If I already have Medicare at 60, can I start using Tricare for Life?
May 22nd, 2012 | TriCare Help | Posted by Military Times
I am a “gray area” Army Reserve retiree. My wife and I are both on Medicare. I will soon turn 60 years old. Can we purchase Tricare For Life at that time?
Military retirees become eligible for Tricare For Life when they become eligible for Medicare. In the vast majority of cases, that happens at age 65. However, people with certain disabilities may qualify for Medicare earlier than age 65, which is apparently the case for you and your wife.
The basic eligibility requirement of Tricare For Life is that beneficiaries be enrolled in Medicare Parts A and B. The fact that you and your wife are already on Medicare means that when you cross the initial threshold to become eligible for military health care as a retired reservist at age 60, you will also become eligible for Tricare For Life at that time.
There is no need to “purchase” TFL coverage; the program charges no enrollment fees or deductibles. However, in addition to your Medicare Part B premiums of about $100 a month, retirees also pay some out-of-pocket costs for prescription drugs under TFL.
A couple of months before you reach your 60th birthday, I suggest you call the Defense Enrollment Eligibility Reporting System (DEERS) support office at 1-800-538-9552 and tell them about your imminent change in status. They will help set you up to use TFL.
If surgery is covered, why did the hospital send a bill?
May 1st, 2012 | TriCare Help | Posted by Military Times
My father is retired Air Force and just recently had retinal re-attachment surgery. He has Medicare as well as Tricare for Life, so I don’t understand why he received a bill from the hospital for over $300. Does Tricare not cover the surgery?
Ordinarily there should be no unpaid balance under Tricare for Life; the combination of payments by Medicare (primary coverage) plus those by Tricare should have paid the Medicare claim and all providers’ bills in full.
The balance most likely results from an error in the way the Medicare claim was filed or processed.
Your father will need to research the matter by comparing the itemized bills for the balance with the explanations of benefits from Medicare and Tricare. He can find contact information for help on the Tricare website.
Do I need Part D when I turn 65?
April 26th, 2012 | TriCare Help | Posted by Military Times
I am a Navy retiree who will turn 65 next year. Like many of your readers, I understand the basics of Tricare, and what it does and does not cover. What I have never seen addressed is “Part D,” or coverage for prescriptions. Can you briefly address that?
Our Tricare Help column has addressed that topic a number of times in the past. But Part D is not a Tricare program — it’s the prescription drug program under Medicare. The consistent advice from the Defense Department’s Office of Health Affairs is that virtually no one who is eligible for Tricare for Life — which you will be when you turn 65 — needs Medicare Part D prescription drug coverage.
Out-of-pocket co-pays for prescription drugs under Part D are usually higher than under Tricare for Life. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
The Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums.
Can veteran dump inferior plan and go with Tricare instead?
April 23rd, 2012 | TriCare Help | Posted by Military Times
I have a friend who is an aging, retired Army colonel. After his long military service, he worked in the legal department of an insurance company from which he is also now retired – with truly lousy retirement benefits. My wife and I told him about the benefits we get from Medicare and Tricare For Life. Can he “renounce” that other retirement health plan that has such skimpy benefits, and enroll in Tricare For Life?
The short answer is yes, your friend can give up his current plan and use Tricare for Life. Not only can he do that, he should do that.
As with any health care plan, Tricare has complex rules that can sometimes be frustrating to deal with. But there is no question that Tricare provides robust health care coverage and is one of the lowest-cost health care plans in the nation, particularly for Medicare-eligible beneficiaries over age 65.
As you mentioned, for Medicare-eligible military retirees, Tricare For Life acts as a virtually free supplement to Medicare (although as many retirees are quick to point out, TFL is not entirely free, since you must be enrolled in Medicare Part B, and paying the monthly Part B premiums, to be eligible for TFL).
Moreover, TFL beneficiaries can take advantage of the Tricare Mail Order Pharmacy program, under which they can receive a 90-day supply of drugs for the same price of a 30-day supply obtained at local retail pharmacies.
