Can disabled adult son get Tricare and dental coverage?
February 3rd, 2012 | TriCare Help | Posted by Military Times
I am a retired, 100 percent disabled Navy officer. I have a 41-year-old son who is disabled and receives SSDI from Social Security. Does he qualify for Tricare and dental coverage?
To begin an inquiry concerning the possibility of your disabled son’s Tricare eligibility, please call the DEERS Support Office, toll-free at 1-800-538-9552.
If your son is determined to be entitled to Tricare, and if he is enrolled in free Medicare Part A, and in Medicare Part B, he will be entitled to the Tricare program called Tricare for Life. To use TFL, he must be properly registered in DEERS.
Under TFL, Medicare Parts A and B becomes the beneficiary’s primary health insurance, and Tricare Standard, as second payer, acts as a free Medicare supplement. The TFL beneficiary, thus, has coverage by two, full-service, stand-alone health “insurance” plans. The second plan, Tricare Standard, is provided without additional cost.
Under TFL, the vast majority of the beneficiary’s medical expenses will be paid in full by the combined coverage of Medicare plus Tricare. The only cost for Tricare for Life coverage is the monthly premium for Medicare Part B. That is somewhat more than $100 per month in 2012.
Tricare does not have a dental benefit. It does, however, provide for enrollment in a commercial dental insurance plan available to Tricare beneficiaries at group rates. There is a plan for active-duty personnel and their Tricare-eligible family members, and there is a similar plan for retirees and their families. You can get more information about the Tricare Retiree Dental Plan here.
How do we know if we’re eligible?
January 30th, 2012 | TriCare Help | Posted by Military Times
My husband is a disabled Army vet and he cannot seem to tell me what Tricare is or if he can get it. I understand it is some kind of insurance. Could we be eligible for it?
There are two programs for which you might be eligible.
You wrote that your husband is a disabled vet. Depending on his disability rating from the Veterans Affairs Department, you may be eligible for care through the VA. If his rating is “100 percent, permanent and total,” he may qualify for free VA medical care for the rest of his life, and his wife and unmarried children under age 18 would be entitled to the program called CHAMPVA.
Alternatively, if your husband is entitled to receive retired pay, he and his family may be entitled to Tricare.
For official information regarding your husband’s Tricare eligibility, he should call the DEERS Support Office, toll-free, at 1-800-538-9552. He must call, himself. Due to provisions of the Privacy Act, that information cannot be given to another person.
Another source of public information regarding Tricare eligibility is at the official Tricare website.
How Social Security disability affects your Tricare coverage
October 19th, 2011 | TriCare Help | Posted by Military Times
I am a 61-year-old retired Marine and have been enrolled in Tricare Prime for a number of years. Over the past few years I was treated for stage 4 neck cancer and was awarded Social Security disability that was back dated almost a year. I understand that once you are on SSD for two years you have to enroll in Medicare. I have received my Medicare card for Parts A & B that will be effective Jan. 1, 2012. Will I need to contact Tricare to discontinue my allotment for Prime, or will they receive notification from Social Security? Also, will I fall under regular Tricare or will I convert to TFL? Do I now also need to be issued a new retired military ID card before Jan. 1?
When a Tricare beneficiary becomes entitled to Medicare and is enrolled in Part B, the Social Security Administration is supposed to notify DEERS to report that fact. Sometimes supposed things do not happen. For help with any eligibility issues or problems, see below.
According to your letter, you are already enrolled in Part B although it will not become effective until Jan. 1, 2012. You can call the DEERS Support Office (DSO) toll-free, at 1-800-538-9552, to check the status of your DEERS record.
If your record has not been updated to show your Part B enrollment and the effective date, ask DEERS what action on your part is needed, if any. Ask DEERS also about your military ID card and for guidance, if needed, to renew it when time to do so.
You can contact DEERS whenever you have any questions relating to your eligibility for military benefits of any kind. DEERS deals with eligibility issues only. Although DEERS can tell you the content of laws relating to eligibility and how they affect you, it cannot provide legal advice. Contact a private attorney or a JAG office, as appropriate, if needed.
In the meantime, I suggest that you call your Tricare Prime office now and make arrangements to pay its enrollment fees on a month-to-month basis that will end automatically with the last payment to be for December 2011. In that way, you will not pay in advance for Prime coverage you cannot use after December 31, 2011. That office will provide any guidance you need about the matter.
