Does Social Security eligibility change affect Medicare, TFL?
December 31st, 2009 | TriCare Help | Posted by Military Times
Q. I am currently 61. Tricare states I have to enroll in Medicare Part B upon reaching age 65. Since the Social Security rules changed and I can’t draw social security until age 67, how is this going to happen?
A few years ago, the Social Security law was indeed amended to make eligibility to receive Social Security payments depend on the beneficiary’s year of birth. The age for entitlement for Medicare, however, remained unchanged at 65.
Medicare will bill the beneficiary every 90 days for the Medicare Part B premium until he or she reaches the statutory age to receive Social Security payments. From that time on, the Part B premium will be deducted from the monthly benefit check.
Since Tricare for Life began in 2001, federal law requires all except active duty family members and Tricare beneficiaries enrolled in the US Family Health Plan to be enrolled in both Medicare Part A and Part B on the effective date of their Medicare coverage. Failure to be enrolled in Part B on that date causes the loss of Tricare eligibility until Part B enrollment is in force.
Cheating on Tricare forms isn’t worth it
December 16th, 2009 | TriCare Help | Posted by Military Times
Q. You’re going to think I’m crazy, but I figure you’re probably a safe person to ask: The Tricare claim form asks if I have other health insurance, and I always report my other policy. But, if I didn’t report it, I could collect from both policies and offset some things that don’t get paid. So, please satisfy my curiosity. What are my chances of getting caught if I don’t report the other policy, and what would happen if I did?
Your question isn’t new and neither is my reply. It’s a legitimate question, and an important one. So, no, you aren’t crazy. Unless you do it, of course.
Deliberate failure to report your other health insurance on your claim form is illegal. Additionally, stating falsely that all information on the form is correct, when you know it is not, is illegal. That is not an auspicious beginning.
Your signature on the Tricare claim form affirms, “under penalty of perjury,” that the information on the form is true. If the information is untrue, it is a false sworn statement used to obtain something of value you are not legally entitled to. That being true, I don’t think the claim would be different from any other false claim against the government. It wouldn’t be special, or somehow different, because it involved Tricare. The prosecuting authority would probably call it fraud.
Some very elaborate and sophisticated insurance fraud schemes appear from time to time. And it goes without saying that you never hear about the successful ones. So, what are your chances of getting caught, and what would happen next? I don’t know your chances of getting caught. I’ve never seen any statistics on the subject. When I worked for Tricare, I wasn’t involved with the folks who investigated fraud. Minor offenses aren’t often reported in the newspapers.
Considering the millions of Tricare claims processed every year, and the fact that bad guys vastly outnumber good guys – the examiners and auditors – you would probably get away with it for a while; maybe for a long time. But once discovered, all of your claims would be audited, forever.
And, once caught, what would happen? I have to guess that it could be anything from a fine to a sudden lifestyle change. But, that would be up to a federal prosecutor and a court. If you decide to do it, and if you get caught, drop me a line from
wherever. It will be your turn to satisfy my curiosity.
Without pension, can my wife still get Tricare?
December 15th, 2009 | TriCare Help | Posted by Military Times
Q. I retired from the Army National Guard. I am drawing a pension from my former employer as well as from the Army. I elected survivor benefits from my employer but not from the Army. If I predecease my wife, is she entitled to Tricare for Life even though she will not be receiving an Army pension?
Your decision regarding military survivor benefits for your wife will have no effect on her Tricare or Tricare For Life coverage. Neither will your death have any effect — unless she were to remarry.
If your wife were to remarry, she would immediately and permanently lose all Tricare eligibility received as a result of your service. If her second marriage were to end by divorce or death, her Tricare benefits under your sponsorship can never be restored.
To confirm those facts officially, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
DEERS is the place to call for answers to all Tricare eligibility questions, for help with resolving eligibility issues or problems, and for help to enroll a new spouse or child in Tricare.
DEERS cannot provide any information about the Tricare program, its benefits, or its claims. For that information, you must call your Tricare Service Center or search for the information in the official Tricare web site.
Tricare beneficiaries should contact DEERS at least once each year to confirm that all information in their DEERS record is correct and up-to-date. Any status changes — such as an address change, or changes in family members such as a newborn child, a child turning 21, a child who marries, or a family member who dies — should be reported to DEERS promptly.
What’s covered for jaw disorder?
