When Tricare Standard becomes your primary coverage
March 4th, 2011 | TriCare Help | Posted by Military Times
Q. I am 62 years old and have been retired from the Navy for 21 years. I have worked at my current job for 18 years and have been covered by my employer’s insurance, with Tricare as my secondary insurance. Now, due to health complications, I have had to cut back on my work hours, and I no longer have my employer’s insurance. Will Tricare Standard take over as my primary insurer? If so, what do I need to do? How much will it cost? How can I get my prescriptions filled? I don’t live near a military base.
You probably already know that you must keep your DEERS registration and your military ID card up to date in order to have Tricare coverage. You can update your DEERS record by calling the DEERS Support Office, toll-free, at 1-800-538-9552. That office will also provide any guidance you need to update your ID card.
It may be, however, that you need some information about how to handle the effects of the loss of coverage by your employer’s health insurance plan. You will be told in advance when your coverage under that plan will end.
You must get an official letter from that insurance company that reports the last date that you will have coverage under that plan. That is, a report of the last date that plan will pay for your medical care. Call DEERS and ask to whom you should send a copy of that letter, together with a brief explanation of the reason the policy will be canceled — whom should you notify and when.
If you have made proper notification, DEERS and Tricare will know the last date of your other coverage. Tricare Standard will automatically become your only health insurance effective on the following day.
When Tricare Standard is your only coverage, you will become responsible for paying the $150 yearly Tricare deductible and your 25 percent cost share of the amount allowed on each Tricare claim. Otherwise, Tricare Standard is free; it has no monthly premium. All Tricare beneficiaries are automatically eligible for the Tricare Pharmacy Program at no cost other than the small copayments for drugs.
A month or two before you lose your employer’s plan, you may want to begin to research the coverage offered by one of the several Tricare supplement plans. Most of the retiree associations offer such a plan.
Write to several associations and request a copy of their Tricare supplemental policy. In that way, you can compare several to find the plan that best meets your needs. Check carefully the policy’s coverage of pre-existing conditions.
I suggest, also, that you contact the Social Security Administration to research possible coverage under the Social Security Disability Program.
If you qualify for that program, you will become eligible for Medicare after receiving disability benefits for 24 consecutive months. Otherwise, you will have to wait until you are 65 to qualify for Medicare and Tricare for Life.
Should I keep my employer’s insurance too?
February 23rd, 2011 | TriCare Help | Posted by Military Times
I have retired from civil service and just turned 60. I will be on Tricare starting in March. Would it be worth keeping my civil service health plan at $100 a month, or should I just go straight Tricare. What would be the benefit of keep two health insurances?
If you retain your federal employees health insurance, it will be your primary coverage. That is, you must file claims with that plan first. My answer in this earlier post outlines how Tricare works in such cases.
The advantage, and it is a big one, is that Tricare Standard, which is free, will act as a supplement for that insurance. Usually Tricare will usually pay whatever your employees plan did not pay — that usually is the deductibles and copayments, which can add up quickly. Except for the cost of your federal employees monthly premium, most of your medical care will be free.
Switching to Tricare and shopping for supplements
January 31st, 2011 | TriCare Help | Posted by Military Times
Q. I am retired from the Army but have never used Tricare. I use health care provided by my employer, but in 18 months I will retire and my health coverage will stop. I will be 58 when I retire. Do you recommend a supplement? What do I do and how far in advance should I start converting to Tricare.
About 30 days before your last day of coverage by your other health insurance (OHI), write to the Tricare Headquarters to advise that you are going to cancel your OHI. The address is Tricare Management Actvity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. Include your full name, Social Security number, and the full names of any family members who are covered by that plan.
Include with your letter an official statement written by your other plan on its official stationery which states your last date of coverage by that plan. You will need to advise any health care providers as well so they will file appropriately with Tricare.
To use Tricare, your DEERS record must be kept up-to-date and report that you are eligible for Tricare. Please call the DEERS Support Office, toll-free, at 1-800-538-9552 to ensure that your DEERS record is correct and up-to-date so you will have no lapse in coverage. It is most likely that your Tricare coverage is in effect now, provided you have kept your DEERS record and military ID card up-to-date.
