How do we decide between Tricare Prime and FEHBP?
September 8th, 2011 | TriCare Help | Posted by Military Times
My husband is retiring from the military and now is eligible for the Federal Employee Health Benefits Program through his new job. He has minimal health issues, but I have a history of cancer and other problems. Should we enroll in FEHBP or use Tricare Prime? The premiums alone for FEHBP equal or exceed Tricare’s yearly $3,000 catastrophic cap. If we had both, could the FEHBP deductibles, copayments and premiums count toward Tricare’s catastrophic cap?
I cannot tell you exactly what you “ought” to do regarding your health insurance coverage; nobody can make that decision except you and your husband. But I can give you as much information as possible about Tricare to help you make that decision.
Tricare Prime functions as a Health Maintenance Organization (HMO). Tricare Prime providers (called network providers) are under contract with Tricare to provide the services mandated by law and regulation to beneficiaries enrolled in Prime.
They have privately negotiated with Tricare the fees they will charge for each of their services, but that’s between Tricare and the provider only. All the patient must be concerned about is the flat rate of $12 he or she must pay per office visit, or the flat rate of $11 per day for hospital stays.
Prime is not available everywhere. It is usually found within a 40- 50-mile radius of a military treatment facility. Tricare beneficiaries enrolled in Prime have priority access, right after active-duty family members, to free care at the MTF.
As with commercial HMOs, you must seek all care, except bona fide medical emergency care, from providers in your local network.
If you take a trip, clear it first with Tricare Prime, because on the road, “routine” care will not be covered inexpensively. There are considerable penalties ($300 deductible, 50 percent cost share) on claims for unauthorized care by non-network providers.
People have exactly the same problems with commercial HMOs under the FEHBP. Personally, I like HMO care except for the limited choice of providers, and the inconvenience if one travels. They are most like military sick call. The big ones have everything — labs, etc. under one roof, plus centralized record-keeping, central appointments, and the like. Big civilian HMOs may even own their own hospital. And their low cost is a big factor.
Like many things in life, it’s a trade-off. Study assiduously; know before you buy. You can download a free Tricare Prime handbook here.
FEHBP deductibles and cost shares do not count for your Tricare catastrophic cap, however. Only Tricare’s deductibles and cost shares count.
How do I keep coverage for younger husband when I get TFL?
March 25th, 2011 | TriCare Help | Posted by Military Times
Q. I’m a retired reservist and retired federal employee with employees’ health insurance. I have a civilian husband who is three years younger, but no children. I’ll be 65 in August and get Medicare and Tricare for Life. What can I do at that time to ensure I still have coverage for my husband?
When you transition to Tricare for Life on Aug. 1, your husband’s federal employee plan and Tricare coverage will continue unchanged until he gets Medicare at age 65 — assuming you keep your own coverage under the federal employees plan. Family members can’t be covered unless the former employee also is covered. Confirm this with the Office of Personnel Management.
For your own transition, you should apply for Medicare Part A and Part B at least 90 days before Aug. 1. If you enroll properly, your coverage will be effective on that date. If your Defense Enrollment Eligibility Reporting Service record reflects your Part B enrollment, you will retain your Tricare eligibility and become eligible for TFL.
TFL consists of full coverage by Medicare Parts A and B plus Tricare Standard. Because you must retain your federal employee plan coverage for your husband’s benefit, however, that plan — not Tricare — will be second payer on your Medicare claims. Tricare Standard will be last payer, and you must file those claims yourself.
Call the DEERS support office at 800-538-9552 to check the accuracy of your and your husband’s DEERS records.
How does Tricare coordinate with FEHB, Medicaid?
January 10th, 2011 | TriCare Help | Posted by Military Times
Q. I am a federal employee and a mobilized reservist on active duty, so I have my FEHB – AETNA as well as Tricare. I recently found out that my son, who has Cerebral Palsy, is covered by Medicaid. He had major surgery after I was mobilized. How are the benefits coordinated?
By law, Tricare is always last payer to all other health insurance, medical plans such as HMOs, or medical payments such as you might receive from an auto accident, slip-and-fall injury and the like.
The only exceptions to that rule are in the case when the other coverage is a bona fide, specially written Tricare supplement, or a welfare-related plan such as Medicaid (not Medicare), Indian Health Service, and the like.
In your son’s case, the order of filing will depend on his coverage. If he has Aetna, those claims must be filed first. Then you can file with Tricare (which will probably pay all, or most, of Aetna’s deductibles and copayments), and finally claims can be filed with Medicaid.
Weighing a switch to Federal Employee Health Benefits plan
December 29th, 2010 | TriCare Help | Posted by Military Times
Q. I’m contemplating switching from my current family coverage, using Tricare Standard as primary and MOAA Mediplus as secondary, to FEHB with Tricare as secondary and dropping Mediplus. Any advice?
