How will my service-connected disability affect my coverage?
October 27th, 2009 | TriCare Help | Posted by Military Times
Q. I currently have Medicare Parts A and B, and Tricare for Life. After a two-year fight with the VA, they now say my hearing loss and tinnitus is service connected. My DAV rep thinks I will get either 20% or 30%, depending on the hearing test the VA is giving me. Once I get the service connected disability, will this change any of my health coverage?
Because you have TFL, Medicare is your primary coverage and half of the TFL Program. Your TFL benefits begin when a Medicare provider files a Medicare claim for the services he provides to you. Because the Medicare claim must be filed first, you need to ask Medicare about any effects of your VA rating on your Medicare coverage.
My guess is that Medicare will have the same rule as Tricare about the rating, but only Medicare can tell you about that officially.
The VA rating you mention should have no effect on your or your family’s Tricare coverage. Tricare Help’s reply is always unofficial, however. To get official information, call Tricare.
Tricare Standard is the other half of your TFL coverage. By law, it is second (last) payer. When Medicare finishes processing a claim for a TFL beneficiary, it will pay its share to the provider. Then it will automatically forward the claim to the special Tricare claims processor for TFL. On the vast majority of your claims, Tricare will pay whatever Medicare did not pay for every medical service that is covered by both Medicare and Tricare. As a TFL beneficiary, you will seldom have any out-of-pocket expenses for your medical care. The major exception is the small copayments (cost shares) for your prescription drugs; all Tricare beneficiaries automatically qualify for benefits under the Tricare Pharmacy Program. It’s the best pharmacy plan I know of. That’s why TFL beneficiaries do not need to enroll in the Medicare Part D Pharmacy Plan. For TFL beneficiaries, Medicare Part D is not necessary, and it can cause a lot of hassles for little in return because you have to file two claims to get full reimbursement for your prescription drugs.
A very few VA medical centers have a special arrangement with Tricare that allows them to file a Tricare claim for those charges, but most of them do not. If you get a bill from the VA, call your Tricare Service Center to ask whether you may file a Tricare claim.
Whom can we ask about suspending Medicare Part B?
October 26th, 2009 | TriCare Help | Posted by Military Times
Q. My wife is legally blind and has Medicare Part B and Tricare for Life. I have recently been told that I can suspend her Medicare Part B since I am still on active duty. If so, where can I find that information? Can we also file for back pay on what we have paid for Part B?
Your request has to do with military regulations concerning Tricare eligibility, not the Tricare program itself. Write to Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, Colo., 80011-9043. That office is not available by phone.
In your letter, explain what you want to do and why, and ask TMA to advise you about the proper procedures and consequences. Include your full name and Social Security number, your military address, your wife’s full name as it is in DEERS, her SSN, and a phone number where you can be reached during the day. In addition, include a statement that she must sign and date in which she authorizes you to represent her with Tricare and Medicare in the matter. That is Privacy Act stuff.
On disability for a year; what happens to my coverage?
October 23rd, 2009 | TriCare Help | Posted by Military Times
Q. I am a 59-year-old military retiree. I’m enrolled in Tricare Prime, was recently treated for cancer and have applied for Social Security disability. The Social Security disability, if approved, will probably be for no more than one year. If it’s granted, do I have to disenroll from Tricare Prime and enroll in Medicare Part B, and revert to Tricare Standard as I would not be eligible for TFL? Also, I do plan on returning to the work force once I am off disability. Will I then have to re-apply to Tricare to go back on Tricare Prime? Also, if company that you work for offers health care with a premium that is deducted from your pay, am I required to use that health plan primarily and Tricare as the secondary?
People who qualify for Social Security disability benefits become entitled to Medicare only after receiving disability benefits for 24 consecutive months. Unless and until you become entitled to Medicare (whether for disability or by reaching age 65) there will be no consequences of any kind for your Tricare coverage.
If your employer sponsors a health insurance plan for employees, regardless of who pays the premium, it will have no effect on your Tricare coverage unless you enroll in that plan. Tricare will not require you to enroll in your employer’s plan.
If you do enroll in the plan, by federal law it will be primary to Tricare. You must file all claims with your employer’s plan first. After that plan completes processing the claim and issues an Explanation of Benefits, you may file a claim with Tricare for the same bills. Tricare will pay part, or all, of what the other health insurance did not pay for every medical service on that claim that is covered also by Tricare. That will usually be the other health insurance’s deductible, if applicable, and your copayment.
I do not recommend Tricare Prime for people with other health insurance because of duplication of services, additional expenses, difficulties with which plan must pay first, and problems with coordination of benefits. To avoid those problems, I recommend Tricare Standard for those with other health insurance.
Does my disability affect my eligibility?
