What do we pay when one spouse switches from Prime to TFL?
March 21st, 2012 | TriCare Help | Posted by Military Times
I will turn 65 in 2014. My husband won’t turn 65 until 2021. I know I must sign up for Medicare Part B at $99.90 per month and will enroll in Tricare for Life. Will I have to continue to pay the annual Tricare Prime fee at the family rate so my spouse will still be covered until he reaches 65? And once he can get Tricare for Life, will we each have to pay $99.90 per month?
Once you become eligible for Tricare for Life, your spouse can continue in Tricare Prime, and you should be able to shift from the family rate to the individual rate for him. Once your spouse turns 65, you will both have to pay the monthly Medicare part B premium; that cost is a standard rate per individual.
For the most definitive response to these kinds of eligibility questions, you should contact the Defense Enrollment Eligibility Reporting System (DEERS) support office, toll-free, at 1-800-538-9552.
Can I keep my doctor after I switch to Tricare for Life?
March 12th, 2012 | TriCare Help | Posted by Military Times
I will be 65 and get Medicare in August. However, I have finally found a doctor I like at my military hospital. He explains things to me and never rushes. How can I keep seeing him after I get Tricare for Life?
I’m afraid I don’t have good news for you: You currently have priority access to the military hospital, and your doctor, under Tricare Prime. But when you turn 65 and get Medicare and Tricare for Life, the Tricare Prime part of your coverage will automatically convert to Tricare Standard. That, along with Medicare Parts A and B, comprise your health coverage. Medicare will become your primary payer, with Tricare paying whatever Medicare does not. You will have to find a new, Medicare-authorized, doctor – hopefully one who communicates as well as your current physician.
Doctor wants to see Tricare for Life card; where can I get one?
March 9th, 2012 | TriCare Help | Posted by Military Times
Several times I’ve had doctor’s office give me a blank look when I tell them my health insurance is Tricare for Life. They say they’ve never heard of it, and they want to see a Proof of Insurance card. Where can I get such a card?
Under Tricare for Life, your primary insurance is Medicare. I know it seems awkward when you know you are a Tricare beneficiary, and your health insurance is called Tricare for Life. But look at it this way. Under TFL, Tricare acts as a free Medicare supplement.
Providers usually don’t care which Medicare supplement you have because they will look to you for payment of what Medicare does not pay. What you owe is your 20 percent Medicare copayment and maybe some Medicare deductible. Whether you have a supplement to pay it for you, or whether it comes out of your own pocket, you, the patient, are responsible.
So, when asked about your health insurance, just say you have Medicare. That’s the important word. If they ask about a Medicare supplement, then you can say you have Tricare.
TFL doesn’t have an identification or proof-of-insurance card because. Just show your Medicare card and your military ID card.
And, any time you go to a new provider of any health care service, whether it’s a doctor, or a hospital, or a physical therapist, or a medical supply and equipment vendor, or anything related to health care, always ask if the provider files Medicare claims, before you incur a debt.
If a provider does not, or cannot file Medicare claims, it is an indication that the provider is not an authorized Medicare provider. That doesn’t mean there is something wrong with the provider. It means, however, that neither Medicare nor Tricare will pay for any services you get from that provider.
Why you shouldn’t worry about those Medicare supplement commercials
February 10th, 2012 | TriCare Help | Posted by Military Times
Despite the open season for Medicare being closed, I keep seeing ads for Medicare supplements, Medicare Part D, Medicare advantage, and the like. Those continuing ads make me wonder whether I need any support for my Medicare coverage as the ads suggest. Do I need to bells and whistles the ads keep pushing, or is Tricare for Life really all I need?
Keep in mind that the ads on TV are designed to only sell insurance coverage — more importantly, to sell coverage to the targeted audience, most of whom are civilians.
While civilians may need additional plans such as Medicare supplements or Medicare Advantage plans to have, as some say, complete coverage, that is not a problem for Tricare for Life beneficiaries.
The original Medicare program that most Americans have doesn’t provide full coverage, such as payment of your Medicare deductible, its copayments, or the costs of prescription drugs. Those things are provided free as the Tricare Standard portion of your Tricare for Life coverage. And regarding pharmacy costs, Tricare beneficiaries are automatically enrolled in the free Medicare Pharmacy Program.