Those with no health insurance other than Tricare are well-advised to purchase a good Tricare supplement. Most of the military associations sell a Tricare supplement. They vary, however, in their price, what they cover, and their rules for doing it.
I suggest that you request a copy of the policy from several plans and read the fine print carefully. Make sure you buy the plan that best meets your needs and that it is a bona fide Tricare supplement. A bona fide Tricare supplement describes itself as a Tricare supplement in writing in the plan itself. In the policy, look at such things as its policy concerning coverage for pre-existing conditions; how long you must be hospitalized before the plan begins to pay; whether it has limits on the amount it will pay during a coverage period. Do not allow price to be the most important factor in your decision.
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.
We didn’t declare other health insurance; now Tricare wants money. Where do we turn?
December 7th, 2010 | TriCare Help | Posted by Military Times
Q. Through my wife’s job we have another health insurance, Blue Cross Blue Shield, but we have never used it. I am retired from the Navy and have Tricare Prime. We were recently notified by Tricare that they were denying payment and requiring reimbursement from providers, which they have passed on to us. How many years back can Tricare demand reimbursement for? We were unaware that we had to declare this unused insurance plan. How should we proceed?
Your problem is that, by federal law, Tricare is always last payer to all other health insurance policies, medical plans such as a Health Maintenance Organization (HMO, such as Kaiser Permanente), or medical payments such as you might receive for auto accident medical expenses, dog bite, slip-and-fall, and the like. If you have another health insurance plan in addition to Tricare, you must use it first.
You must file each claim with the other coverage first. After it has paid its maximum and issued you an EOB, you may file a Tricare claim for whatever the other coverage left unpaid. The unpaid portion will usually be what is often called the “patient’s share.” It usually consists of the other plan’s copayment and, when applicable, the other plan’s deductible.
That law has two exceptions: First, if the other coverage is a bona fide, specially written, Tricare supplement, you must file first with your Tricare plan. The other exception is if the other coverage is a welfare-related plan such as Medicaid (not Medicare), Indian Health Service, or the like. In those cases, you must file first with your Tricare plan.
I believe you have a problem with federal law, but I’m not a lawyer, so take anything I tell you with a grain of salt Only lawyers can give legal advice. I think yours is a simple mistake, not a “hanging offense.” But, I believe you are going to owe Tricare some money.
My guess is that what you owe will be some of the difference between the amount Tricare actually paid and the amount Tricare would have paid if you had filed the claim with your wife’s insurance plan first, as the law requires.
In answer to your question, I don’t know how far Tricare can go back in recouping the amount it paid in excess. For that information, you need official help: Write to the Tricare Headquarters. The address is Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. TMA is a federal agency under the auspices of the Office of the Assistant Secretary of Defense for Health Affairs. Everything you tell them is confidential except for need-to-know stuff required for the investigation.
For starters, tell TMA about the problem just as you did with me. As the military sponsor, tell TMA your full name and SSN as they appear on your military ID card, and report the name of each member of your family who is enrolled in Tricare. You can call the DEERS Support Office toll-free, at 1-800-538-9552, for information about your family’s DEERS registration.
Then tell TMA your wife’s full name and SSN as they appear on her employer’s policy, the name and address of the insurance company, the name of the plan, and the date when your family was enrolled in it.
I am sure that TMA will have other questions. They may refer you to your Regional Tricare Contractor to resolve the matter. Don’t panic; just answer the questions. If you think you need a lawyer, use one who is familiar with the practice of federal administrative law. Yours is a federal issue. I don’t believe the state is involved in any way.
How will employer’s plan, TFL work for wife?
November 24th, 2010 | TriCare Help | Posted by Military Times
Q. I am a retired sailor and a federal employee. We have my employer’s health insurance, with Tricare as second payer. My wife is two years older than I am and will be eligible for Medicare this year. How will Medicare, Tricare and my employer’s plan work together for her? What will be the effect on my coverage?
A. At least 90 days before the first day of the month before she turns 65, your wife must apply for Medicare. Because she has Tricare, she is required by federal law to enroll in both Medicare Part A and Part B.
