How can I make sure my surgery is covered?
April 18th, 2012 | TriCare Help | Posted by Military Times
I’m married to an active-duty airman. I have an ovarian cyst that must be removed ASAP. Does Tricare cover this kind of surgery?
Tricare does cover medically necessary care, including surgery, for your condition. If you live near a military hospital, make an appointment to be seen by military physicians. If you do not live near a military facility, you must find a civilian physician who is, or who is willing to become, a Tricare-authorized provider, to provide the care you need.
Tricare may provide coverage only if you use a military hospital, or a civilian physician who is authorized by Tricare to attend its beneficiaries.
How do I change my military treatment facility after a move?
March 23rd, 2012 | TriCare Help | Posted by Military Times
How do I change my military treatment facility? I moved from North Carolina to Texas over a year ago, and apparently the outpatient clinic I go to now to keep up with my VA appointments is not classified as my military treatment facility. All this time, I had assumed that kind of information would have changed as I moved and enrolled in a different medical center. Whom should I contact to straighten this out?
In moving from North Carolina to Texas, you have moved from the Tricare North region to the Tricare South region (unless you are in the El Paso area; that single, specific area of Texas is in the Tricare West region). Without knowing more details about your situation — your beneficiary status and which Tricare plan you are covered under, for example — I can only suggest you contact the regional contractor or one of the Tricare regional service centers for your region and ask them for guidance.
Can I sign up elderly mother for Tricare?
March 14th, 2012 | TriCare Help | Posted by Military Times
My 82-year-old mother is a recent legal immigrant to the U.S. She lives with us and is our dependent. How can I get her signed up for Tricare?
Dependent parents and parents-in-law are not eligible for Tricare. Under certain circumstances, however, the uniformed services may determine a parent or parent-in-law to be the dependent of an active duty member or retiree. In those circumstances, the parent or in-law may be allowed to use a military treatment facility, subject to the availability of space, personnel, and technical capacity.
You must apply with your service for your mother to be designated, legally, as your dependent. Then you may apply with your MTF for her to be allowed to use its facilities. Ask whether she can be eligible for Tricare Plus, which will give her the same access rights to free MTF care as are enjoyed by Tricare Prime members. She will not have Tricare Prime health care coverage, but the medical care she will get will be just as good.
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.
Do we still need Tricare Prime Plus under Tricare for Life?
January 25th, 2012 | TriCare Help | Posted by Military Times
My wife and I just qualified for Medicare and Tricare for Life. We were both enrolled in Tricare Prime. We are also enrolled in Tricare Prime Plus at a military treatment facility. Do we need to continue paying the annual enrollment fee to use Tricare Prime Plus?
If a person is enrolled in Tricare Prime when they become eligible for Medicare and Tricare for Life, his or her Prime enrollment is terminated. On the effective date of Medicare coverage, it is automatically changed to Tricare Standard, which becomes a free supplement to Medicare. The person is no longer eligible for Tricare Prime. He no longer has priority access to free care at a military hospital, and any Tricare Prime enrollment fees paid in advance are lost; they cannot be refunded.
Can girlfriend give birth in military hospital?
December 2nd, 2011 | TriCare Help | Posted by Military Times
I’m an active-duty soldier and my girlfriend and I are getting ready to have a baby. She doesn’t have health care at the moment. I know the baby can be covered as my dependent, but my question is, can she have the baby in a military hospital?
Whether your girlfriend can give birth at a military hospital does not fall under Tricare’s authority. Only your military hospital can decide. Contact the hospital’s Patient Administration Office for an official answer.
Of course, the problem is instantly resolved if you get married. She would be covered under Tricare.
The baby will be covered after birth either way, however. Call the DEERS Support Office, toll free, at 1-800-538-9552, to discuss that matter.
Can I still go to military doctors once I’m on Tricare for Life?
November 11th, 2011 | TriCare Help | Posted by Military Times
I will get Medicare and Tricare for Life on Dec. 1. I live near an Air Force base and have been getting most of my health care from specialists there. I know that under Tricare for Life, I need to get my care from Medicare providers, which is fine, but can they still refer me to the military doctors if necessary?
When most Tricare beneficiaries turn 65, get Medicare and are enrolled in Part B, those who were formerly enrolled in Tricare Prime are automatically transferred from Prime to Tricare Standard, which, along with Medicare, makes up your Tricare for Life coverage. If you are no longer enrolled in Prime, your access to free medical care at your local military treatment facility will likely be curtailed.
Retirees and their family members have priority access to military hospital care as a result of being enrolled in Tricare Prime. Once you are switched from Prime to Standard, you do not have the same priority access.
As there are individual differences among MTFs, however, the facility near your home may still have space and personnel available to allow non-Prime enrollees to access their services. You will need to ask the patient administration office if you can continue to use their facilities, including their pharmacies.
Can sister be covered under my husband’s Tricare?
September 23rd, 2011 | TriCare Help | Posted by Military Times
I have a sister who is going to be moving in with me. She is on Social Security disability and Medicare. My husband is retired Navy. Can he add her to his Tricare as a dependant?
Tricare eligibility is established by federal law for certain categories of people. Brothers, sisters, parents or other family members do not meet the legal requirements for Tricare eligibility.
If you live near a uniformed service facility with a hospital or clinic, it is possible that your husband can arrange for your sister to get some, or even all, of her medical care and pharmacy services there. He should contact the Patient Administration Office or the Executive Officer at the facility for more information about that.
For your sister to have access to any military benefits, there are some administrative actions your husband would have to take to establish her as his legal dependent. His Personnel Office can help make those arrangements, including her registration in DEERS.
For confirmation of my reply, above, and for official answers to any and all questions about Tricare eligibility, please call the Defense Enrollment Eligibility Reporting System Support Office at 1-800-538-9552. DEERS deals with eligibility issues only.
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.
Son is an airman; can I get Tricare?
August 19th, 2011 | TriCare Help | Posted by Military Times
My son is in the Air Force, stationed at Hickam Air Force Base, Hawaii. He applied to have me as a secondary dependent (I am his mother) and it was approved in June. I went to MacDill Air Force Base, Fla., a few weeks ago to get my military ID and to find out about medical care. They told me I couldn’t see a doctor there, but if I saw a civilian doctor and he ordered tests, they could do them on base. I’m sure there is some way for me to get some medical care. Can I join Tricare? Can I go to another military medical facility?
By law, a service member’s parents are not eligible for Tricare. That is true even if the parent is totally dependent on the service member. You can get official confirmation of the above by calling the Defense Enrollment Eligibility Reporting System at 1-800-538-9552.
Dependent parents may be authorized medical services, at varying levels of care, at a military hospital. Depending on the situation at the particular hospital, a parent may get total care there, limited services or no services. The parent has no legal right to care at the military hospital. If granted, it is a matter of courtesy only.
Apparently, that was your experience in that, although you cannot see a military doctor at your hospital, it can provide certain laboratory services for you when ordered by your civilian physician.
The primary consideration for whether a dependent parent can get care is usually the availability of space, personnel, and/or the technical capacity of that hospital to provide the care the parent needs.
The primary mission of military hospitals, by law, is to provide care for active duty military personnel. That must always be the hospital’s primary concern.
The decision to grant or deny a dependent parent’s access to care at the military hospital rests entirely with its Commanding Officer. That decision is based on his or her professional opinion, after consideration of the hospital’s primary mission.
You may want to approach the hospital’s Patient Administration Office or Executive Officer about your concerns.