Will my Prime premiums go down automatically?
October 19th, 2009 | TriCare Help | Posted by Military Times
Q. My wife and I both have Tricare Prime and we pay the family premium rate. I will turn 65 in January and will transition to Medicare and Tricare for Life. My wife will remain on Tricare Prime. Will Tricare automatically reduce her premium to the single premium rate, or do I need to contact them and request the lower premium? If I need to call, whom do I contact?
When DEERS receives an official report from Social Security that you are entitled to Medicare Part A and are properly enrolled in Medicare Part B, it will do two things.
First, it will update your DEERS record to report your Medicare entitlement, Part B enrollment, and Tricare for Life eligibility, effective on a date established by Social Security, most likely on the first day of the month when you will be 65 years old. You will have received your official Medicare ID card by then reporting your Medicare A and B coverage effective on that date.
Note that your Medicare ID card will not mention Tricare for Life. TFL is merely the name of the Tricare program that allows combined Medicare and Tricare coverage. TFL is not related to Medicare. It is a DoD program under Tricare, so it has no reason to be on your Medicare ID card.
Tricare Standard is Tricare’s half of TFL. Part A and Part B are Medicare’s half of TFL. It is your eligibility for coverage by both programs at the same time that creates the program called TFL. Tricare Standard becomes the free second payer to your Medicare Part A and Part B claims.
Second, DEERS will cancel your Tricare Prime enrollment effective on the day your Medicare, and thus, Tricare for Life, eligibility become effective. That action will leave you eligible for Tricare Standard. DEERS will notify Tricare Prime that you are no longer eligible for that program, and your yearly Tricare Prime registration fee will be reduced by $230. The fee for your wife will be only $230.
Call the DEERS Support Office around the time your TFL eligibility goes into effect at 1-800-538-9552. Make sure your and your wife’s records have been properly updated. (I never trust anything that is supposedly “automatic.” ) If your records have not been updated, ask DEERS how to fix it.
Can VA file a claim with Tricare?
October 18th, 2009 | TriCare Help | Posted by Military Times
Q. I have Tricare For Life and a 40% disability from VA. I go once a year for a VA physical. I also get an eye exam and a hearing exam.
In May I had my eyes examined at the VA clinic. Before this I used to receive a voucher and would then go to a local civilian clinic. I just received my explanation of benefits from Tricare and saw that VA had billed Tricare for $298.81 and Tricare had allowed $138.62. No charge to me.
This is the first time I had ever had the VA bill Tricare. Is this legal? Is it a new procedure?
Without seeing the Tricare EOB, I can only guess about what happened. (Please don’t send it to me, since I no longer have any formal connections with the Defense Department or with Tricare.)
Most VA medical centers cannot file claims with Tricare. For your VA center to do so, it must have a special arrangement with Tricare. That is not a common situation, but it is quite legal when it exists.
How will my daughter be covered while studying abroad?
October 17th, 2009 | TriCare Help | Posted by Military Times
Q. I’m a retired soldier and my daughter is covered under Tricare Prime as a dependent. She will be studying abroad in Bath, England, next semester. Will she be covered? What additional insurance will I need to provide her?
Tricare Prime is not available overseas for retirees or their family members. Your daughter will have to rely on Tricare Standard, which requires a $150 deductible per fiscal year and a 25 percent cost share. Local providers may require up-front payment of fees at time of service. You can read more about Tricare Standard and the Tricare Pharmacy Program online.
Unless she is eligible for a commercial health insurance policy that will cover her as primary payer to Tricare outside the U.S., you may want to consider buying a Tricare supplement through one of the military associations. Most supplements pay, at least, the patient’s Tricare deductible and cost share. Compare several plans, and make sure you read the fine print carefully before buying. Be certain it states in the body of the policy itself that it is a specially written plan, designed to be a Tricare supplement, and that it covers Tricare claims for medical care received outside the U.S.