Only you and your family know what is the best plan for you. I know nothing about your situation, so I could not presume to advise you specifically about such matters.
Both Tricare and most of the FEHBP plans provide adequate coverage for the majority of persons. If you decide to enroll in one of the FEHBP plans, study each plan carefully to see how well it will meet your needs.
You should expect a significant increase in your health insurance costs if you opt for an FEHBP plan. My guess is that most of the FEHBP plans will cost at least twice what you now pay for the MOAA Tricare supplement. My wife and I have the FEHBP Blue Cross and Blue Shield plan and pay in excess of $400 per month for it. Tricare Standard, of course, is free.
Covered by Standard and federal plan – what happens when I turn 65?
June 28th, 2010 | TriCare Help | Posted by Military Times
Q. This September I will be 65 years old and eligible for Medicare. I am retired from the Navy, and have Tricare Standard for myself and my family. I am also retired from federal service, and I am enrolled in the Government-wide Service Benefit Plan (BlueCross BlueShield) for government retirees. This is my primary health insurance. My wife will not be eligible for Medicare for another seven years.
What should I do about my health insurance needs when I turn 65 and go on Medicare? I know I will have Tricare for Life, and I realize I need to get Part B of Medicare. Am I correct to assume that my wife and child (20 years old) will still be eligible for Tricare Standard, and I will have TLF and Medicare? What should I do about my government retiree plan?
In your case, unfortunately, your transition from “ordinary” Tricare to TFL will be expensive for you. Here’s why.
Your transition to TFL will have no effect of any kind on your family’s eligibility for “ordinary” Tricare Standard. And, they will continue to need other health insurance – the federal employees plan (FEP) — in addition to Tricare, just as they do now. Your family’s coverage will not change in any way.
Your FEP premium is at the family rate — two or more family members. That will not change, because you will still have the FEP plan.
You cannot leave the FEP plan. You, the former employee and sponsor, must also be enrolled in the FEP in order for your family to have FEP coverage. You will have to pay the FEP monthly premium at the family rate just as you do today for two or more family members.
Now about your TFL. You know that federal law requires you to be enrolled in Medicare Part B when your free Medicare Part A becomes effective. That means you will have to pay a monthly premium for Medicare Part B in addition to the FEP premium.
Your own personal costs for health insurance will increase by the amount of the Part B premium. Your first payment will be due on August 1. You will pay for Part B one month in advance. For the remainder of this fiscal year, which ends on September 30, it’s around $100. You can arrange for the premium to be taken from your OPM pension.
For your family, the FEP will be primary and Tricare will act as a free supplement (second payer) for it, just like today. Nothing will change for them.
For you, Medicare will become primary on Sept. 1, the FEP will be secondary, and Tricare, by law, is always last. Your Medicare coverage, Part A and Part B, will be effective on Sept. 1. You will get a Medicare ID card in August that shows Sept. 1 as the date for your Part A and Part B to become effective.
Social Security wants people to apply for benefits at least 90 days prior to the effective date of their coverage. You must apply for Part B at that time according to the law that governs Tricare. That is a different law from the one that governs Medicare.
As of Sept. 1, you must seek all your civilian medical services from Medicare providers. That is, providers that will file Medicare claims for their services. Do not use any provider who cannot, or will not, file Medicare claims for your bills. If you do, Medicare will deny payment on the claim.
When the provider asks about your secondary insurance or Medicare supplement, tell them it is your FEP plan. Show them your FEP ID card. After Medicare pays a claim, it will automatically forward the claim to the FEP as second payer.
FEP will be primary and Tricare will be your second payer for all medical care you receive until midnight on Aug. 31.
When Medicare and the FEP are both done with a claim, and both have sent you EOBs, it’s time to file a Tricare claim, even if there is nothing left to pay. You should always file a Tricare claim as third payer in order to get family credit on your Tricare Catastrophic Cap.
Call your Tricare Service Center for help with filing the Tricare claim the first two or three times until you learn how to do it yourself. Your FEB will not forward the claim to Tricare. You must file it.
Using Tricare for Life with FEHBP
May 19th, 2010 | TriCare Help | Posted by Military Times
Q. I’m federal employee with government health insurance plus Tricare Standard. I’ll soon turn 65 and get Medicare, but I must keep my FEHB plan because my wife is only 57. In what order must I file claims? Do I file first with Tricare for Life and then with my FEHB plan? Also, Medicare says I do not have to enroll in Part B for as long as I continue to work. Tricare told me I must enroll in Part B as soon as I become eligible for Medicare. Who is right?
As far as the order of filing claims, remember one simple rule: By law, Tricare is always last payer to all other health insurance.