If your DEERS record is up-to-date and accurately reports that you are enrolled in Medicare Part B, DEERS will automatically switch your Tricare plan from Prime to Tricare Standard at midnight on December 31, 2011. One second later you will become eligible for Medicare Parts A and B, Tricare Standard, and be eligible for Tricare for Life.
TFL consists of coverage by two, full-service, stand-alone, health insurance plans – Medicare Parts A and B plus Tricare Standard. Either plan, alone, will provide adequate health insurance for most people, although a supplement would be recommended, if feasible, to pay the plan’s copayment and deductible. Under TFL, your coverage will be excellent.
Medicare Part A is free. Tricare Standard is free. Medicare Part B costs a monthly premium. If you call Medicare, toll-free, at 1-800-633-4227, you can learn how much Part B will cost in 2012.
How can I help blind friend get Tricare?
August 22nd, 2011 | TriCare Help | Posted by Military Times
My friend retired and has gone blind. How can I get him on Tricare?
If your friend is entitled to receive retired pay, he is most likely eligible for Tricare. He needs to be registered with his uniformed service, which can do the paperwork needed to enroll him in the Defense Enrollment Eligibility Reporting System, better known as DEERS, and to issue a current uniformed service identification card.
I believe it is most likely those things were done when your friend retired, but to confirm that, or to receive instructions about doing it, if necessary, please contact the DEERS Support Office, toll-free, at 1-800-538-9552. Be prepared to take notes.
His wife and unmarried children younger than 26 also are Tricare-eligible, but they, also, must be enrolled in like manner.
You may encounter some problems initially in working on your friend’s behalf due to Privacy Act restrictions. DEERS, however, will advise you about working around them.
The uniformed service ID card is used as “proof of insurance” when dealing with providers of medical care. On the back of the card is information regarding eligibility for civilian medical care. The word, “YES” in the appropriate place confirms Tricare eligibility.
Complete information about Tricare can be found at the official Tricare website. For information about filing claims, forms, and addresses, please go to the claims section or call the beneficiary’s Regional Tricare Service Center.
If your friend has not already done so, he should contact the Social Security Administration regarding his disability. That toll-free number is 1-800-772-1213. If he qualifies, he can become entitled to disability payments and, after two years of receiving those benefits, he will become entitled to Medicare.
Enrollment in Medicare Parts A and B will make him eligible for the Tricare plan called Tricare for Life, or TFL. In the absence of other health insurance, TFL is a Tricare plan under which Medicare becomes the beneficiary’s primary health insurance, and Tricare Standard will automatically serve as his free Medicare supplement.
Under TFL, he must get all civilian medical care from Medicare providers only. A Medicare provider is one that is registered with Medicare and is authorized to file Medicare claims for services provided to Medicare beneficiaries. Medicare will process the claim, pay its share to the provider, and automatically forward the claim to Tricare.
For every medical service on the Medicare claim that is covered by both Medicare and by Tricare, Tricare Standard will pay the balance on the Medicare claim (the Medicare copayment and deductible). That done, the provider’s bill will be paid in full. The patient will owe nothing.
Occasionally a Medicare provider will render a service that is not covered by both Medicare and by Tricare. In that case, only one of the two plans will pay. The other plan will deny payment as a non-covered service. In those cases, the patient (or his supplement) is responsible for the unpaid balance on the claim. Such Medicare claims will be relatively uncommon. The vast majority of the medical care will be paid in full under TFL (the combined Medicare plus Tricare payments).
I really need Tricare; can I keep it after divorce?
April 13th, 2011 | TriCare Help | Posted by Military Times
Q. My husband is in the National Guard full time. We have been married 12 years and I have been disabled for the past 7. My husband has now moved out and is living with another woman. My life depends on me keeping Tricare for Life; my medications are very expensive and my attorney and I have found there is no other option for me but to keep Tricare. Without it I will die, and my husband knows this but isn’t willing to work with me. What do I do to get a waiver keep my Tricare?
Tricare eligibility is a matter of federal law, not of merit or need. Tricare does not have the authority to declare a person to be eligible for Tricare because of their special needs or for compassionate reasons. Each individual must meet the requirements of law in order to be eligible for Tricare.
If there comes a time when you are no longer married to your military sponsor (your husband), you will immediately lose all eligibility for Tricare. An exception would be if you were married to the same military sponsor for at least 20 years during which time your sponsor is earning service points creditable for retirement. According to your letter, you do not meet that requirement.