There will be some problems with the Tricare Pharmacy Program due to international laws concerning mailing of prescription drugs outside the U.S. If there is a U.S. Consulate in Bath, it is possible that she can arrange to have drugs sent to that address. To get official clarification about that matter and advice about filing prescription claims, call Express Scripts Inc. at 1-866-363-8779.
I strongly suggest that you contact the Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, Co 80011-9043, to discuss your daughter’s plans officially with Tricare Management. Among other things, if your daughter is 18 or older, you will need to file with Tricare a statement, signed and dated by your daughter, authorizing Tricare to deal with you concerning matters of her medical care and Tricare claims. This is a Privacy Act concern if she is, or will be, 18 or older. That way, you can help her with claims and/or medical care should the need arise.
I’m deploying – how can I make sure my wife gets care?
October 16th, 2009 | TriCare Help | Posted by Military Times
Q. I’m on active duty, and this is my first deployment since I got married. I don’t think I will need medical care, but my wife is on disability and requires medicine every week. What is the best plan for us?
All your personal medical care will be provided free by your service. Your personnel section will take care of that for you.
You need official advice and information concerning registering your wife and any children in DEERS and getting military ID cards for your family.
Call the DEERS Support Office, toll-free, at 1-800-538-9552, for all your questions about eligibility for military benefits, including getting your wife enrolled in Tricare.
Then, go to the official Tricare web site and review the eight options for Tricare information. Write down the contact information for the Tricare regional office for the area where your wife will live while you are deployed. Call that office, tell them your situation and ask them to send your wife a Tricare Prime Handbook. (You can also download one here.) Then, read up on the Tricare Pharmacy Program, Tricare Prime, and Tricare Standard.
In the Patient Affairs Office at every military treatment facility you will find a person called a Health Benefits Advisor or Tricare Advisor whose job is to help resolve Tricare problems or answer questions you or your wife might have. That person works for the treatment facility, not for Tricare. If you have a complaint about that person, talk with the hospital’s adjutant about it, not with Tricare.
Make sure your wife knows how, if necessary, to file Tricare claims, use the Point of Service option under Prime, resolve claims problems and file appeals.
She needs to know to call DEERS for any and all questions regarding eligibility for any military benefit, how to contact Tricare — and how to reach me, for usually quick, but unofficial help, at tricarehelp@atpco.com
You mentioned your wife’s disability and special medication needs. Her medicine will be free at the hospital pharmacy. The nationwide phone number for the non-military treatment facility Tricare Pharmacy Program Administrator, Express Scripts, Inc, is 1-866-363-8779.
If your wife is eligible, or will soon become eligible, for Medicare due to her disability, ask her to contact me.
Spouses are the real backbone of all the services and the most important morale element of all. Encourage your wife to socialize with the other wives — there’s nobody tougher, and all will be glad to help.
Tricare and Medicare Parts A and B
October 15th, 2009 | TriCare Help | Posted by Military Times
Q. I retired from the Army and currently use Tricare Standard as my primary medical insurance. My wife will turn 65 soon and is retired and drawing Social Security. When she contacted the Social Security Administration about registering for Medicare Parts A and B, they said that if she was currently receiving a Social Security benefit she will automatically be signed up for Medicare Parts A and B on the 1st day of the month she turns 65. But I have seen a lot of information that says that you must personally sign up for Medicare Parts A and B or face losing your Tricare coverage. Does my wife need to go to the local Social Security Office and sign up or is this taken care of automatically?
Remember that Medicare and Tricare are totally different and unrelated programs. They operate under the authority of different laws and regulations. Depending on what previous contact you have had with Social Security and Medicare, your Medicare enrollment may, or may not, be automatic. It is your responsibility to contact that office to make sure you are doing things properly.
To allow time for the administrative things to be done, Social Security wants everyone approaching their 65th birthday to apply for benefits at least 90 days before the first day of the month when they will be 65. Only Social Security can tell you the status of your application and whether you still need to apply. The toll-free number for that office is 1-800-772-1213.