Will Tricare cover my second PSA test?
January 9th, 2012 | TriCare Help | Posted by Military Times
I am 66 and have Tricare for Life. Medicare covers only one PSA test a year. I just had a PSA test and it was high. The biopsy showed cancer. They are going to remove the prostate. After 3 months I am going to need another PSA to see if they got it all. Will tricare cover the test?
Federal law requires Tricare to always be last payer to all other coverage. Claims must always be submitted to any other coverage first.
Under Tricare for Life, Medicare has become your primary health insurance. All claims must be filed with Medicare first. Tricare is second payer on all claims.
When a medical service is covered by both Medicare and by Tricare, Tricare will act as your free Medicare supplement and will pay whatever Medicare did not pay.
It is important for you and your providers to understand that, regardless of whether or not Medicare will cover the second test, all claims for the second test still must be submitted to Medicare first. That is true even if Medicare will deny payment on that claim.
If you diagnosis is made a part of your Medicare claim, I feel certain that it will be paid. Regardless of whether Medicare covers the second PSA or not, Tricare will cover it if the claim, including your diagnosis, is submitted properly to Medicare first.
Even if Medicare denies payment, it will still forward the claim to Tricare just as it always does. That’s the way Tricare for Life works.
I’m about to get Tricare for Life; what else do I need?
December 29th, 2011 | TriCare Help | Posted by Military Times
I am going to turn 65 in February. I am in the process of enrolling in Medicare Parts A and B. Besides Tricare for Life, do I need to buy other insurance, such as Medicare Part C? My husband is a military retiree.
Tricare for Life was designed especially for Tricare beneficiaries who become eligible for free Medicare Part A and are enrolled also in Medicare Part B. Those beneficiaries also retain their eligibility for all the benefits of Tricare Standard which, as second payer to Medicare, acts as a free Medicare supplement. If they are enrolled in Tricare Prime, it will be converted automatically to Tricare Standard on the date their Medicare coverage becomes effective.
TFL beneficiaries, therefore, are covered by two, full-service, stand-alone, health insurance plans, all for the cost of the monthly premium for Medicare Part B.
You should be cautious also of Medicare Part C, the Medicare Advantage plans. They are the original Medicare plan plus important medical services added by the commercial carriers of the Advantage plans. Advantage plans, however, are designed for civilians who do not have your free Medicare supplement. You should examine the Part C add-ons before buying to see which ones Tricare Standard automatically includes at no additional cost to you. With Tricare Standard, you do not need the Part C add-ons.
You also should not enroll in the Medicare Pharmacy Program, called Part D, because you, like all Tricare beneficiaries are automatically eligible for the free Tricare Pharmacy Program. The Defense Department’s Health Affairs office says, in effect, that you won’t benefit from Medicare Part D unless your income is so low that you qualify for financial aid to pay your Medicare Part B premiums.
Plus, enrollment in Part D will prevent your use of the Tricare Mail Order Pharmacy Plan, where the big savings come in. If you use the mail order plan, you can a 90-day supply of drugs for the same price that you would pay locally for a 30-day supply.
What benefits can retiree’s new wife get?
December 19th, 2011 | TriCare Help | Posted by Military Times
I am a retired Marine. If I get married, is my new wife eligible for Tricare for Life if I enroll her in DEERS? What medical benefits will she get?
If you are entitled to receive retired pay, you are probably also entitled to Tricare. And, if you are entitled to Tricare, your wife will be entitled also, just as soon as you kiss the bride.
You will have to register her with DEERS and get her a military ID card before she can use Tricare, but that won’t take long to do. If you need instructions or other help for getting her on the program, please call the DEERS Support Office, toll-free, at 1-800-538-9552. That office can answer all your questions about Tricare eligibility and walk you through the registration process with your new wife.
You can enroll your wife in Tricare Standard, which is free, but she will have a $150 deductible every fiscal year and a copayment of 25 percent of the amount Tricare allows on each of her claims up to a total of $3,000 for the two of you.
Then there is Tricare Prime, which is not available everywhere. But, if you live in an area where you can get Prime, it’s the least expensive in terms of out-of-pocket costs. Prime, however, has a yearly enrollment fee of $260 per person, or $520 for a family of two or more people. Prime is also great because it gives you priority access to free care in military hospitals.