Once she does, she must seek all her care from Medicare providers. Medicare cannot pay for care she receives from a provider who is not authorized to file Medicare claims.
While you are still working for the government, your employer’s plan will remain her primary coverage. She must file first with that plan, just as she does now.
Medicare will be her secondary insurance. And Tricare, by law, is always the last payer. After your federal employees plan and Medicare have processed a claim, she should file a claim with Tricare.
Changes to your wife’s coverage will have no effect on your coverage. You will pass through the same transition when you get Medicare at age 65.
When I get TFL, what happens to my wife’s coverage?
November 5th, 2010 | TriCare Help | Posted by Military Times
Q. When I am 65, my federal employee plan will convert to Medicare and Tricare for Life. My wife is only 58 and can’t get Medicare yet. Will Tricare be her only insurance?
Your employee plan will not convert to Medicare. Medicare is a separate plan and you must enroll in Part A and Part B at least 90 days before the month when you turn 65.
Both you and your wife will continue to be covered under your federal employees plan, and her Tricare coverage also will continue unchanged.
Your Medicare Parts A and B coverage will become effective on the first day of the month of your 65th birthday. It will be in addition to your federal employees insurance.
If you are no longer working for the government, Medicare will be your primary insurance coverage and the federal employee plan will be secondary. If you are still employed, your employee plan will be primary and Medicare will be secondary.
In either case, Tricare Standard will be your third plan, and you will have to file those claims yourself.
Tricare can help defray costs of a more expensive plan
September 22nd, 2010 | TriCare Help | Posted by Military Times
Q. I have a health insurance policy at work, but its prescription plan’s copayment is much higher than Tricare’s. Is there any way we can use Tricare for our prescriptions instead of my company insurance?
Unfortunately, no. Federal law requires Tricare always to be last payer. That means if you have other health insurance with a pharmacy benefit, you must use it first. However, you can file claims with Tricare for reimbursement of a portion of your other plan’s copayment.
With some commercial plans, the pharmacy benefit is optional. Contact your other health insurance to determine whether that’s the case with your policy. If you can drop the other plan’s pharmacy benefit, you can use the Tricare Pharmacy Program as first payer for your prescription services.
Tricare works with other insurance and covers pre-existing conditions
September 13th, 2010 | TriCare Help | Posted by Military Times
Q. My job doesn’t offer health insurance, so I bought my own policy. Now they say they will not cover my pre-existing conditions. Does Tricare cover pre-existing conditions? Do I still have to file a claim with my commercial plan first even if I know they will not pay?
Tricare has no restrictions or limitations on payments for pre-existing conditions that are otherwise covered by Tricare.
You must file a claim with your commercial plan first, even if you know it will deny the claim. After it has processed the claim and sent you an Explanation of Benefits (EOB), you may file a Tricare claim.
File the Tricare claim just as you would if the other plan had paid part of the bill. Don’t forget to send Tricare copies of the bill you sent to the other plan and of the EOB reporting its actions on those charges. If you have questions about filing the Tricare claim, call your Tricare Service Center.
For secondary insurance: Prime or Standard?
August 25th, 2010 | TriCare Help | Posted by Military Times
Q. I have Blue Cross and I also am eligible for Tricare. Is there any benefit to me getting Tricare Prime versus Tricare Standard as my secondary insurance?
No, to the contrary. Tricare Prime functions as a Health Maintenance Organization. HMOs have restrictive rules that require you to use only their physicians and facilities, and to use them first.
Having an HMO (such as Tricare Prime) as second payer to your other health insurance (OHI) can make coordination of benefits more difficult and increases the chance of errors and misunderstandings.
I believe you will be better off using Tricare Standard, which is free, as second payer to your OHI.
Here’s how to do it:
1. Complete an official Tricare Claim Form DD2642.
2. Attach a copy of exactly the same itemized bills as were sent to your OHI.
3. Attach a copy of the OHI’s EOB that reports details of its processing of those same charges.
4. Send the packet to the Tricare claims processor for your residential area.
The official Tricare website has a section dedicated to claims filing, where you will find claim forms to download, filing instructions, points of contact, and claims filing addresses.