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.
TFL’s Medicare provider rule doesn’t apply overseas
November 14th, 2011 | TriCare Help | Posted by Military Times
You have written that “under Tricare for Life, you must get all your civilian medical care from Medicare providers only.” That’s only if you expect Medicare to pay its portion under Tricare for Life, right? I live overseas and will enroll in both Medicare Part A and Part B when the time comes, precisely so that my current Tricare Standard coverage will continue, under the name Tricare for Life. Of course, Medicare will not pay for any care received outside the U.S., so I won’t expect any reimbursement from Medicare. However, I will still be covered, as I am now, by Tricare Standard, generally getting 80 percent of covered charges reimbursed by Tricare, with essentially the same deductibles and catastrophic cap I have now — right? Or am I confused?
Indeed, if a beneficiary wants Medicare to pay any part of the bill, he must get care from Medicare providers only. True, one who lives overseas — where Medicare coverage does not exist — is not required to use Medicare providers only for his care.
You are correct that, when you become legally entitled to free Medicare Part A (usually at age 65), federal law requires you to be enrolled also in Medicare Part B in order to retain your Tricare eligibility.
Retirees who live overseas have complained for many years about the requirement to be enrolled in, and pay a monthly premium for, Medicare Part B, which they cannot use. The issue has been raised to Congress many times, but Congress has never changed, or even debated changing, that law. My understanding is that the proposal has never made it out of committee.
Your claims must be filed with Tricare Standard, and they are subject to the usual $150 Tricare fiscal year deductible and your 25 percent cost share (for retirees and their family members) of the amount allowed on the claim. They must be processed as if you did not have Medicare. A suitable Tricare supplement may be a good idea for you.
Will Tricare for Life cover me in England?
May 16th, 2011 | TriCare Help | Posted by Military Times
Q. Am I covered by my Tricare for Life while traveling to England, and if so, at what percent?
From the moment you leave US waters or air space, your Medicare coverage ceases. Federal law does not allow Medicare to pay for any medical care you receive when outside the US and its possessions. Your only coverage will be Tricare Standard until you return to US soil.
For that reason, while on your trip, it is essential that you save every scrap of medical bills, payment receipts, doctor’s statements, copies of prescriptions and receipts, and the like. You will need those documents to file a Tricare Standard claim for any medical services you receive while outside the US.
Tricare Standard will process claims for those services just as it always does, making the same payments and charging you the same cost shares and deductibles as if you did not have Medicare for those services.
Will my granddaughter be covered overseas?
November 16th, 2010 | TriCare Help | Posted by Military Times
Q. I would like to take my daughter and granddaughter to Korea. I want to know if my granddaughter will be covered in Korea. Her dad is in the Army and she is in Tricare under him.
Please call the DEERS Support Office, toll-free, at 1-800-538-9552, to ensure that your granddaughter’s DEERS record is correct, up-to-date, and won’t expire before she returns home.
If she is enrolled in Tricare Standard — not Tricare Prime — she has coverage worldwide. Tricare Prime does not provide coverage overseas.
I suggest that you call your Regional Tricare Service Center to discuss the matter with that office.
If she receives foreign medical care, it is important that you save all medical documentation — copies of bills, receipts, prescriptions, doctor’s statements, clinical notes, and the like. You will need that information to file Tricare claims after she returns home. You do not have to provide translations or currency conversions. Tricare will do that.
Note that foreign providers are not likely to recognize U.S. health insurance of any kind. Most will expect payment “up front” when services are rendered.
If you or any member of your party is a Medicare beneficiary, please be aware that Medicare, by law, cannot pay for any foreign medical care. Medicare benefits are lost the moment a beneficiary departs US waters or air space.
When TFL beneficiaries travel overseas
October 20th, 2010 | TriCare Help | Posted by Military Times
Q. I understand that Tricare for Life members are covered only by Tricare Standard when traveling outside the U.S. Are any short-term Tricare supplemental policies available to cover the difference between Tricare’s payments and total charges while traveling?
Yours is a question frequently asked. Unfortunately, I know of no such short-term supplemental policy.
I have decried the absence of such policies for years in this column. Their continued absence from the offerings of all insurers must indicate some universal obstacle of which I’m unaware — I doubt the insurance industry would otherwise ignore such a potential money-maker.
Short of buying a “regular” Tricare supplement, your only protection against costs beyond the amount Tricare pays is your $3,000 catastrophic cap.
If you consider buying a regular supplement, read the fine print carefully before you buy to be certain the supplement will meet all your needs outside the U.S.
Be careful before buying a short-term Tricare supplement
September 20th, 2010 | TriCare Help | Posted by Military Times
Q. My wife and I have Tricare for Life. We’re going to take a cruise, and we know that Tricare Standard will be our only coverage as soon as we leave U.S. waters, since the Medicare portion of Tricare for Life can’t be used. We need a short-term Tricare supplement that will pay our Tricare Standard deductible and cost shares. Do you know of any? The cruise company offers a health insurance policy, but it won’t work with Tricare.
I know of no reliable U.S. insurer that sells a genuine, short-term Tricare supplement.
A genuine Tricare supplement states in its fine print that it is written specifically to be a Tricare supplement. It covers only what Tricare covers, and it pays only after Tricare pays. Regardless of whatever else the policy provides, that description and purpose are required by federal law.
Short-term policies offered by cruise agents are inadvisable for Tricare beneficiaries because, on analysis of their fine print, all require them to be second payer to the customer’s other health insurance. But federal law does not allow Tricare to pay first, with only two exceptions: when it is used with a genuine Tricare supplement, or with welfare-related plans such as Medicaid. If the short-term policy doesn’t pay first, Tricare can’t pay anything.