Finally, you mentioned Tricare for Life. That’s the best deal of all, and I get the idea you already know about it. If your new wife is entitled to Medicare and is enrolled in Part A and Part B, she is set for life Tricare for Life.
If you go to the Tricare web site, you can get official information about all Tricare plans and rules, including the free Tricare Pharmacy Program. Note: Do not enroll your wife in the Medicare Pharmacy Program, called Medicare Part D. She won’t need it, and it will block her from using the Tricare Mail Order Pharmacy Plan, which is a big money-saver. If she is already enrolled in Part D, she can call Medicare and cancel it.
Do I have to cancel employer’s policy to use Tricare for Life?
December 9th, 2011 | TriCare Help | Posted by Military Times
I will turn 65 later this year and become eligible for Medicare and Tricare for Life. I have another health insurance policy through my employer. I’ve heard that I have to cancel the other policy to use Tricare for Life, but my wife and children still need that coverage. I asked and was told that I can’t cancel just my own coverage and leave my family insured under my employer’s plan. What can I do?
You were misinformed. You do not need to cancel your other health insurance policy to qualify for Tricare for Life. The legal requirement regarding other health insurance is that Tricare must always be last payer to all other coverage, except welfare-related plans such as Medicaid.
When Tricare beneficiaries become entitled to Medicare and are enrolled in Part B, they are covered under Tricare for Life. If they have no other health insurance, Tricare Standard acts as a free Medicare supplement and last payer to Medicare.
After it processes a claim and makes whatever payment is due, Medicare automatically transfers the claim to Tricare electronically. In the vast majority of claims, Tricare pays whatever Medicare did not pay for Tricare-covered services — usually the beneficiary’s Medicare deductible and co-payment.
Your situation will be different because of your other health insurance. As you read the following, keep in mind that Tricare must always be last payer to all your other coverage, regardless of which plan is first or second payer.
Let me summarize the situation regarding your family:
Tricare for Life rules do not require you to cancel or alter your employer’s health insurance policy. You and your family may continue coverage under your employer’s plan. Regardless of decisions you make about your Medicare coverage, your family’s Tricare coverage as second payer to your employer’s plan will not be affected.
Now, the following pertains to you only, not your family:
When you become entitled to Medicare, you will be told that Medicare does not require you to enroll in Part B as long as you continue to work for the employer that provides the other health insurance. Also, for as long as you continue to work for that employer, your employer’s plan will be your primary coverage. Medicare will be second payer.
Although Medicare’s rules allow you to postpone Part B enrollment for as long as you continue to work, Tricare’s rules do not allow that.
According to law, retirees or their family members who become entitled to Medicare must enroll in Part B of Medicare in order to retain Tricare eligibility.
If you feel that Medicare Part A plus your employer’s plan is enough health insurance for you (yourself only) while you continue to work, you might want to postpone Part B enrollment during that period. That will allow you to avoid paying the monthly premium for Part B. But you will be ineligible for Tricare for Life until you enroll in Part B.
That’s a decision only you can make. Before you do, I suggest you contact Medicare for details about the kinds of health care services Part A covers.
You’ll want to enroll in Part B, however, as soon as you stop working. Your Tricare eligibility will be restored as soon as you do that and your Defense Enrollment Eligibility Reporting System (DEERS) record has been updated.
For as long as you continue to work, you must file claims with your employer’s plan first. Medicare Part A will be second payer to that plan. You will no longer have Tricare as a last-payer backup because you are not enrolled in Medicare Part B.
When you are no longer working, you will file claims with Medicare first. Your employer’s plan will be second payer to Medicare. If you have enrolled in Part B, Tricare will be last payer to your other coverage.
Depending on the extent of the other plan’s coverage, it will very likely pay what Medicare does not pay in much the same way that Tricare would. After Medicare and the other plan have both completed processing and you have the explanations of benefits from both, you may file a claim with Tricare for any amounts they left unpaid.
As I said earlier, regardless of decisions you make, your family members will continue to have your employer’s plan as their primary coverage and Tricare as second payer on their claims. Their Tricare coverage will not be affected by your Medicare entitlement or the decision you make about Part B enrollment.
