible for Tricare if paternity is judicially determined. The child’s eligibility presumably begins at the moment of birth. But to the best of my knowledge, that does not confer any Tricare eligibility on the mother, not even for her maternity care.
Tricare Help has no official affiliation with the Defense Department, however. For official answers about eligibility, you must contact the the Defense Enrollment Eligibility Reporting System (DEERS) at 1-800-538-9552. DEERS is a federal agency under auspices of the Defense Department. All matters discussed with DEERS are protected by the federal Privacy Act of 1974. It maintains a computerized database of all Defense Department beneficiaries and the military benefits to which each is entitled by law.
Tricare itself does not have the authority to make individual eligibility determinations. Only the uniformed services have the authority to determine whether a given individual meets the legal criteria for Tricare eligibility, to register an eligible person in DEERS, and to issue a uniformed service identification card. DEERS will help you resolve the matter of the child’s Tricare eligibility. They can tell you what to do and whom to contact.
Will Tricare and federal plan cancel out my copays?
October 29th, 2009 | TriCare Help | Posted by Military Times
Q. I am trying to make a decision about health care and looking for some answers. I am pregnant, and in order to see a civilian doctor I have to disenroll from Tricare Prime and enroll in Tricare Standard. I am not happy with the military treatment facility OB care, as the doctors are never the same and each has their own opinion. I am also a federal employee and in my window to enroll for my own insurance. The cost per month will be about $80 for myself, but there are copays and deductibles.
Will having two health insurances take care of the copays and deductibles, or will I still incur these out-of-pocket fees?
If you are enrolled in one of the plans available under the federal employees health benefits program, it will become your primary coverage. If you are also enrolled in Tricare Standard, it will be second payer.
As second payer, Tricare Standard will probably pay most, perhaps even all, of the deductibles and copayments of the FEHBP plan. There are no guarantees, but you should have very little, if any, out-of-pocket medical expenses.
You didn’t say, but I assume you are married and eligible for Tricare through your husband’s service. He will have to register the baby in DEERS and enroll the baby in Prime or in Standard very soon after birth. Talk with the Tricare Adviser at your MTF about that soon, because I believe you personally will be locked out of Prime for one year.
If you are not married, and if your Tricare eligibility is a result of your father’s or your mother’s military service, your baby, as a grandchild, will not be eligible for Tricare at all.
If you do not know how to file a claim with Tricare as second payer, see my response to this previous question.
How will my service-connected disability affect my coverage?
October 27th, 2009 | TriCare Help | Posted by Military Times
Q. I currently have Medicare Parts A and B, and Tricare for Life. After a two-year fight with the VA, they now say my hearing loss and tinnitus is service connected. My DAV rep thinks I will get either 20% or 30%, depending on the hearing test the VA is giving me. Once I get the service connected disability, will this change any of my health coverage?
Because you have TFL, Medicare is your primary coverage and half of the TFL Program. Your TFL benefits begin when a Medicare provider files a Medicare claim for the services he provides to you. Because the Medicare claim must be filed first, you need to ask Medicare about any effects of your VA rating on your Medicare coverage.
My guess is that Medicare will have the same rule as Tricare about the rating, but only Medicare can tell you about that officially.
The VA rating you mention should have no effect on your or your family’s Tricare coverage. Tricare Help’s reply is always unofficial, however. To get official information, call Tricare.
Tricare Standard is the other half of your TFL coverage. By law, it is second (last) payer. When Medicare finishes processing a claim for a TFL beneficiary, it will pay its share to the provider. Then it will automatically forward the claim to the special Tricare claims processor for TFL. On the vast majority of your claims, Tricare will pay whatever Medicare did not pay for every medical service that is covered by both Medicare and Tricare. As a TFL beneficiary, you will seldom have any out-of-pocket expenses for your medical care. The major exception is the small copayments (cost shares) for your prescription drugs; all Tricare beneficiaries automatically qualify for benefits under the Tricare Pharmacy Program. It’s the best pharmacy plan I know of. That’s why TFL beneficiaries do not need to enroll in the Medicare Part D Pharmacy Plan. For TFL beneficiaries, Medicare Part D is not necessary, and it can cause a lot of hassles for little in return because you have to file two claims to get full reimbursement for your prescription drugs.
A very few VA medical centers have a special arrangement with Tricare that allows them to file a Tricare claim for those charges, but most of them do not. If you get a bill from the VA, call your Tricare Service Center to ask whether you may file a Tricare claim.
Whom can we ask about suspending Medicare Part B?
October 26th, 2009 | TriCare Help | Posted by Military Times
Q. My wife is legally blind and has Medicare Part B and Tricare for Life. I have recently been told that I can suspend her Medicare Part B since I am still on active duty. If so, where can I find that information? Can we also file for back pay on what we have paid for Part B?
Your request has to do with military regulations concerning Tricare eligibility, not the Tricare program itself. Write to Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, Colo., 80011-9043. That office is not available by phone.
In your letter, explain what you want to do and why, and ask TMA to advise you about the proper procedures and consequences. Include your full name and Social Security number, your military address, your wife’s full name as it is in DEERS, her SSN, and a phone number where you can be reached during the day. In addition, include a statement that she must sign and date in which she authorizes you to represent her with Tricare and Medicare in the matter. That is Privacy Act stuff.
Wanted: A guide to filing Tricare Standard claims
October 24th, 2009 | TriCare Help | Posted by Military Times
Q. My first wife died three years ago, and I remarried in July 2009. My new wife registered in DEERS, and now we both use Tricare Standard, with MOAA MediPlus as supplemental health insurance. My first wife used to handle the bills, so I did not keep track myself. Now, I have been getting bills, and EOBs, but so far — over the past three years — have not submitted any claims, as I don’t know how to go about it. Is there a procedure or pamphlet I can get that explains how I should proceed?