Your only issue, then, is whether to file first with Medicare or with your FEHB plan. Medicare’s rules say that depends on whether you continue to work for the employer who sponsors the other plan. So, for as long as you work for that employer, the FEHB plan is primary, Medicare is second, and Tricare is last. When you retire, Medicare becomes primary, the FEHB plan second, and Tricare last, as always.
As for enrolling Medicare Part B, because you are a Tricare beneficiary who is retired from the military, the rule under Tricare law takes precedence over the Medicare rule.
Tricare law requires any retiree, retiree family member, or survivor who becomes entitled to Medicare to be enrolled in Part B on the effective date of Medicare coverage. Failure to do that causes the immediate loss of all your Tricare eligibility. Note that this would have no effect on your wife’s Tricare eligibility.
Just remember to apply for Medicare Part A and Part B at least 90 days before the month of your 65th birthday.
No Tricare coverage on active duty
May 7th, 2010 | TriCare Help | Posted by Military Times
Q. My 20-year-old son is a college student and in the Air National Guard. I work for the federal government and have BCBS FEP for self and family, so he, my wife and two young daughters are all covered under my BCBS FEP Basic Option. Last week, my son received orders to support a contingency operation oversees in two weeks. As an eligible dependent under my FEHP, and now seemingly eligible for Tricare, is he eligible for dual coverage? If so, how will this dual coverage work oversees, and what Tricare option will best compliment BCBS FEP’s Basic Option?
From the moment your son’s orders to active duty are effective, that is, once he is officially on active duty, he will no longer be eligible to receive civilian medical care at government expense under Tricare. All his medical care and related services will be provided without cost by his uniformed service. Tricare or the FEHBP will not be involved in any way.
During the period of active duty, it would be unwise for him to seek civilian care for any medical condition because, in the event of an associated problem, the medical condition resulting could be considered not to be in the line of duty. That is no adverse reflection on him personally, but it could adversely affect any subsequent claims against the government for a related service-connected condition.
Whether the FEHBP plan would even cover him while on active duty, and particularly if it were outside the US and possessions, is a question you will have to ask of your FEHBP plan. Tricare is not involved in that because, as noted, he will not be eligible for Tricare while on active duty.
If Tricare were involved when he is not on active duty, it would be only as second payer to his FEHBP coverage. Tricare exercises no control over such claims or care. It acts merely as second payer to supplement the other plan’s coverage. His primary coverage as a civilian, according to your letter, is his FEHBP plan. Again, it is unrelated to Tricare.
Depending on the duration of his active duty call and its nature, he could be eligible for continuing military coverage for up to 180 days after the active duty period, but that will not be known until the end of his active duty period. That is not related to Tricare. He should talk with his personnel section near the end of his tour.
Is long term care covered?
March 5th, 2010 | TriCare Help | Posted by Military Times
Q. I am a retired reservist who will be eligible for Tricare when I turn 60. I am also a current federal employee covered by the FEHBP. Do I need to purchase a separate long term care insurance policy or will my FEHBP, Tricare and eventually Medicare cover those expenses? What about my spouse?
When people talk about “long term care,” they often have in mind a nursing home type of environment where people go to live when they can no longer care for themselves.
It is a place where you can live, and be watched over and protected. Your meals will be provided and, if you are unable to “do” for yourself, you will be helped to eat, dress, bathe, attend to personal hygiene, and the like. In insurance and medical vernacular, such care is usually referred to as “custodial care.”
It is very expensive to live in a place where you have have nurses and aides of several kinds, and probably a doctor on call 24/7 to care for you and meet your needs with the “activities of daily living.” (That is a technical term used in the law.)
The federal laws that created both Medicare and Tricare make no provision to help pay for such living arrangements. In fact, both programs are specifically prohibited by law to pay for “custodial care.”
Other than specific long term care policies, I know of no commercial health insurance policy, such as your FEHBP plan, that will pay for it.
Only you can decide whether you and your wife need such insurance. But, you cannot count on Medicare and Tricare (Tricare for Life), or your FEHBP plan, to help pay for it. Those programs will continue to pay for your medical care, including hospitalization, and your pharmacy needs, just as they do now, but they cannot pay for the costs of being cared for in such a facility.
The insurance for that kind of “long term care” is expensive, and the older you are when you buy the policy, the more it costs.
Should I drop FEHBP and use Prime instead?
January 2nd, 2010 | TriCare Help | Posted by Military Times
Q. I work for the federal government and I will be a retired reservist at 60. I would like to enroll in Tricare Prime instead of using the federal benefits plan, which is more expensive. Am I allowed to do that?
On your 60th birthday, you, your wife, and any unmarried children under 21 (under 23 if an unmarried, full-time college student) will become eligible for Tricare.
