Choosing an FEHB plan
November 13th, 2009 | TriCare Help | Posted by Military Times
Q. My husband is retired from the U.S. Army and currently carries the FEHB Standard Blue Cross & Blue Shield and Tricare Standard. The cost of the FEHB BCBS Standard has risen considerably; do you know which fee-for-service FEHB plan works best with Tricare Standard as a secondary insurance? We were thinking about going with the BCBS Basic, which is almost half of what I am paying now for the BCBS Standard.
Regardless of what other health insurance (OHI) you have, Tricare is always second (last) payer, by law. When Tricare Standard coordinates its benefits with their OHI, some beneficiaries have told me that it usually pays most, or sometimes all, of the OHI’s deductibles and copayments. I have the impression, however, that much depends on the quality of the OHI.
Retirees I worked with at the CHAMPUS Headquarters (CHAMPUS was Tricare’s precursor until 1995) in the 1980s chose the cheapest FEHBP plan available because of the way Tricare coordinated benefits.
Folks working in the (now) Tricare Headquarters’ Coordination of Benefits (COB) section have told me that unless they have in hand a copy of the OHI claim, they can’t predict the amount Tricare will pay as second payer. Coordination of benefits has become that complicated.
I have been writing Tricare Help since 1992, and I have responded to thousands of beneficiary inquiries about many things. But, I have never heard of anybody collecting the data and doing the calculations necessary for a comparative analysis of the kind you suggest.
Not to be interpreted as advice — because I don’t know — but the BCBS Basic might be a nice conservative trial to see how well Tricare Standard serves as second payer to a less expensive plan than BCBS Standard. If you are willing to gamble, you can always change back during Open Season the next year if it doesn’t work out well.
If you do it, you’ll have a story to tell me about it in 2011. In turn, I will have something to report to the next person who asks the same question.
Will Tricare and federal plan cancel out my copays?
October 29th, 2009 | TriCare Help | Posted by Military Times
Q. I am trying to make a decision about health care and looking for some answers. I am pregnant, and in order to see a civilian doctor I have to disenroll from Tricare Prime and enroll in Tricare Standard. I am not happy with the military treatment facility OB care, as the doctors are never the same and each has their own opinion. I am also a federal employee and in my window to enroll for my own insurance. The cost per month will be about $80 for myself, but there are copays and deductibles.
Will having two health insurances take care of the copays and deductibles, or will I still incur these out-of-pocket fees?
If you are enrolled in one of the plans available under the federal employees health benefits program, it will become your primary coverage. If you are also enrolled in Tricare Standard, it will be second payer.
As second payer, Tricare Standard will probably pay most, perhaps even all, of the deductibles and copayments of the FEHBP plan. There are no guarantees, but you should have very little, if any, out-of-pocket medical expenses.
You didn’t say, but I assume you are married and eligible for Tricare through your husband’s service. He will have to register the baby in DEERS and enroll the baby in Prime or in Standard very soon after birth. Talk with the Tricare Adviser at your MTF about that soon, because I believe you personally will be locked out of Prime for one year.
If you are not married, and if your Tricare eligibility is a result of your father’s or your mother’s military service, your baby, as a grandchild, will not be eligible for Tricare at all.
If you do not know how to file a claim with Tricare as second payer, see my response to this previous question.
Tricare and FEHB: What are my options?
October 8th, 2009 | TriCare Help | Posted by Military Times
Q. I am a retired naval officer who will be 60 in 2010. I am also a retired federal employee who now uses the Federal Employee Health Benefits plan as primary health insurance. I intend to continue with FEHB after age 60. Its costs are reasonable now, about $75 per month plus medicines from an online pharmacy.
I am trying decide if signing up for Tricare for Life makes economic sense. I am not counting on any significant payout from Social Security because of the dual compensation offset. I am estimating about a 60% reduction there. I am not at all confident that Medicare will cover all my health costs. Would Tricare for Life cover hospitalization as secondary to Medicare? What will TFL cost, and what will it cover after age 60?
When you ask about Tricare for Life, you are talking about five years from now, when you are old enough for Medicare — unless you qualify for Medicare disability benefits and become entitled to Medicare before you are 65. A retiree must be entitled to Medicare and be enrolled in Parts A and B to be eligible for Tricare for Life. It isn’t possible to predict what the program will be like in 2015 when you are 65 and become entitled to Medicare. In the meantime, you can read more about Tricare for Life online, and even download the handbook if you want to plan ahead.
