Tricare’s official word on health care reform
March 31st, 2010 | TriCare Help | Posted by Military Times
Tricare has posted updated information on health care reform on its web site, along with a Q&A. Remember, information from official sources is more reliable than most things you receive via e-mail from family and friends.
News update: Tricare and health care reform
March 30th, 2010 | TriCare Help | Posted by Military Times
Whenever Military Times posts a news story about health care reform and Tricare, we’ll post a link here. The latest:
Tricare health benefits for older children would not be free to their parents under a bill introduced in the House to ensure military parents are not left out of a key early benefit of the national health care reform bill. Read the full story
Health care reform and Tricare: No firm answers yet
March 29th, 2010 | TriCare Help | Posted by Military Times
The president recently signed into law the biggest piece of social legislation since the Civil Rights Act. Millions wonder how it will affect their personal lives, and among them are the 9.5 million Tricare and Tricare for Life beneficiaries, plus VA beneficiaries, and millions of Medicare beneficiaries, mostly civilians. People want answers, and they want them now. The answers, unfortunately, are not available yet. The agencies affected must first determine how to implement the law.
Congress created special agencies to manage medical programs for the military, retirees, and veterans. Each agency wrote regulations to interpret and implement the various laws that affect their programs. Now, they must analyze the new law to determine if it will require changes in those regulations, or changes in the way their programs operate. To determine how that must be done may take weeks. No changes will take effect without advanced, official, public, notification.
My mailbox is filling with questions about whether this or that will happen. I don’t know the answers. Tricare Help has no more information than you have. I have talked with Health Affairs, and that office does not know yet if the new law will require any changes in Tricare’s rules or operations. It isn’t possible to know until the law is analyzed by DoD’s legal experts. At this time, no one knows whether any provision of the law will have any effect of any kind on Tricare or Tricare for Life.
If the new law requires changes in any government program including Tricare and Tricare for Life, the information will quickly be made public by official sources as soon as the changes are in place. Until then, sit tight. Adopt a wait-and-see attitude. Don’t believe, and don’t repeat, rumors. Wait for official facts. Official information is not distributed to individuals by e-mail.
I am reminded to say, beware of any e-mail, presumably from Tricare, about benefits or eligibility and asking for personal information. Don’t click their links. Tricare will never start an e-mail correspondence by contacting you first.
Call DEERS, toll-free, at 1-800-538-9552, with any eligibility questions. Call your Tricare Service Center for benefit information. Don’t forget your official Tricare Web site at www.tricare.mil.
Why most beneficiaries have no need for Medicare Part D
March 29th, 2010 | TriCare Help | Posted by Military Times
Q. I’m in the process of signing up for Medicare. I know that I have to enroll in Part A and Part B to become eligible for Tricare for Life. My sister says her Medicare plan required her to sign up for Medicare Part D, the Medicare pharmacy plan. She has no military connections. Does that apply to me as well?
Unless you were to enroll in a Medicare Advantage plan that has Part D as a requirement, as in your sister’s case, you have no obligation to enroll in Medicare Part D, the pharmacy plan. To the contrary, as I mentioned above, it is not recommended.
Under Tricare for Life, you will have full coverage with Medicare Part A and Part B plus full coverage by Tricare Standard. All Tricare beneficiaries are eligible for the free Tricare Pharmacy Plan; it is probably the best pharmacy plan in the country. It needs no help to meet all your pharmacy needs.
For more information about the Tricare Pharmacy Plan, you can read about it online or call Express Scripts Inc. toll free at (866) 363-8779. I also suggest that you download a free Tricare for Life Handbook.
What happens to my pharmacy benefit when I get TFL?
March 26th, 2010 | TriCare Help | Posted by Military Times
Q. I will get Medicare and Tricare for Life on July 1. It’s bad enough that we’ll have to start paying a lot more for our health insurance, but the loss of Tricare Prime and its pharmacy benefit when we get transferred to Medicare seems unfair. Is there any way my wife, at least, can keep her Tricare Prime insurance and its pharmacy plan?
Only you, not your wife, will get Medicare when you are 65. Only you will be affected by the loss of Tricare Prime eligibility at that time.
Your Tricare Prime coverage will be changed to Tricare Standard when you get Medicare and become eligible for Tricare for Life. Your wife’s Tricare Prime coverage, however, can continue unchanged until she gets Medicare, probably not until she is 65.
You seem confused also about requirements concerning Medicare Part D, the drug-insurance plan. Neither Medicare nor Tricare require enrollment in Medicare Part D. The Pentagon’s Office of Health Affairs does not recommend Part D for most Tricare for Life beneficiaries because most will not gain any financial advantage from that plan unless their income is below the federal poverty line and they qualify for financial aid to pay their Medicare Part B monthly premiums.
But even if you did enroll in Part D, it would affect only you. Your wife could not be affected because she will not be entitled to Medicare.