Both Medicare and Tricare have rules about when a person is required to be enrolled in Medicare Part B.
Medicare’s rule concerns the penalty for failure to enroll in Part B within a grace period after the effective date of their Medicare Part A entitlement. That is an important rule and it applies to all Medicare beneficiaries, both civilian and military. If you call Medicare regarding Part B enrollment, you will get information about that rule. Do not ask Medicare about any rules concerning Tricare.
Tricare’s rule is even more important because it affects all uniformed service retirees, their eligible family members, and survivors of deceased active duty and retired personnel. It does not apply to active-duty family members. Because you are a retiree, however, it does apply to both of you at the time each of you, individually, becomes entitled to Medicare.
If you have applied properly for Medicare, you will receive an award notice a few weeks before the first day of the month when you will be 65. It will contain a number of information documents, but three are very important:
- An official notification that you have been awarded Medicare Part A and Part B.
- An official Medicare Identification Card confirming that you are entitled to Medicare Part A and Medicare Part B, effective on the first day of the month when you will be 65. That is your proof of insurance that you will have to show to Medicare providers when you go to get care.
- A post card that you can sign and return to Medicare. It states that you wish to drop out of Medicare Part B. If you sign and return that card, your Part B entitlement will be canceled. Do not sign and return that card.
Federal law requires that every uniformed service retiree, eligible retiree family member, or survivor who becomes entitled to Medicare Part A must be enrolled also in Medicare Part B, effective on the same day that their Part A entitlement becomes effective.
Failure to be enrolled in Part B causes the immediate loss of all Tricare eligibility. It cannot be restored until the beneficiary has effective Medicare Part B coverage.
Social Security/Medicare is supposed to notify DEERS automatically when you are enrolled in Medicare Part B. Occasionally, through human or machine error, that does not happen. So, a couple of weeks after you receive your Medicare packet and ID card, call the DEERS Support Office, toll-free, at 1-800-538-9552. Ask if your DEERS record has been updated to show Part B enrollment and Tricare for Life eligibility. If your record has not been updated, ask DEERS what you need to do to fix it.
One more thing: Call your Tricare for Life service center, toll-free at 1-866-773-0404, and ask them to send you a free Tricare for Life Handbook. Or you can download one here.
Tricare and FEHB: What are my options?
October 8th, 2009 | TriCare Help | Posted by Military Times
Q. I am a retired naval officer who will be 60 in 2010. I am also a retired federal employee who now uses the Federal Employee Health Benefits plan as primary health insurance. I intend to continue with FEHB after age 60. Its costs are reasonable now, about $75 per month plus medicines from an online pharmacy.
I am trying decide if signing up for Tricare for Life makes economic sense. I am not counting on any significant payout from Social Security because of the dual compensation offset. I am estimating about a 60% reduction there. I am not at all confident that Medicare will cover all my health costs. Would Tricare for Life cover hospitalization as secondary to Medicare? What will TFL cost, and what will it cover after age 60?
When you ask about Tricare for Life, you are talking about five years from now, when you are old enough for Medicare — unless you qualify for Medicare disability benefits and become entitled to Medicare before you are 65. A retiree must be entitled to Medicare and be enrolled in Parts A and B to be eligible for Tricare for Life. It isn’t possible to predict what the program will be like in 2015 when you are 65 and become entitled to Medicare. In the meantime, you can read more about Tricare for Life online, and even download the handbook if you want to plan ahead.
You need to know about the plans you and your family will become eligible for when you are 60. So, online, read about Tricare Standard, Tricare Extra, and Tricare Prime. Also, become familiar with the Tricare Pharmacy Program. All Tricare beneficiaries get the Pharmacy benefit.