December 14th, 2009 | TriCare Help | Posted by Military Times
Q. We have Tricare Standard. I have been looking through our handbook and cannot find anything on coverage or exclusion of Temporomandibular Joint Disorder, or TMJ. I suffer from this and need to know if Tricare covers any kind of surgery or therapy.
I checked with Health Affairs, and they told me that the only service covered for TMJ problems is oral surgery under certain specific conditions. Health Affairs advises that you or the provider should contact your Regional Tricare Service Center for advice and for information about the procedures that must be followed prior to any surgery.
My opinion is that it might be best if your provider made the call to Tricare in case there are technical or medical questions that he can address best.
Don’t go forward on any treatment procedure without contacting Tricare first.
Why do some doctors take Standard but not Prime?
December 11th, 2009 | TriCare Help | Posted by Military Times
Q. Why do doctors out of the network accept Tricare Standard, and not Tricare Prime?
Tricare Standard and Tricare Prime have different payment agreements with health care providers.
A provider is at complete liberty to provide care to Tricare Standard or Tricare Prime beneficiaries, or both, or neither, totally ad lib. It is the provider’s choice.
To understand the differences in payment methods, you can read more about Standard and Prime on the Tricare web site.
If we marry and my husband dies, will I be eligible?
December 4th, 2009 | TriCare Help | Posted by Military Times
Q. My fiance is 84, a retired Navy man, and he’s just been diagnosed with pancreatic cancer. He would like me to marry him so I can be covered by Tricare after his death.
My question is, if he dies — say, a month after marriage — would I still be eligible for Tricare benefits?
Your fiance should contact the Defense Enrollment Eligibility Reporting System, better known as DEERS, for instructions to enroll you in Tricare. That can be done only through the uniformed services. DEERS is the official Defense Department agency that will provide the help he will need to do that. The toll-free number for DEERS is 1-800-538-9552.
You will become legally entitled to Tricare the moment your husband kisses the bride. If he were to die in the next minute, your Tricare eligibility will still be in effect. It is the fact of your legal marriage that creates your Tricare eligibility, immediately. To use Tricare, of course, there will be administrative details to accomplish. Call DEERS for help.
You didn’t mention your age. If you are, or if you become, entitled to Medicare, federal law requires you to be enrolled both in Medicare Part A and Medicare Part B to qualify for Tricare eligibility.
For the rest of your life, you will be responsible for checking your registration in DEERS to keep it up-to-date, and to promptly advise DEERS of any changes in your status, such as an address change.
Similarly, you will be responsible for keeping your military identification card up-to-date. At least 90 days before your card expires you will need to contact DEERS for help with renewing it.
Every time a Tricare claim is processed, the claims processing computer automatically contacts the DEERS computer to ensure that the patient on the Tricare claim was eligible for Tricare on the date she received the medical care. At that time, also, Tricare confirms the beneficiary’s eligibility generally by comparing the information on the claim form with the information in the beneficiary’s DEERS record. Thus, you see the need to keep it up to date. Discrepancies can cause claims to be denied until they are corrected.
If you are, or if you become, entitled to Medicare and are enrolled in Part B, you will be eligible for the Tricare program named Tricare for Life, also called TFL for short. TFL is a Tricare plan created by Congress in 2001. It allows a Tricare beneficiary who has Medicare to use Tricare Standard as second payer to her Medicare A and B coverage. In the vast majority of claims, the combined payments by the two federal benefit programs will pay your medical bills in full.
I suggest you visit the official Tricare web site now. Here you can locate your Regional Tricare Office (make a permanent record of the contact information — that will be your primary source for official Tricare help and information), see an overview of the Tricare plans, and — if you are entitled to Medicare now, or will become entitled soon, and are enrolled in Part B — look at the information about TFL and download a Tricare for Life Handbook.
If you are not near Medicare entitlement age (65), your choices for coverage will be Tricare Standard or Tricare Prime.
Prime is not available in all areas, so if you are interested in that plan, call your Regional Office again to ask if Prime is available for persons in your residential area. Tricare Prime costs the least in out-of-pocket expenses, but it also has certain inconveniences for members who travel frequently.
Under Prime, you must use only certain providers in your local area who are under contract with Tricare to provide care at discounted rates. Prime membership also allows you priority access to your nearby military treatment facility where you can get free medical care including hospitalization.
When you become eligible for Tricare, it is for life, unless, as a widow, you remarry. If you remarry, you will lose all military benefits from this husband. They can never be restored, even if the next marriage ends in death or divorce.
