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.
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
Fee hikes for hospital stays: What do they mean?
October 7th, 2009 | TriCare Help | Posted by Military Times
Q. Since the Defense Department announced on Sept 30 that it would be raising the hospital inpatient copay for retired Tricare Standard beneficiaries by $110 per day (from $535 to $645) as of Oct 1, what is the practical impact on retirees not yet on Medicare and those who have reached age 65 and are on Medicare? Does it just mean that retirees not yet on Medicare will need supplementary insurance to pay the additional cost? What about those whose primary insurance is Medicare and secondary is Tricare for Life?
Something many beneficiaries forget is that the inpatient cost share increases every year on October 1. It is not a phenomenon special for this year only.
The consequences are the same as for any other year. Tricare Standard beneficiaries who do not have other health insurance or a Tricare supplement have more to pay out-of-pocket as a share of the increasing costs of hospitalization for the entire U.S. population, not Tricare beneficiaries alone.
The Defense Department has always recommended a Tricare supplement. The 25 percent Tricare Standard cost share for retirees is required by the federal law.
You might not be old enough to remember that, prior to Tricare (called CHAMPUS when it was enacted in 1966), there was no government program to pay even a penny for civilian medical care for active-duty family members, retirees, their family members or survivors.
I was on active duty when my children were small in the 1950s. I paid out-of-pocket for their civilian medical care during periods when our base hospital had no pediatrician.
Those fortunate enough to have Tricare for Life (TFL) have the advantage of Tricare Standard as a free Medicare supplement. On the vast majority of their Medicare claims, Tricare Standard pays whatever Medicare does not pay when the medical services involved are covered by both Medicare and by Tricare. The only service covered by Medicare, but not by Tricare, is chiropractic care.
TFL came into existence by act of Congress in 2002. Before that, any beneficiary who became entitled to Medicare at age 65 lost all Tricare eligibility.