While you are online, make a note of the contact information for your regional Tricare office. Call and ask them to send you Handbooks for Tricare Standard or for Tricare Prime if you are interested in that program and if it is available in your residential area. That is also the office to call if you need official Tricare information or help. You can also download the handbooks here: Standard, Prime.
Please note that Tricare Prime is not recommended for people who have other health insurance. It is a useless expense, and coordination of benefits by Tricare Prime with other health insurance can be difficult.
When you are 60 years old and become entitled to receive retired pay, you, your wife, and any unmarried children under age 21 will become eligible for “ordinary” Tricare. An unmarried child who is a full-time student at an accredited college, university, or trade school can remain eligible for Tricare until marriage, graduation, or his 23rd birthday. Your reserve component will probably register you in DEERS, but you must apply on behalf of your family for them to be Tricare eligible.
For questions about Tricare eligibility, call the DEERS Support Office, toll-free, at 1-800-538-9552. DEERS deals with eligibility issues only. It cannot provide any information about the Tricare program or Tricare claims.
Tricare Standard is free. Tricare Prime, if available, costs $230 per person per fiscal year, or $460 for an entire family of two or more people.
As you plan to retain your FEHBP plan, Tricare Standard would probably be your best choice of Tricare plans. Tricare Standard is free, and it combines very easily with commercial health insurance such as your FEHBP plan, as second payer. In most cases, Tricare Standard will pay the patient’s share (usually your FEHBP deductible and copayment) – in part at least, but often completely, leaving you with little or no out-of-pocket medical care expense.
Tricare Standard or Prime will cover at least the same medical services as your FEHBP plan, and probably more. It may not pay as much because the amounts Tricare may pay are linked by federal law to Medicare payments. But, as you will have the FEHBP as your primary coverage, a smaller Tricare payment will not be significant, as it will be second (last ) payer and will need to pay only what the FEHBP plan did not pay.
Fee hikes for hospital stays: What do they mean?
October 7th, 2009 | TriCare Help | Posted by Military Times
Q. Since the Defense Department announced on Sept 30 that it would be raising the hospital inpatient copay for retired Tricare Standard beneficiaries by $110 per day (from $535 to $645) as of Oct 1, what is the practical impact on retirees not yet on Medicare and those who have reached age 65 and are on Medicare? Does it just mean that retirees not yet on Medicare will need supplementary insurance to pay the additional cost? What about those whose primary insurance is Medicare and secondary is Tricare for Life?
Something many beneficiaries forget is that the inpatient cost share increases every year on October 1. It is not a phenomenon special for this year only.
The consequences are the same as for any other year. Tricare Standard beneficiaries who do not have other health insurance or a Tricare supplement have more to pay out-of-pocket as a share of the increasing costs of hospitalization for the entire U.S. population, not Tricare beneficiaries alone.
The Defense Department has always recommended a Tricare supplement. The 25 percent Tricare Standard cost share for retirees is required by the federal law.
You might not be old enough to remember that, prior to Tricare (called CHAMPUS when it was enacted in 1966), there was no government program to pay even a penny for civilian medical care for active-duty family members, retirees, their family members or survivors.
I was on active duty when my children were small in the 1950s. I paid out-of-pocket for their civilian medical care during periods when our base hospital had no pediatrician.
Those fortunate enough to have Tricare for Life (TFL) have the advantage of Tricare Standard as a free Medicare supplement. On the vast majority of their Medicare claims, Tricare Standard pays whatever Medicare does not pay when the medical services involved are covered by both Medicare and by Tricare. The only service covered by Medicare, but not by Tricare, is chiropractic care.
TFL came into existence by act of Congress in 2002. Before that, any beneficiary who became entitled to Medicare at age 65 lost all Tricare eligibility.
Will Tricare cover my copayments?
October 5th, 2009 | TriCare Help | Posted by Military Times
Q. I’m a reservist and eligible for Tricare. My civilian job has an excellent medical benefit, so I haven’t signed up for Tricare. My question is: If I did sign up, could I use Tricare to cover my copays?