All Tricare beneficiaries without exception are automatically eligible for and are enrolled in the Tricare Pharmacy Program. It is one of the very best prescription drug programs in the nation. It needs no help from any other pharmacy insurance plan. You can get a 90-day supply of a drug for the same price as you pay for a 30-day-or-less supply when purchased locally.
We’re not married – can I still get maternity care?
December 3rd, 2009 | TriCare Help | Posted by Military Times
Q. I’m a civilian but my boyfriend is in the Army. I’m pregnant and we were wondering, could I be covered under his insurance without us getting married? Just until the baby is born. I don’t know how the whole military insurance thing works.
Because you are not legally married to the baby’s father, you are not eligible for Tricare for any of your maternity care.
If you were married, you would be covered from the date of the marriage. You can confirm that by asking DEERS. Its toll-free telephone number is 1-800-538-9552. Everything you tell DEERS is completely confidential, and the information DEERS will give you is official.
I urge you to call DEERS now and talk with them about your eligibility question, especially as concerns the baby’s Tricare eligibility from the moment he is born. You need official information and help.
Because the father is on active duty, federal law makes the baby eligible for Tricare from the moment he is born. But, the father must do some things to get the baby signed up in Tricare because you and he are not married. The baby cannot use Tricare until he is properly signed up for the program. Talk with DEERS about that also.
Tell the father to go to the Legal Office (JAG Office) at his base and to talk with one of the Legal Officers (a military lawyer) about his baby’s Tricare coverage. He will need help to do the things that are necessary for the baby to get Tricare benefits for his medical care. That legal help will be free.
Tell the father about DEERS and give him the DEERS phone number. He should also talk with DEERS about the baby’s Tricare eligibility. Both you and the father need to know about those things so Tricare can help pay for any medical care the baby needs from birth, and for as long as the father is on active duty.
Tricare eligibility is established by federal law for designated categories of persons. Tricare does not have the authority to make individual eligibility determinations. Only the uniformed services have the authority to determine whether a particular person meets the legal conditions to be eligible for Tricare, to register an eligible person in DEERS, and to issue an appropriate identification card.
Will my Prime premiums change?
December 2nd, 2009 | TriCare Help | Posted by Military Times
Q. I’m a retired Navy CPO, and we currently pay roughly $420 a year for our Tricare insurance. Everyone is saying our coverage won’t change, and the list of providers may decrease, but my question is: Will my premiums change? I can’t seem to find any answers.
No one can predict what the future may bring, but you can include me on your list of “everyone” who says the Tricare Prime enrollment fee and coverage will not be be changed in fiscal 2010.
Any changes would have gone into effect on October 1, 2009, at the beginning of the government’s fiscal 2010. If an increase were intended, or significant benefit changes were planned, however, they would not be a secret or a surprise. The information would have been widely publicized months ago.
Changes in the number of Tricare Prime providers, however, are subject to constant potential change nationwide. That is because a Tricare Prime provider is one who chooses to provide medical services to Tricare Prime beneficiaries at discounted rates. Tricare has no control over whether a provider chooses to do that.
Remember that Tricare is not a health insurance policy or company. It is a federal health benefits program created by Congress by Public Law 89-614 in 1966. All Tricare operations are governed by federal law and regulation. It has no secrets.
Covering dental work after an accident
December 1st, 2009 | TriCare Help | Posted by Military Times
Q. A friend fell off a ladder at work and broke off some teeth below the gum line. It took the dentist an hour to dig the roots out. Now Tricare won’t pay for it. I told him it’s because the bill is from a dentist, and Tricare won’t pay dentist bills. Was I right?
You might be right, but I haven’t seen your friend’s Tricare Explanation of Benefits form. An EOB is the statement you get from a health insurance plan that explains how it processed each of the charges on the claim.
If Tricare denied payment for all or part of the claim, the reason for the denial is reported on the Tricare EOB.
I think it may be more likely that your friend’s Tricare claim was denied because it resulted from a work injury. But there’s a way to find out, and perhaps to get payment.
Tell your friend he has 90 days to file an appeal of the denial. The appeal must be in writing and state the specific matter in dispute. It must be signed by the adult patient and include a copy of the EOB that reports the denied charges. He should send it to the address on the EOB.
If he has questions, advise him to call his Tricare Service center. He can get that number by calling the Defense Enrollment Eligibility Reporting System office toll-free at (800) 538-9552.