Your and your wife’s coverage under the Tricare Pharmacy Program will continue unchanged: yours because you will be enrolled in Tricare Standard, and your wife’s because she will continue to be enrolled in Tricare Prime. All Tricare beneficiaries are eligible.
Pregnant daughter will lose eligibility after her birthday – no matter what
March 25th, 2010 | TriCare Help | Posted by Military Times
Q. My unmarried daughter will turn 21 years old on June 18. She is pregnant, totally dependent on us, and lives with her father and me. Her Defense Enrollment Eligibility Reporting System record is up to date. The problem is that her doctor has counted the days and says she is due to deliver around the time of her birthday.
In a worst-case scenario, what would happen if she is in labor on her birthday? Will Tricare pay for the delivery that is already in process?
By federal law, your daughter’s Tricare eligibility will end, unfortunately, at 2400 hours on June 17, regardless of what else is going on at the time.
I told a father recently that if his son were in surgery at midnight, it is hypothetically possible that one stitch would be covered by Tricare, but when the clock strikes midnight, the next stitch would not. That’s just an imaginary example, of course, but it’s the way the law is written.
Midwives say that babies come when they are ready, regardless of what doctors say. Perhaps the baby will decide to be born a few days sooner than your daughter’s doctor expects. Medicine is not an exact science, and such miscalculations certainly are not unknown.
Good luck.
Mixed messages on Medicare rules
March 24th, 2010 | TriCare Help | Posted by Military Times
Q. I got Tricare when I turned 60, and now I’m signing up for Medicare and Tricare for Life. Medicare told me that because I’m still working and have health insurance from my job, I don’t have to sign up for Part B until I retire. Then, the Navy told me that is true, but that I cannot get Tricare for Life until I sign up for Part B. The only coverage I will have will be my employer’s plan and Medicare Part A.
I’m confused by the mixed messages. Who is right, Medicare or the Navy?
You’re going to love this: Both are right. You’re dealing with two different laws concerning Part B enrollment — and you must choose between them.
The Medicare law says that if beneficiaries have a creditable health insurance policy through employment, they can delay enrolling in Part B without penalty for as long as they work for the employer who sponsors the insurance.
A creditable health insurance policy is one whose benefits Medicare agrees are at least as good as what Medicare provides.
Some people choose that way if they feel their employer’s plan meets their needs, because they can avoid having to pay Part B’s monthly premium. But they must understand that when a retiree, or a retiree family member, gets Medicare, Tricare law requires immediate Part B enrollment in order to retain Tricare eligibility.
Without Tricare eligibility, they can’t have Tricare for Life. They have only Part A and their employer’s insurance plan, as you were told.
To be eligible for Tricare for Life, Medicare beneficiaries must be enrolled in Medicare Part B. That way, they will have their employer’s plan as their primary coverage, Medicare Parts A and B as secondary and Tricare, which is always last, as required by law.
Only you can decide what is best for you.
If you’re married, your loss of Tricare eligibility (if you decide not to enroll in Part B yet) will not affect your spouse’s Tricare eligibility in any way.
Medicare should advise the Defense Enrollment Eligibility Reporting System automatically as soon as you are enrolled in Part B. Sometimes that doesn’t happen, though, and you must do it yourself. Your DEERS record must show Part B enrollment for you to use Tricare for Life. Contact DEERS toll-free at (800) 538-9552 for information and instructions.
Is my doctor taking advantage of Tricare?
March 23rd, 2010 | TriCare Help | Posted by Military Times
Q. My wife and I feel that our doctor is taking advantage of Tricare by scheduling us for unnecessary appointments and services. Is there an organization such as the Better Business Bureau for doctors that I should contact?
Billing Tricare for excessive and unnecessary services is called abuse and is illegal. Tricare takes such matters very seriously.
I suggest you write a letter to the Tricare office that processes your claims. The address is on your explanation of benefits forms. In your letter, provide as many examples and other details as possible, including names and dates. If other providers are involved — as in a case of excessive laboratory tests —include their names, as well.
Also include copies of any pertinent documents relating to your complaint. Because of provisions of the Privacy Act, both you and your wife should sign the letter. Don’t forget to include a daytime phone number.
What about the expiration date on my ID card?
March 22nd, 2010 | TriCare Help | Posted by Military Times
Q. In answering questions about proof of insurance, you have said to look on the back of the retired ID card about eligibility for civilian medical care and look for the word “yes”. However, one of the next entries is an expiration date that seems to coincide with the day before you turn 65. What do we tell doctors’ offices about the expiration date?
Tricare has no authority or responsibility in matters pertaining to the issue or correction of military identification cards. Only the services have that authority. Timely renewing of your ID card and keeping your DEERS record current in a timely manner, however, is your responsibility.
With regard to using Tricare, the only proof of insurance your provider needs is your currently valid military ID card.
