Why Tricare isn’t quite like Medigap
November 3rd, 2010 | TriCare Help | Posted by Military Times
Q. I was told that under Tricare for Life, Tricare Standard serves as a Medigap policy. Medigap plans are lettered A through L. Which one is Tricare in Tricare for Life?
Medigap policies supplement Medicare by providing services in addition to the original Medicare plan. But that’s not the way Tricare Standard operates for Tricare for Life beneficiaries.
Under Tricare for Life, Tricare does not add covered services to your Medicare coverage. Instead, for medical services covered by both Medicare and Tricare, it pays your Medicare deductible and copayment.
All Tricare for Life claims must be filed with Medicare first.
If there is a service on the Medicare claim that is not covered by Medicare, but is covered by Tricare, Tricare will process that particular charge as if it were your only health insurance. You must pay any Tricare deductible and cost share for that medical service.
One example is an elastic stocking prescribed if your ankles swell. Medicare cannot pay for it, but Tricare can.
A claim must be filed first with Medicare. Medicare will deny payment and forward the claim to Tricare, which will pay the amount allowed less your Tricare deductible and cost share.
If there is a charge on the Medicare claim for a service that is covered by Medicare but not by Tricare, Tricare will pay nothing. You must pay any Medicare deductible and copayment yourself. An example is chiropractic care.
For more information, call your Tricare Service Center and ask for a free TFL Handbook, or download one from the Tricare website.
Tags: Medicare, Medigap, Tricare For Life
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