If surgery is covered, why did the hospital send a bill?
May 1st, 2012 | TriCare Help | Posted by Military Times
My father is retired Air Force and just recently had retinal re-attachment surgery. He has Medicare as well as Tricare for Life, so I don’t understand why he received a bill from the hospital for over $300. Does Tricare not cover the surgery?
Ordinarily there should be no unpaid balance under Tricare for Life; the combination of payments by Medicare (primary coverage) plus those by Tricare should have paid the Medicare claim and all providers’ bills in full.
The balance most likely results from an error in the way the Medicare claim was filed or processed.
Your father will need to research the matter by comparing the itemized bills for the balance with the explanations of benefits from Medicare and Tricare. He can find contact information for help on the Tricare website.
Do I need Part D when I turn 65?
April 26th, 2012 | TriCare Help | Posted by Military Times
I am a Navy retiree who will turn 65 next year. Like many of your readers, I understand the basics of Tricare, and what it does and does not cover. What I have never seen addressed is “Part D,” or coverage for prescriptions. Can you briefly address that?
Our Tricare Help column has addressed that topic a number of times in the past. But Part D is not a Tricare program — it’s the prescription drug program under Medicare. The consistent advice from the Defense Department’s Office of Health Affairs is that virtually no one who is eligible for Tricare for Life — which you will be when you turn 65 — needs Medicare Part D prescription drug coverage.
Out-of-pocket co-pays for prescription drugs under Part D are usually higher than under Tricare for Life. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
The Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums.
Can veteran dump inferior plan and go with Tricare instead?
April 23rd, 2012 | TriCare Help | Posted by Military Times
I have a friend who is an aging, retired Army colonel. After his long military service, he worked in the legal department of an insurance company from which he is also now retired – with truly lousy retirement benefits. My wife and I told him about the benefits we get from Medicare and Tricare For Life. Can he “renounce” that other retirement health plan that has such skimpy benefits, and enroll in Tricare For Life?
The short answer is yes, your friend can give up his current plan and use Tricare for Life. Not only can he do that, he should do that.
As with any health care plan, Tricare has complex rules that can sometimes be frustrating to deal with. But there is no question that Tricare provides robust health care coverage and is one of the lowest-cost health care plans in the nation, particularly for Medicare-eligible beneficiaries over age 65.
As you mentioned, for Medicare-eligible military retirees, Tricare For Life acts as a virtually free supplement to Medicare (although as many retirees are quick to point out, TFL is not entirely free, since you must be enrolled in Medicare Part B, and paying the monthly Part B premiums, to be eligible for TFL).
Moreover, TFL beneficiaries can take advantage of the Tricare Mail Order Pharmacy program, under which they can receive a 90-day supply of drugs for the same price of a 30-day supply obtained at local retail pharmacies.
There’s one potential wrinkle in your friend’s case: You don’t say exactly how old he is, but you indicate that he is over age 65. If he did not sign up for Medicare when he first became eligible at age 65, he will have to pay a penalty to enroll late in Medicare Part B. The penalty adds 10 percent to the Part B premium for each year that the individual delayed Part B enrollment after becoming entitled to Part A, and that penalty must be paid for life.
Your friend should contact the Defense Enrollment Eligibility Reporting System (DEERS) support office at toll-free 1-800-538-9552 for more information and to get started on registering for TFL.
How can I get information on Medicare Part C?
April 20th, 2012 | TriCare Help | Posted by Military Times
I turned 65 in February and have enrolled in Medicare Parts A and B. I have also contacted Medicare about information on Part C, but it’s been three weeks and I have not heard back. Can you help?
I can’t help get you a reply from Medicare — that’s outside the scope of the Tricare Help column. But I can tell you that as a general rule, Tricare for Life beneficiaries do not need Medicare Part C coverage.
Medicare Advantage Plans under Part C are offered by private companies that are approved by Medicare. They may offer supplemental coverage beyond the standard Medicare Parts A and B, and most also offer Medicare Part D prescription drug coverage — all at additional out-of-pocket costs to beneficiaries beyond the monthly premiums required for Medicare Part B outpatient coverage.
Advantage plans, however, are designed for civilians who do not have your free Medicare supplement known as Tricare for Life. TFL offers the same supplemental coverage, along with its own prescription drug plan, at far less cost. While there has been talk of implementing an annual enrollment fee for Tricare for Life, at this time there are no enrollment costs for the Tricare portion of TFL.
In addition, prescription drug costs through TFL are less costly than under Medicare Part D. In fact, the Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
To sum up, you are already covered by two full-service, stand-alone, health insurance plans — Medicare and Tricare for Life — all for the cost of the monthly premium for Medicare Part B.
Can I use TFL outside the U.S.?