There’s one potential wrinkle in your friend’s case: You don’t say exactly how old he is, but you indicate that he is over age 65. If he did not sign up for Medicare when he first became eligible at age 65, he will have to pay a penalty to enroll late in Medicare Part B. The penalty adds 10 percent to the Part B premium for each year that the individual delayed Part B enrollment after becoming entitled to Part A, and that penalty must be paid for life.
Your friend should contact the Defense Enrollment Eligibility Reporting System (DEERS) support office at toll-free 1-800-538-9552 for more information and to get started on registering for TFL.
How can I get information on Medicare Part C?
April 20th, 2012 | TriCare Help | Posted by Military Times
I turned 65 in February and have enrolled in Medicare Parts A and B. I have also contacted Medicare about information on Part C, but it’s been three weeks and I have not heard back. Can you help?
I can’t help get you a reply from Medicare — that’s outside the scope of the Tricare Help column. But I can tell you that as a general rule, Tricare for Life beneficiaries do not need Medicare Part C coverage.
Medicare Advantage Plans under Part C are offered by private companies that are approved by Medicare. They may offer supplemental coverage beyond the standard Medicare Parts A and B, and most also offer Medicare Part D prescription drug coverage — all at additional out-of-pocket costs to beneficiaries beyond the monthly premiums required for Medicare Part B outpatient coverage.
Advantage plans, however, are designed for civilians who do not have your free Medicare supplement known as Tricare for Life. TFL offers the same supplemental coverage, along with its own prescription drug plan, at far less cost. While there has been talk of implementing an annual enrollment fee for Tricare for Life, at this time there are no enrollment costs for the Tricare portion of TFL.
In addition, prescription drug costs through TFL are less costly than under Medicare Part D. In fact, the Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
To sum up, you are already covered by two full-service, stand-alone, health insurance plans — Medicare and Tricare for Life — all for the cost of the monthly premium for Medicare Part B.
Can I use TFL outside the U.S.?
April 19th, 2012 | TriCare Help | Posted by Military Times
How does a Tricare for Life beneficiary get reimbursed for hospital and doctor bills when traveling outside the continental U.S.?
From the moment you leave U.S. territory, you will have no coverage by the Medicare portion of Tricare for Life. Federal law does not allow Medicare to pay for foreign medical care. Your only coverage will be Tricare for any medical care received outside the US and its territories.
Thus, you must carefully save copies of all medical bills, receipts, doctors’ statements, prescriptions, and the like until you return home. You will need them at that time to file Tricare claims.
Do Medicare-eligible Tricare beneficiaries need Part D?
April 13th, 2012 | TriCare Help | Posted by Military Times
My wife will get Medicare this summer, and her sister told her that she will have to enroll in the Medicare Pharmacy Program, or Part D. Is that correct?
Unless your wife enrolls in one of the Medicare Advantage plans that requires it, she is not required to enroll in Medicare Part D.
Neither Medicare nor Tricare require their beneficiaries to enroll in the Medicare Pharmacy Plan, Part D of Medicare. To the contrary, Medicare Part D is not recommended for Tricare for Life beneficiaries.
The Office of the Assistant Secretary of Defense for Health Affairs is on record for saying that the only Tricare beneficiaries likely to achieve any financial advantage from Medicare Part D enrollment are those whose incomes are below the federal poverty level and who qualify for financial aid to help pay their Medicare Part B premiums.
If your wife were to enroll in a Medicare Part D plan, she would have to file Tricare claims to be reimbursed for the plan’s copayments and deductibles, if applicable. She might be limited to that plan’s formulary in the drugs that are covered, and she would not be eligible to use the Tricare Pharmacy Program’s Mail Order Pharmacy Plan.