Without a short-term Tricare supplement, it appears that your only protection from Tricare’s deductible and cost shares may be to buy a regular Tricare supplement, or to rely on your $3,000 catastrophic cap to limit your out-of-pocket liability.
If you opt for a regular Tricare supplement, read the fine print carefully before you buy. Some have deductibles, restrictions on pre-existing conditions or other limitations. Thus, they may provide less protection than you need for the short term.
Will Tricare cover flights to see a doctor?
April 21st, 2010 | TriCare Help | Posted by Military Times
Q. I live in the Philippines and I travel by air for my medical appointments. Is my airfare covered under Tricare Standard?
No. I’m sorry, but travel pay — the costs of transportation to seek medical care — generally is not a service Tricare is allowed to pay for.
Air ambulance and air evacuation may be covered in certain, specific, limited situations involving a true medical emergency, but not the costs of transportation merely to see a doctor.
A bona fide medical emergency is a situation requiring immediate medical care to save life, limb, or sight, or to relieve severe and otherwise-intractable pain.
How TFL works outside the U.S.
March 18th, 2010 | TriCare Help | Posted by Military Times
Q. If I decide to live outside of the United States (i.e. Philippines) upon retirement at age 65, I understand that I will still need to pay the Medicare Part B to be covered under Tricare For Life. Then, when I visit the medical facility over there, my claims would be processed just like I had Tricare Standard (since Medicare does not cover claims outside the U.S.) with the deductible having to be met and the co-pay also. Is that correct?
You are correct, unfortunately. The only time you will have full TFL coverage (Medicare plus Tricare) is when you visit the U.S. or a U.S. possession.
People have tried for many years without success to get Congress to change the law. I hear that the proposal never even makes it out of committee.
Will Tricare cover ER visit in Canada?
March 9th, 2010 | TriCare Help | Posted by Military Times
Q. While on a visit to Canada, I injured my knee and was taken to an emergency room. The total cost was over $800. It’s my understanding that Medicare does not cover these expenses. Is there any coverage under Tricare?
Medicare can provide coverage for medical care received outside the U.S. and its possessions only in certain limited situations.
I suggest that you contact Medicare to explain the details of the events resulting in your Canadian medical care. Medicare will tell you whether it can provide any coverage and how to file a Medicare claim in that event. If Medicare can provide coverage, the claim will be processed as any other TFL claim — that is, with Medicare as primary payer and Tricare Standard, automatically, as second payer.
As a Tricare for Life beneficiary, you have coverage by two full service, stand-alone, health insurance policies, Medicare and Tricare Standard. If you receive a medical service that is not covered by Medicare, such as your Canadian care, you have Tricare Standard as fall-back coverage.
If Medicare is unable to pay anything toward your care in this case, Tricare will be your only coverage. In that case, the Tricare claim will be subject to all of Tricare’s claims processing rules including the application of the Tricare deductible and cost share. Let me explain the consequences in that event.
Under TFL, when a medical service is covered by both Medicare and Tricare, the Tricare deductible and cost share are waived. In those cases, the combined payments by both plans (Medicare plus Tricare) will pay the Medicare claim and the provider’s bill in full.
All medical services on the vast majority of a TFL beneficiary’s Medicare claims are covered by both Medicare and Tricare. Because Tricare’s deductible is waived on those claims, it is possible that the beneficiary has paid very little toward satisfying the $150 fiscal year Tricare deductible.
When Medicare does not pay on a medical service, Tricare becomes the beneficiary’s only health insurance for that particular medical service. Thus, when the Tricare-only claim is processed, any amount of the Tricare deductible not previously paid must be applied to that claim.
Depending on the beneficiary’s previous claims history during that fiscal year, the deductible amount remaining unpaid could be large. It must be subtracted from the amount Tricare allows on that item, then the beneficiary’s 25 percent cost share must be subtracted from the amount remaining. Those actions can considerably reduce the amount Tricare pays on the claim. That rule is required by federal law.
If you find that Medicare can be of no help in paying your foreign medical bill, please call Wisconsin Physicians Service, the Tricare claims contractor for TFL. The toll-free number is 1-866-773-0404. That office will provide instructions for filing a Tricare Standard claim for your care.
So there are no surprises when the claim is paid, WPS also can tell you how much of the amount allowed on the claim must be subtracted and credited to your Fiscal Year 2010 Tricare deductible.
Coverage during international travel
November 30th, 2009 | TriCare Help | Posted by Military Times
Q. My husband and I have Tricare for Life. We plan a trip to Canada. Will Tricare for Life pay for emergency medical care we might need? Does it have a special plan for tourists? Do you know of any other plans?
Generally, only the Tricare Standard portion of Tricare for Life will cover you in Canada. I have heard that Medicare covers some limited emergency care in parts of Canada, but you’ll need to call Medicare for details. To the extent that is true, it would be a Tricare for Life benefit.
Before buying any “tourist” plans, read them carefully. If the plan does not agree to be primary payer, don’t buy it. Tricare will be unable to pay anything because of federal law requiring Tricare to always be last payer to any other insurance.
Tricare for Life is a U.S. government program, and U.S. law prevails in its operation, regardless of where the medical care is received.
If you can use Tricare only, be prepared for the likelihood that you will have to pay much of your Tricare $150 deductible when the claim is processed, along with a 25 percent Tricare cost share.
I believe the first commercial health insurance company to come up with an affordable, short-term Tricare supplement for travelers like you will make a killing.