April 19th, 2012 | TriCare Help | Posted by Military Times
How does a Tricare for Life beneficiary get reimbursed for hospital and doctor bills when traveling outside the continental U.S.?
From the moment you leave U.S. territory, you will have no coverage by the Medicare portion of Tricare for Life. Federal law does not allow Medicare to pay for foreign medical care. Your only coverage will be Tricare for any medical care received outside the US and its territories.
Thus, you must carefully save copies of all medical bills, receipts, doctors’ statements, prescriptions, and the like until you return home. You will need them at that time to file Tricare claims.
Can my family keep Tricare once I leave active duty?
April 18th, 2012 | TriCare Help | Posted by Military Times
I have been in the Navy for four years and am looking to get out this summer. After I get out, can I still use Tricare? Would my family be eligible as well?
I’m sorry to be a bearer of bad news, but your and your family’s entitlement to Tricare will end automatically at midnight on the day you are separated from active duty.
There is a commercial health insurance plan that is similar to Tricare in coverage. It is available in short-term blocks and was designed to meet the health insurance needs of families in your situation. It’s called the Continued Health Care Benefit Program.
How can I make sure my surgery is covered?
April 18th, 2012 | TriCare Help | Posted by Military Times
I’m married to an active-duty airman. I have an ovarian cyst that must be removed ASAP. Does Tricare cover this kind of surgery?
Tricare does cover medically necessary care, including surgery, for your condition. If you live near a military hospital, make an appointment to be seen by military physicians. If you do not live near a military facility, you must find a civilian physician who is, or who is willing to become, a Tricare-authorized provider, to provide the care you need.
Tricare may provide coverage only if you use a military hospital, or a civilian physician who is authorized by Tricare to attend its beneficiaries.
Do Medicare-eligible Tricare beneficiaries need Part D?
April 13th, 2012 | TriCare Help | Posted by Military Times
My wife will get Medicare this summer, and her sister told her that she will have to enroll in the Medicare Pharmacy Program, or Part D. Is that correct?
Unless your wife enrolls in one of the Medicare Advantage plans that requires it, she is not required to enroll in Medicare Part D.
Neither Medicare nor Tricare require their beneficiaries to enroll in the Medicare Pharmacy Plan, Part D of Medicare. To the contrary, Medicare Part D is not recommended for Tricare for Life beneficiaries.
The Office of the Assistant Secretary of Defense for Health Affairs is on record for saying that the only Tricare beneficiaries likely to achieve any financial advantage from Medicare Part D enrollment are those whose incomes are below the federal poverty level and who qualify for financial aid to help pay their Medicare Part B premiums.
If your wife were to enroll in a Medicare Part D plan, she would have to file Tricare claims to be reimbursed for the plan’s copayments and deductibles, if applicable. She might be limited to that plan’s formulary in the drugs that are covered, and she would not be eligible to use the Tricare Pharmacy Program’s Mail Order Pharmacy Plan.
I’m on Tricare for Life, but my doctor won’t take Medicare
April 11th, 2012 | TriCare Help | Posted by Military Times
I am going to get Medicare and Tricare for Life soon. The problem is that the doctor I have used for several years does not take Medicare. I don’t want to change doctors if I can help it. Is there anything I can do?
Medicare cannot pay for any services received from a health care provider who has opted out of the Medicare program. Although you can continue to use his services, you could not receive any payment from Medicare for his services.
You could file a Tricare claim. Tricare can calculate the amounts it would have paid if Medicare had paid the doctor’s claim. Tricare will pay you that amount only. At the most, that would be the amounts the Medicare copayment and Medicare deductibles would have been.
Unless you can persuade your doctor to become a Medicare provider, your dollar-wisest choice will probably be to change physicians.
If you will contact your Tricare Service Center, you can get a list of Medicare providers in your area. That will help if you decide to change physicians.
What happens once my family reaches its Catastrophic Cap?
April 10th, 2012 | TriCare Help | Posted by Military Times
How much is Tricare supposed to pay when my family has reached its $3,000 Catastrophic Cap? My friend said it won’t pay anything because that is all the cost shares that I am allowed to pay in a year.
Your friend is mistaken. During each fiscal year, Tricare maintains a running total of all the deductible and cost share amounts your family has had to pay out-of-pocket – or that was paid by your Tricare supplement, if applicable.
As a retiree family, your Catastrophic Cap amount is $3,000 as you have assumed.
When your family members, combined, have paid $3,000 in deductibles and cost shares during a given fiscal year, Tricare will begin to pay 100 percent of the amount it allows on each claim. That is, you will not be charged any more cost shares or deductibles for the remainder of that fiscal year.
The government’s fiscal year runs from October 1 of one year through September 30 of the next year. At midnight on September 30 every year, the amount accumulated in your family’s Catastrophic Cap account is returned to zero and the accumulation of deductibles and cost shares your family pays begins anew.