October 1st, 2009 | TriCare Help | Posted by Military Times
Q. I am a retired member of the National Guard. My wife (who is younger than I am) and I receive Tricare Standard. I will be 61 next month and recently applied for Social Security disability. If my application is approved, am I required to do anything? Do I need a new military retired ID? Will my retirement be affected? My disability is not service connected.
I know very little about the rules governing Social Security disability benefits, except that if Social Security finds you eligible for disability benefits, it will have no immediate effect on your Tricare eligibility.
After receiving disability benefits for twenty-four consecutive months, it is my understanding that you will become entitled to Medicare. If you become entitled to Medicare, it will affect your Tricare coverage in one of two ways:
First, a uniformed service member who is entitled to receive retired, retainer or equivalent pay is required by federal law to be enrolled in Medicare Part B if he becomes entitled to Medicare Part A. If the retiree with Medicare Part A does not enroll in Medicare Part B, he will lose his Tricare eligibility on the day his Medicare Part A coverage becomes effective. That is not a Tricare rule. It is a requirement of federal law.
Second, Medicare entitlement makes you eligible for Tricare for Life if you are enrolled in both Medicare Part A and Part B. That program is very favorable for its beneficiaries.
Tricare for Life consists of full coverage under Medicare Part A and Part B plus full coverage under Tricare Standard. You become a Medicare beneficiary because Medicare is your primary health “insurance” plan.
You must seek all your medical care from Medicare providers. The provider will file a Medicare claim for the services he provides to you. Medicare will pay its statutory amount directly to the provider. Then, Medicare will automatically forward the claim to Tricare as second payer.
For every medical service on the Medicare claim that is covered also by Tricare, Tricare will pay to the provider whatever Medicare did not pay. Usually that will be your Medicare copayment and your Medicare deductible, if applicable on that particular claim.
The combined payments by Medicare and Tricare will pay the balance on the Medicare claim. The Tricare payment, together with Medicare’s previous payment, will pay the Medicare claim, and the provider’s bill in full. You will have no out-of-pocket expense for the medical services on that Medicare claim. The vast majority of your Medicare claims will be of that nature.
Apart from the small copayments (called cost shares) for prescription drugs, you will seldom have to pay anything for your medical care.
While you’re still at least two years away from being eligible for that program, you can read more about Tricare for Life on the Tricare web site, or even download a handbook.
Regarding the questions about your retirement, ID card, and Medicare disability, I suggest that you contact DEERS, toll-free, at 1-800-538-9552 for official information.
I’m already on Medicare Part A
September 15th, 2009 | TriCare Help | Posted by Military Times
Q. I turn 60 in February. I have been disabled for the last 10 years and am on Medicare Part A. I didn’t have to accept a penalty for not signing up for Part B because my wife works and I use her insurance. Do I have to sign up for Part B to receive any Tricare benefits? My wife retires in March and we will still be covered by her policy until she becomes eligible for Medicare.
The following information is unofficial. For official information about avoiding the late enrollment penalty for Part B, call Social Security at 1-800-772-1213. For official information about getting Tricare when you are 60, call DEERS at 1-800-538-9552.
Both Medicare and Tricare have laws about when a person must enroll in Medicare Part B. The Tricare law is going to affect you first when you turn 60. Then, the Medicare law will affect you when your wife retires. Either way, you are going to have to be enrolled in Medicare early next year. Here’s why.
The law that governs Tricare says that a retiree who has Medicare is required to be enrolled in Part B. Although you are not 65, you got Medicare early due to your disability. That means you must have Part B up and running in order for you to get Tricare when you are 60 next February.
Because you will be a retiree with Medicare at age 60, you must be enrolled in Part B for your Tricare eligibility to go into effect. You will begin your Tricare eligibility by being enrolled in Tricare for Life.
If you did not have Medicare already, your Tricare eligibility would begin on your 60th birthday Because you have Medicare, however, you have to be enrolled in Medicare Part B before your Tricare eligibility can start.
You need to contact Social Security in October and enroll in Medicare Part B. Arrange with Social Security for your Part B to become effective on the first day of February because that is the month when you will be 60 years old. Your Medicare Part B must be in effect when you turn 60 because you cannot get Tricare without it.
You can hold off one more month enrolling in Part B because you wife is still employed by the company that provides her and your health insurance. But, as soon as she retires, the grace period for you to enroll in Part B without penalty will start to run. And you can’t get Tricare until you are enrolled in Part B due to your already having Medicare.
You will save yourself a lot of needless administrative hassles by starting your Part B and Tricare on the first of February as I suggested above. The longest you can hold off enrolling in Part B will be the grace period between the date of your wife’s retirement and the end of the grace period for enrolling in Part B without penalty. That will be two or three months at most, and during that time, you will not have Tricare.
You cannot get Tricare and Tricare for Life until you are enrolled in Medicare Part B.