I’m on Tricare for Life, but my doctor won’t take Medicare
April 11th, 2012 | TriCare Help | Posted by Military Times
I am going to get Medicare and Tricare for Life soon. The problem is that the doctor I have used for several years does not take Medicare. I don’t want to change doctors if I can help it. Is there anything I can do?
Medicare cannot pay for any services received from a health care provider who has opted out of the Medicare program. Although you can continue to use his services, you could not receive any payment from Medicare for his services.
You could file a Tricare claim. Tricare can calculate the amounts it would have paid if Medicare had paid the doctor’s claim. Tricare will pay you that amount only. At the most, that would be the amounts the Medicare copayment and Medicare deductibles would have been.
Unless you can persuade your doctor to become a Medicare provider, your dollar-wisest choice will probably be to change physicians.
If you will contact your Tricare Service Center, you can get a list of Medicare providers in your area. That will help if you decide to change physicians.
My doctor says Tricare for Life gives me substandard version of Medicare
April 6th, 2012 | TriCare Help | Posted by Military Times
My doctor told me that the kind of Medicare I have under Tricare for Life pays him much less than the kind civilians get. He said that is so the combined payments of Medicare plus Tricare come out to total the same amount that the government would pay if I had civilian Medicare only. It that true?
Your doctor is mistaken. When a military retiree applies for Medicare, he or she gets exactly the same Medicare Part A and Part B as any other person. Medicare was created by federal law enacted by Congress. It would take another act of Congress to create a “special” kind of Medicare just for military retirees. That didn’t happen when Congress authorized Tricare for Life in 2001.
Your doctor can set his mind at ease with a quick letter to the Social Security Administration. If he won’t do it, and if his belief is putting your health care in jeopardy, maybe you should offer to write the letter. You will get the same reply that he would.
In the same way, the Tricare Standard that Tricare for Life members get is exactly the same Tricare Standard they were eligible for before they got Medicare. It has some special rules to allow it to function smoothly as second payer to Medicare under Tricare for Life.
Under Tricare for Life, Tricare Standard acts as a free Medicare supplement. In the vast majority of claims, when both Medicare and Tricare cover a medical service, Tricare Standard will pay the remainder of the Medicare-approved amount after Medicare pays its maximum.
If Tricare and Medicare cover everything, why do I still get billed?
March 28th, 2012 | TriCare Help | Posted by Military Times
I have been married for 55 years to a military retiree. You have said many times that when a medical service is covered by both Medicare and Tricare, Tricare acts as a secondary payer and will pay whatever Medicare does not. So I don’t understand why, when I go to the doctor, I receive a bill. On my last doctor’s visit, I was billed $84.07 as my balance. Other times, it has been more. What am I doing wrong?
You state correctly that Tricare acts as a second payer to Medicare. Usually, the Medicare provider will forward your paperwork directly to Tricare to resolve any outstanding balance for the services you received. However, note that I said usually … in certain circumstances, beneficiaries themselves must file the second claim with Tricare. This occurs most often when the health care provider does not formally participate in Tricare (i.e., he/she is not a “Tricare-authorized provider”).
It should be noted that a very limited number of health care services are covered by Medicare but not Tricare, and vice versa. From the documentation you sent me, I can’t say for sure if that is the case in this instance.
I would suggest a couple of things here. First, contact your provider and explain to them that you are married to a military retiree and that you are both eligible for Tricare for Life military health care coverage, then ask whether they forwarded the unpaid portion of your bill to Tricare, and if not, why not.
Then I would gather up copies of all the documentation you received from your provider, including the detailed Explanation of Benefits that they should have sent you, and file a claim yourself with Tricare for the unpaid balance.
Here’s how you file a claim with Tricare as second payer:
- Complete a Tricare claim form DD2642.
- Attach a copy of the same itemized bill that was sent to the other plan.
- Attach a copy of the other plan’s EOB reporting its processing of each of the charges on that bill.
- Send the claim to the proper Tricare claims processor for the state where you live.
The claims form and all pertinent information about filing Tricare claims is available online.