Why are Medicare and Tricare telling me opposite things?
December 7th, 2011 | TriCare Help | Posted by Military Times
My employer provides a Medicare-approved health insurance policy. I’ll be 65 soon, and Medicare tells me I don’t have to enroll in Part B as long as I continue to work for that company. On the other hand, Tricare tells me I must enroll in Part B as soon as I turn 65 and get Medicare. Two government health insurance plans are telling me exactly opposite things, and both say they are right. I’m caught in the middle. Can you help me?
Both Medicare and Tricare are correct in what they told you. They are talking about different rules that exist for unrelated purposes.
Both rules concern requirements for Medicare Part B enrollment.
One of the two is a Medicare rule concerning a penalty for late enrollment in Part B after becoming entitled to Part A. The rule says you may delay Part B enrollment in some circumstances. You hear about this rule from Medicare.
The other is a Tricare rule. It concerns the federal law requiring Part B enrollment when you become eligible for Part A entitlement in order to retain Tricare eligibility. The Tricare rule says you must enroll in Part B “now.” You hear about this rule from Tricare. (It does not apply to active-duty family members.)
Under the Medicare rule, those who become entitled to Medicare Part A have a grace period during which they must enroll in Part B or face a penalty that increases their Part B premiums for the rest of their lives. The penalty adds 10 percent to the Part B premium for each year someone delays Part B enrollment after becoming entitled to Part A. However, there is a situation in which Medicare can waive that late-enrollment penalty.
Some companies sponsor health insurance and even pay a part of the employee’s insurance premium. If Medicare determines that the company’s insurance plan provides benefits that are at least as good as Medicare’s, it is called a creditable plan.
The Medicare rule says employees enrolled in an employer’s creditable plan can delay enrolling in Part B without penalty as long as they work for that employer.
Once they leave that employer, they have a grace period during which they must enroll in Part B to escape the late-enrollment penalty.
Nothing in this Medicare rule applies to Tricare; the Tricare rule is quite different.
The law that governs Tricare has a provision to the effect that a Tricare beneficiary who becomes entitled to Medicare Part A must be enrolled in Part B to retain Tricare eligibility.
Tricare beneficiaries who become entitled to Medicare Part A must be enrolled in Part B or lose all Tricare eligibility until they are enrolled in Part B.
Shortly before your Medicare entitlement becomes effective, you’ll get a letter advising you of your Medicare award. It will contain a Medicare ID card showing that you are enrolled in Part A and Part B. At that point, you’re a Medicare beneficiary.
In the same packet, you will receive a form allowing you to opt out of Part B. I strongly recommend that you do not opt out; if you do, you will find yourself with no Tricare benefits of any kind.
How should I time the renewal of ID card?
November 28th, 2011 | TriCare Help | Posted by Military Times
I am an Army retiree and my wife and I are enrolled in Tricare Prime. I turn 65 next August 1. The front of my ID card reads an expiration date of INDEF, while the reverse shows an insurance expiration date of June 30, 2012. Having a birthday on the first of the month means I start Medicare not on August 1, but on July 1, and my recent Tricare billing correctly reflected a pro-rated premium to that effect. Provided I confirm that Tricare knows that I did indeed timely enroll in both Medicare Parts A and B, ensuring coverage under Tricare for Life, may I safely re-new my ID card in mid-July, or must I renew it before then?
Tricare has no authority regarding the issue/reissue of uniformed service ID cards. That operation is totally under the authority and control of the uniformed services.
The only need for the ID card, for Tricare purposes, is as proof of Tricare eligibility. It should be presented to each health care provider for that purpose.
The back of the ID card has statements regarding eligibility for medical care. The word “YES” in the appropriate space concerning civilian medical care is proof of Tricare eligibility at the time the card was issued.
Please note that proof of Tricare eligibility is not a guarantee that claims will be paid or, if paid, of any guaranteed amount. Claims and services must meet certain standards for Tricare coverage. The provider of care must be Tricare-authorized, and the medical service must be one that is allowed by federal law and regulation.
For official information about the renewal of your ID card, please contact the DEERS Support Office, toll-free, at 1-800-538-9552.