You need to know about the plans you and your family will become eligible for when you are 60. So, online, read about Tricare Standard, Tricare Extra, and Tricare Prime. Also, become familiar with the Tricare Pharmacy Program. All Tricare beneficiaries get the Pharmacy benefit.
While you are online, make a note of the contact information for your regional Tricare office. Call and ask them to send you Handbooks for Tricare Standard or for Tricare Prime if you are interested in that program and if it is available in your residential area. That is also the office to call if you need official Tricare information or help. You can also download the handbooks here: Standard, Prime.
Please note that Tricare Prime is not recommended for people who have other health insurance. It is a useless expense, and coordination of benefits by Tricare Prime with other health insurance can be difficult.
When you are 60 years old and become entitled to receive retired pay, you, your wife, and any unmarried children under age 21 will become eligible for “ordinary” Tricare. An unmarried child who is a full-time student at an accredited college, university, or trade school can remain eligible for Tricare until marriage, graduation, or his 23rd birthday. Your reserve component will probably register you in DEERS, but you must apply on behalf of your family for them to be Tricare eligible.
For questions about Tricare eligibility, call the DEERS Support Office, toll-free, at 1-800-538-9552. DEERS deals with eligibility issues only. It cannot provide any information about the Tricare program or Tricare claims.
Tricare Standard is free. Tricare Prime, if available, costs $230 per person per fiscal year, or $460 for an entire family of two or more people.
As you plan to retain your FEHBP plan, Tricare Standard would probably be your best choice of Tricare plans. Tricare Standard is free, and it combines very easily with commercial health insurance such as your FEHBP plan, as second payer. In most cases, Tricare Standard will pay the patient’s share (usually your FEHBP deductible and copayment) – in part at least, but often completely, leaving you with little or no out-of-pocket medical care expense.
Tricare Standard or Prime will cover at least the same medical services as your FEHBP plan, and probably more. It may not pay as much because the amounts Tricare may pay are linked by federal law to Medicare payments. But, as you will have the FEHBP as your primary coverage, a smaller Tricare payment will not be significant, as it will be second (last ) payer and will need to pay only what the FEHBP plan did not pay.
Tricare Standard: Where do I begin?
September 23rd, 2009 | TriCare Help | Posted by Military Times
Q. I retired from the Air Force in 1995 and since early 1996 have been employed by the U.S. Postal Service and have always had FEHBP health coverage. Now thanks to your columns I understand I can also enroll in Tricare Standard and possibly have my co-payments and deductibles covered by Tricare. Great! How and where do I go about enrolling in Tricare Standard? Must I let my medical care providers know that I have a primary insurance (FEHBP) as well as secondary (Tricare Standard)? Will my primary insurer send the bill for the co-pay to Tricare? If not, do I submit the co-pay and/or deductible to Tricare myself?
As you have discovered, not knowing about all your retirement benefits can be costly. I say this not to chide you, but to remind others uniformed service retirees to be alert regarding their rights and those of their eligible family members. To learn more about their eligibility, they should call DEERS.
Your service probably registered you in DEERS as being eligible for Tricare when you retired. It was your responsibility to register your family members. DEERS registration reports the benefits a person is entitled to, including Tricare.
I suggest you call the DEERS Support Office, toll-free, at 1-800-538-9552, to verify your registration and to ensure that it is up to date. Ask DEERS to confirm your Tricare eligibility and to provide instructions and help to register your eligible family members.
You should tell your health care providers that you have health insurance as a postal employee and that Tricare is your secondary coverage.
Unlike the situation of a person whose only coverge is Tricare for Life (Medicare plus Tricare Standard), Tricare cannot accept a claim as second payer from your employer’s insurance plan. You must file that claim yourself.
To do that, download a official Tricare Claim Form DD2642. The Tricare web site can also give you the claims filing address for your residential area and other claims filing information, including a number to call for help.
Here’s how to file a claim with Tricare as second (or third) payer:
- Complete a Tricare Claim Form DD2642.
- Attach copies of the same itemized bills as were sent to your other health insurance. Please note: The requirement is for an itemized bill that lists each medical service you received and the charge for that service. A “balance due” bill will not serve.
- Attach a copy of the other plan’s Explanation of Benefits, which reports the way it processed each of the charges on the itemized bill.
- Make copies of all documents for your records.
- Send the packet to the Tricare claims processing contractor for your residential area.