If you enroll in one of the plans under the Federal Employees Health Benefits Program, Tricare will automatically be second payer to that plan. Usually it will pay all, or most, of the FEHBP plan’s deductibles and copayments. Whether you keep an FEHBP plan is entirely up to you; Tricare doesn’t care.
I recommend against choosing Tricare Prime if you retain the FEHBP coverage. Standard is the best way to go when you have other health insurance. That’s because it is free, and with Standard, it’s much easier to coordinate benefits between the two plans.
If you leave the FEHBP plan, be sure to suspend membership — do not cancel. If you cancel you can never get it back. If you suspend, you can get it back any year during Open Season. Talk with the Office of Personnel Management to make sure you understand thoroughly before you decide.
Prime is not available everywhere. Check with your Tricare Service Center to find out if Prime is available where you live. Prime is your best bet if that will be your only coverage. If it’s not, the best coverage is to retain the FEHBP.
As an alternative, consider a bona fide Tricare Supplement — a specially written plan designed to be a Tricare supplement. Study the fine print carefully before deciding which supplement to buy. What you will get for your money is what is written in the fine print, not in the ads or sales pitches.
But don’t be seduced by a few bucks. Tricare Standard plus an FEHBP plan, even the least expensive one, provides much better coverage than Tricare plus a supplement.
Remember to check with DEERS (call 1-800-538-9552, toll-free) to confirm that you and your family have been made eligible for Tricare on your 60th birthday. Registration is supposed to be automatic, but people make mistakes.
Will Mail Handlers plan plus Tricare be enough?
November 20th, 2009 | TriCare Help | Posted by Military Times
Q. My wife and I have long had Mail Handlers Standard but now are considering Mail Handlers Value. We also have Tricare. I am concerned that the Value policy and Tricare won’t be enough insurance. Can you provide any thoughts or sources of information?
I’m disadvantaged because I don’t know what benefits are provided under various plans available through the Federal Employees Health Benefits Program (FEHBP). I am aware that Mail Handlers is one of the better plans available for federal employees, but I don’t know how Mail Handlers Value differs from Mail Handlers Standard. I must leave that analysis and its applicability to your needs to you alone.
Let me talk briefly about what I do know.
I can tell you that Tricare Standard is a full service, stand-alone plan that, when it was created in 1966, was modeled after the FEHBP’s High Option Blue Cross and Blue Shield Plan. That plan was considered to be one of the best available in the nation at the time. Because of its generous and broad coverage, it was the most expensive plan available to federal employees. It is no longer available, perhaps for that reason.
Over the years, many beneficiaries have had Tricare Standard as their only health insurance. It’s greatest deficiency as one’s only coverage is its $150 deductible and 25 percent copayment (cost share). Tricare has always recommended a good Tricare supplement, when possible, for those enrolled only in Tricare Standard.
In my experience, and having corresponded with several thousand Tricare beneficiaries, I believe that when Tricare Standard is combined with a good Tricare supplement — or much better, with a good primary plan such as any of the FEHBP plans — beneficiaries find that most of their health care costs are paid in full or almost in full. The latter would be my choice for coverage.
That is particularly true because all Tricare beneficiaries are automatically eligible for, and are enrolled in, the free Tricare Pharmacy Program, which is one of the best prescription drug plans available. A Tricare beneficiary does not need any other pharmacy insurance.
Note: The Tricare Pharmacy Program has a new, combined information center at 1-877-363-1303, toll-free.
By federal law, Tricare is always last payer to all other health insurance plans. Whatever commercial plan you choose under the FEHBP, Tricare will serve as second payer, and it will usually pay most, often all, of what the primary FEHBP plan does not pay.
The FEHBP doesn’t offer any “junk” plans. Although they differ in the kinds and amounts of coverage, all the FEHBP plans are solid, legitimate plans. Tricare Standard is a good choice as your second payer for any plan under the FEHBP.
Thus, your decision must be based on your reading of the fine print in your two Mail Handlers plans, to decide which of the two provides more adequately for you and your family. With Tricare Standard as second payer, only the details of the two Mail Handlers plans and their application to your particular family needs to concern you
Tricare Prime, on the other hand, is in my opinion the plan of first choice as an individual’s or a family’s only coverage. But I do not recommend Tricare Prime for any beneficiary who has other health insurance. Tricare Prime functions as a Health Maintenance Organization, or HMO — a plan under which the beneficiary must receive all his care from providers who are under contract with the plan, and he usually pays a fixed fee which is the same for each doctor visit.
Because you may use only plan providers, an HMO limits your choice of physicians to those on a list of certain providers in one specific geographic locality. Because of those requirements under Tricare Prime, it is not a good choice to be second payer to any other health insurance. It has a potential for too many problems when benefits are coordinated between the two plans. That invites errors and, especially, misunderstandings.