For an official statement regarding your Tricare eligibility and the criteria you must meet in order to continue your Tricare eligibility following divorce, please contact the DEERS Support Office, toll-free, at 1-800-538-9552.
Social Security has a program for people who become disabled and are not capable of self support. I suggest that you contact the Social Security Administration, toll-free, at 1-800-772-1213 for more information.
As I feel certain your lawyer has advised you, you should contact your state’s Social Services office to learn what benefits, such as Medicaid, might be available for you.
When Tricare Standard becomes your primary coverage
March 4th, 2011 | TriCare Help | Posted by Military Times
Q. I am 62 years old and have been retired from the Navy for 21 years. I have worked at my current job for 18 years and have been covered by my employer’s insurance, with Tricare as my secondary insurance. Now, due to health complications, I have had to cut back on my work hours, and I no longer have my employer’s insurance. Will Tricare Standard take over as my primary insurer? If so, what do I need to do? How much will it cost? How can I get my prescriptions filled? I don’t live near a military base.
You probably already know that you must keep your DEERS registration and your military ID card up to date in order to have Tricare coverage. You can update your DEERS record by calling the DEERS Support Office, toll-free, at 1-800-538-9552. That office will also provide any guidance you need to update your ID card.
It may be, however, that you need some information about how to handle the effects of the loss of coverage by your employer’s health insurance plan. You will be told in advance when your coverage under that plan will end.
You must get an official letter from that insurance company that reports the last date that you will have coverage under that plan. That is, a report of the last date that plan will pay for your medical care. Call DEERS and ask to whom you should send a copy of that letter, together with a brief explanation of the reason the policy will be canceled — whom should you notify and when.
If you have made proper notification, DEERS and Tricare will know the last date of your other coverage. Tricare Standard will automatically become your only health insurance effective on the following day.
When Tricare Standard is your only coverage, you will become responsible for paying the $150 yearly Tricare deductible and your 25 percent cost share of the amount allowed on each Tricare claim. Otherwise, Tricare Standard is free; it has no monthly premium. All Tricare beneficiaries are automatically eligible for the Tricare Pharmacy Program at no cost other than the small copayments for drugs.
A month or two before you lose your employer’s plan, you may want to begin to research the coverage offered by one of the several Tricare supplement plans. Most of the retiree associations offer such a plan.
Write to several associations and request a copy of their Tricare supplemental policy. In that way, you can compare several to find the plan that best meets your needs. Check carefully the policy’s coverage of pre-existing conditions.
I suggest, also, that you contact the Social Security Administration to research possible coverage under the Social Security Disability Program.
If you qualify for that program, you will become eligible for Medicare after receiving disability benefits for 24 consecutive months. Otherwise, you will have to wait until you are 65 to qualify for Medicare and Tricare for Life.
I’m on VA disability – does Tricare have a role?
December 9th, 2010 | TriCare Help | Posted by Military Times
Q. I served in the Army from 1966 to 1969 and received an honorable discharge. In August of this year, I was given a 100 percent service-connected disability rating for prostate cancer linked to exposure to Agent Orange. I have been issued a Department of Defense Uniformed Services ID card. Am I eligible for participation in Tricare?
If you have a 100 percent, permanent and total, service-connected disability, the Department of Veterans Affairs should provide for all your medical care without cost to you.
Tricare should not be involved unless you were medically retired from the service and are entitled to retired or equivalent pay.
As Tricare eligibility is a matter of federal law, however, I will not comment further about it.
Please call the DEERS Support Office, toll-free, at 1-800-538-9552 to inquire about your Tricare eligibility. DEERS deals with eligibility issues only. They will tell you what to do if you are eligible for Tricare. If you are not eligible for Tricare, you need to contact the Department of Veterans Affairs for more information about your status with VA.
Can disabled adult daughter get TFL?
June 29th, 2010 | TriCare Help | Posted by Military Times
Q. I am retired from the Air Force and would like to get my 37-year-old daughter on Tricare for Life. She was diagnosed with fibromialgia about 10 years ago and had to go on full disability two years ago. She had to sell her home and move in with us. She has never been married and Social Security disability is her only source of income. She has Medicare parts A, B and D and a supplemental policy. I want to get her on TFL so I won’t have to pay for Part D and the supplemental policy. How can I do this?
I’m sorry to learn of your daughter’s disability, but it’s good to know, at least, that she qualifies for Social Security disability benefits and Medicare.