If you are at least 60 years old and have become entitled to receive retired pay, your Personnel Section should have registered you in DEERS when you applied for retirement. To confirm your DEERS registration and Tricare eligibility, please call the DEERS Support Office at 1-800-538-9552.
If you are not properly registered, ask DEERS how to fix it. You cannot use Tricare unless you are properly registered in DEERS.
When you became eligible for Tricare, so did your wife and any unmarried children under age 21 — or under age 23 if the unmarried child is a full-time student at an accredited college or trade school. Like you, they must also be registered in DEERS.
For detailed instructions on filing claims with Tricare as second payer to other health insurance, see this question that I answered a couple weeks ago.
Does my disability affect my eligibility?
October 1st, 2009 | TriCare Help | Posted by Military Times
Q. I am a retired member of the National Guard. My wife (who is younger than I am) and I receive Tricare Standard. I will be 61 next month and recently applied for Social Security disability. If my application is approved, am I required to do anything? Do I need a new military retired ID? Will my retirement be affected? My disability is not service connected.
I know very little about the rules governing Social Security disability benefits, except that if Social Security finds you eligible for disability benefits, it will have no immediate effect on your Tricare eligibility.
After receiving disability benefits for twenty-four consecutive months, it is my understanding that you will become entitled to Medicare. If you become entitled to Medicare, it will affect your Tricare coverage in one of two ways:
First, a uniformed service member who is entitled to receive retired, retainer or equivalent pay is required by federal law to be enrolled in Medicare Part B if he becomes entitled to Medicare Part A. If the retiree with Medicare Part A does not enroll in Medicare Part B, he will lose his Tricare eligibility on the day his Medicare Part A coverage becomes effective. That is not a Tricare rule. It is a requirement of federal law.
Second, Medicare entitlement makes you eligible for Tricare for Life if you are enrolled in both Medicare Part A and Part B. That program is very favorable for its beneficiaries.
Tricare for Life consists of full coverage under Medicare Part A and Part B plus full coverage under Tricare Standard. You become a Medicare beneficiary because Medicare is your primary health “insurance” plan.
You must seek all your medical care from Medicare providers. The provider will file a Medicare claim for the services he provides to you. Medicare will pay its statutory amount directly to the provider. Then, Medicare will automatically forward the claim to Tricare as second payer.
For every medical service on the Medicare claim that is covered also by Tricare, Tricare will pay to the provider whatever Medicare did not pay. Usually that will be your Medicare copayment and your Medicare deductible, if applicable on that particular claim.
The combined payments by Medicare and Tricare will pay the balance on the Medicare claim. The Tricare payment, together with Medicare’s previous payment, will pay the Medicare claim, and the provider’s bill in full. You will have no out-of-pocket expense for the medical services on that Medicare claim. The vast majority of your Medicare claims will be of that nature.
Apart from the small copayments (called cost shares) for prescription drugs, you will seldom have to pay anything for your medical care.
While you’re still at least two years away from being eligible for that program, you can read more about Tricare for Life on the Tricare web site, or even download a handbook.
Regarding the questions about your retirement, ID card, and Medicare disability, I suggest that you contact DEERS, toll-free, at 1-800-538-9552 for official information.
Worried about rumors of Medicare cuts
October 1st, 2009 | TriCare Help | Posted by Military Times
Q. If the Congress cuts the Medicare program by $500 billion, what happens to Tricare for Life? While it is a government health benefits program, Tricare for Life is tied to the Medicare program. I am confused as to how Tricare for Life will come out.
Remember that Medicare, too, is a government program, governed by federal law. In any case, that figure is contrary to the President’s public declarations regarding Medicare, and I’m not one to speculate about speculations. Let’s wait until we have something definitive to talk about. Then we can worry.
I’m certain you can understand my reasons. Que será será.