Health Affairs maintains an official Tricare web site at www.tricare.mil. It is designed especially to be of service to Tricare beneficiaries.
Go to the site and complete a profile, following instructions at the site. You should find all you need there. Be sure to make a permanent, easily accessible record of contact information for your Tricare Service Center (your Regional Tricare Office). You will need to talk with them from time to time. Then contact that office on its toll-free number to ask your questions and to order a free Tricare Standard Handbook, or download one from the site.
On disability for a year; what happens to my coverage?
October 23rd, 2009 | TriCare Help | Posted by Military Times
Q. I am a 59-year-old military retiree. I’m enrolled in Tricare Prime, was recently treated for cancer and have applied for Social Security disability. The Social Security disability, if approved, will probably be for no more than one year. If it’s granted, do I have to disenroll from Tricare Prime and enroll in Medicare Part B, and revert to Tricare Standard as I would not be eligible for TFL? Also, I do plan on returning to the work force once I am off disability. Will I then have to re-apply to Tricare to go back on Tricare Prime? Also, if company that you work for offers health care with a premium that is deducted from your pay, am I required to use that health plan primarily and Tricare as the secondary?
People who qualify for Social Security disability benefits become entitled to Medicare only after receiving disability benefits for 24 consecutive months. Unless and until you become entitled to Medicare (whether for disability or by reaching age 65) there will be no consequences of any kind for your Tricare coverage.
If your employer sponsors a health insurance plan for employees, regardless of who pays the premium, it will have no effect on your Tricare coverage unless you enroll in that plan. Tricare will not require you to enroll in your employer’s plan.
If you do enroll in the plan, by federal law it will be primary to Tricare. You must file all claims with your employer’s plan first. After that plan completes processing the claim and issues an Explanation of Benefits, you may file a claim with Tricare for the same bills. Tricare will pay part, or all, of what the other health insurance did not pay for every medical service on that claim that is covered also by Tricare. That will usually be the other health insurance’s deductible, if applicable, and your copayment.
I do not recommend Tricare Prime for people with other health insurance because of duplication of services, additional expenses, difficulties with which plan must pay first, and problems with coordination of benefits. To avoid those problems, I recommend Tricare Standard for those with other health insurance.
Switching Tricare from primary coverage to secondary
October 22nd, 2009 | TriCare Help | Posted by Military Times
Q. I recently married, and my husband is active-duty Army and will be deployed in December. I went part-time with my job so I am not eligible for benefits right now, but I will go back to full time in January and will once again be eligible for benefits through that job. Do I have to use that as my primary insurance, or can I keep Tricare as my primary insurance?
Federal law requires that Tricare must always be last payer to all other health insurance, medical plans such an HMO, or medical payments — such as you might receive as the result of an insurance settlement in an auto accident, slip-and-fall accident, and the like. The only exceptions under the law is if the other coverage is a bona fide, specially written Tricare supplemental policy, or if it is a welfare-related plan such as Medicaid (not Medicare).
During the time when your plan through employment is inactive, Tricare will be first payer — you will file claims with Tricare as your only coverage. On the first day that your employer’s plan is reactivated, it must become your primary coverage.
When your other health insurance is in force and becomes first payer, you may use Tricare as your secondary coverage. Tricare will pay much, if not all, of the OHI’s deductibles and copayments, which will greatly reduce your out-of-pocket health care costs. And Tricare Standard, of course, is free. You can read more about filing claims with Tricare as a second payer here.
Is Lasik covered?
October 21st, 2009 | TriCare Help | Posted by Military Times
Q. I am the spouse of an active-duty member, and I had Lasik surgery on my eyes to improve my vision. Will Tricare pay for any of the surgery — the operating room, meds, anything at all? If not, is there a chance of appealing? It seems to me, it would save them money over the long term, as I no longer need glasses or contacts.
I’m sorry to be the bearer of bad news, but I checked with Health Affairs and was told officially that, as of this writing, Lasik is still a noncovered service under Tricare. When a medical service is not covered by Tricare, none of its associated costs can be covered either.
Continuing coverage for children older than 21
October 20th, 2009 | TriCare Help | Posted by Military Times
Q. Is there a Tricare Prime that can be purchased for our children after they turn 21 so they have health insurance?
Unlike an insurance policy that can be purchased, Tricare eligibility is established by federal law.
Unmarried children are eligible for all Tricare benefits, including Tricare Standard, Tricare Prime, and the pharmacy benefit until the child marries or reaches age 21. There are two exceptions:
- An unmarried child who is a full-time student at an accredited college, university, or trade school may remain eligible for Tricare Standard or Prime and the pharmacy program until the child marries, graduates, or reaches age 23.
- An unmarried child who becomes disabled and incapable of self-support prior to reaching age 21 may remain eligible for Tricare Standard, Prime, and the pharmacy program indefinitely, for as long as the disability endures. If the disability ever improves, however, and the child becomes capable of self-support after age 21, Tricare eligibility is lost and cannot be restored even if the disabling condition recurs later in life.
There is a commercial plan available in short blocks of time designed to form a bridge between the loss of Tricare eligibility — due to discharge, divorce, “aging out” of eligibility, etc. — and obtaining other coverage through employment and the like. You can read more about the Continued Health Care Benefit Program online.
For official information about the Tricare eligibility of children, and confirmation of all the above, please contact the DEERS Support Office, toll-free, at 1-800-538-9552.
What about dental?
October 20th, 2009 | TriCare Help | Posted by Military Times
Q. Are there any dental benefits for military retirees?
Tricare has arranged for a commercial dental program available at special group rates for uniformed service retirees. Most beneficiaries who subscribe say it is quite good, and cheaper than plans available for civilians. You can get more information about it here.