If your ID card reports that you are eligible on the date you receive the medical care, your doctor need have no concerns about eligibility.
Now, let’s talk about why the card-issuing office chose that date for your card to expire. It has to do with your Medicare eligibility and its effect on your Tricare eligibility.
If they apply in a timely manner, the vast majority of Americans become entitled to Medicare on the first day of the month of their 65th birthday. If the person was born on the first day of the month, their Medicare entitlement becomes effective on the first day of the previous month.
When your ID card was issued, the issuing office assumed you will become eligible for Medicare on the first day of the month of your 65th birthday.
I haven’t read service regulations concerning the matter, but I believe it is SOP. Every ID card I’ve seen follows that procedure. That is, ID cards show Tricare eligibility ending on the last day of the month preceding the first day of the month of the bearer’s 65th birthday.
With three exceptions, any Tricare beneficiary who becomes entitled to Medicare Part A, at any age or for any reason, is required by federal law, to be enrolled in Medicare Part B on the date his Medicare Part A becomes effective.
The three exceptions are: (1) an active duty family member; (2) a person enrolled in the US Family Health Plan; or, (3) an active duty uniformed service member. The legal requirement for Part B enrollment does not apply to them. (Active duty members’ Tricare Prime enrollment [#3, above] is a special category which is exempt from everything discussed here.)
Medicare has a different law about when you must enroll in Part B. But you must obey the Tricare law, reported above, about Part B enrollment.
Every month, DEERS runs through the list of Tricare beneficiaries who are going to be 65 in the next month. Each of them must have in his DEERS record one of two reports: (1) an official report from Medicare that the person is not eligible for Medicare; or, (2) a report from Medicare that the person is enrolled in Medicare Part B. If a beneficiary does not, DEERS automatically terminates his Tricare eligibility. That is required by federal law.
Medicare is supposed to notify DEERS automatically when the Tricare beneficiary is enrolled in Part B. If, for any reason, the beneficiary’s DEERS record does not report your Medicare Part B is in effect as required by law, or if it doesn’t report that you are not eligible for Medicare, DEERS must automatically terminate your Tricare eligibility.
To restore or preserve Tricare eligibility, the beneficiary is responsible for any action needed to correct his DEERS record to report that he has Medicare Part B in effect. A person who loses Tricare eligibility because his DEERS record does not report Part B enrollment should ask DEERS for help about how to fix it. Mostly it will involve enrolling in Part B and telling Social Security that you have an emergency and need to have Part B go into effect immediately.
Automatic weapons can fail. So can Medicare’s action to notify DEERS of the beneficiary’s Part B enrollment. I recommend calling DEERS, toll-free, at 1-800-538-9552, a week or so before the effective date of your Medicare coverage to ensure your DEERS record has been updated automatically and that it reports that you are enrolled in Part B. The DEERS update also should report Tricare for Life eligibility. If any of it was not done, ask DEERS how to fix it.
When a spouse has other insurance
March 19th, 2010 | TriCare Help | Posted by Military Times
Q. I’m a retired reservist with Tricare For Life. My wife has her own civilian health insurance, as well as Tricare Standard, since I am her sponsor. How does coordination of benefits work for medical care and prescriptions? For example, her drug plan has a higher copay for some drugs than Tricare has. Can she use Tricare to get the lower co-pay, or does she pay the higher co-pay and file a claim with tricare to get the difference? And can my wife and I use the Tricare mail order drug plan?
As required by federal law, Tricare is always last payer to all other health insurance, medical plans such as an HMO, or medical payments such as one might receive for medical bills resulting from an auto accident, slip-and-fall injury, or the like. The beneficiary must file first with all other plans. When the other health insurance (OHI) has paid its maximum and issued the beneficiary an Explanation of Benefits, a Tricare claim may be filed.
The only exceptions to the rule making Tricare last payer are if the OHI is a bona fide, specially written Tricare supplement, or if the OHI is a welfare-related plan such as Medicaid (not Medicare), Indian Health Service, and the like.
Your wife must use her OHI first for all medical and pharmacy services. For medical care, to file with Tricare as second payer, she must do the following:
1. Complete an official Tricare Claim Form DD2642.
2. Attach copies of exactly the same bills (the same sheets of paper) that were sent to the OHI.
3. Attach a copy of the OHI’s Explanation of Benefits that reports details of its processing of each of those charges.
4. Make copies of all the documents for your records.
5. Send Tricare’s copy of the package to the proper Tricare claims processing contractor for your Tricare Region.
Your wife must use her commercial plan’s pharmacy benefit first.
To be reimbursed a portion of the OHI’s pharmacy deductibles and copayments, contact Express Scripts, toll-free, at 1-877-363-1303, for instructions.
Please note that because of the way federal law requires pharmacy benefits to be coordinated, Tricare beneficiaries who have OHI are not eligible to use the Tricare Mail Order Pharmacy Plan.