Unless her disability was discovered before she was 21 years old, I doubt that your daughter will be found to be eligible for Tricare. For official information about Tricare eligibility, you should contact the DEERS Support Office, toll-free, at 1-800-538-9552. Though she will likely not be found eligible, DEERS will discuss with you what federal law may allow in her case. If it is possible that she is eligible for Tricare, DEERS will provide instructions and any help needed to enroll her in the program.
Tricare eligibility is established by federal law and regulation. Tricare, however, 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 criteria for Tricare eligibility, to register an eligible person in DEERS, and to issue a uniformed service identification card which can be used as proof of Tricare eligibility.
If she has not done so already, it might be of benefit for her to contact your state’s Social Services office to learn whether there may be additional benefits available, including Medicaid.
Can coverage be reinstated for disabled adult son?
May 24th, 2010 | TriCare Help | Posted by Military Times
Q. My husband is still active duty. My question is about coverage for our oldest son, who is 25. He has learning disabilities, ADD, dylexia and seizures. He was on medication for seizures, but when he lost his Tricare coverage due to his age he stopped taking his seizure medication, as he could not afford it (he works a minimum-wage job). He recently went to the hospital by ambulance because he had a seizure. As he was diagnosed with the seizure disorder before he lost his Tricare coverage, why does he not qualify for medical care?
I assume your son’s Tricare eligibility ended when he was 21. If he became disabled and incapable of self-support before he was 21, his Tricare eligibility could have been extended indefinitely, for as long as the disabling condition lasted, even for life. Having a seizure disorder would not automatically qualify your son for extended Tricare benefits unless it made it impossible for him to work.
For official information and advice regarding Tricare eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552. Alternatively, your husband should talk with his military personnel section.
Your husband should talk with his military hospital and inquire about the possibility of restoring your son’s Tricare eligibility. Your case could be damaged because you have waited so long, and because he does seem to be able to be self-supporting to a degree, at least. It’s worth the effort. At the worst, they say no.
He should also ask at the hospital whether it is possible to arrange for your son to get some help there. Your husband should start with the hospital’s Executive Officer and work his way up through the chain of command to the Commading Officer.
Has your son applied with the Social Security Administration for disability benefits? If not, he should contact that office.
Finally, nobody is certain about all the implications of the new health care reform law as it is implemented over the next several years, but to some extent, it may help people like your son.
Can I keep TFL after my divorce?
January 20th, 2010 | TriCare Help | Posted by Military Times
Q. My husband and I are divorcing after 16 years of marriage. He was in the military for 43 years, but I was only married to him from 1993 to 1996 when he retired. I am on Social Security disability and Tricare for Life. I went on this disability while being married to him. Will I be able to keep my Tricare for Life forever or for any time after the divorce?
Tricare eligibility is established by federal law for designated categories of persons. Tricare, however, does not have the authority to make individual eligibility determinations. Only the uniformed services have the authority to determine whether a given individual meets the legal criteria for Tricare eligibility, to register an eligible person in the Defense Enrollment Eligibility Reporting System (DEERS) computer database, and to issue an appropriate uniformed service identification card.
Following your divorce from your military sponsor, you will be in a category referred to as a former spouse. In order to remain eligible for Tricare following your divorce, you will have to meet the eligibility criteria federal law requires for persons in that category. According to the information in your letter, above, I do not believe you would meet those criteria. I believe you will lose all rights to Tricare and to any medical care provided at government expense at midnight of the day the divorce is final.
For official confirmation of my statement and for official information and answers to all questions regarding Tricare eligibility, I urge you to contact DEERS, by calling its toll-free number, 1-800-538-9552, to discuss your personal and individual circumstances. Before you call, perhaps you would find it helpful to make a list of all your questions so you forget none of them and are prepared to make notes about your conversation with DEERS.
DEERS is a federal agency under the auspices of the US Department of Defense. DEERS is not related in any way to any program under the Social Security Administration, such as Medicare.
For official information concerning your rights to coverage by any Medicare program or plan, you should call the Social Security Administration, toll-free, at 1-800-772-1213.
The Tricare program called Tricare for Life consists of full coverage by Medicare Part A and Part B plus full coverage by Tricare Standard. To be eligible for Tricare for Life, you must be enrolled in Medicare Part A, and Medicare Part B, and Tricare Standard. The loss of either Medicare eligibility or of Tricare eligibility will cancel your eligibility for Tricare for Life.