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.
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.
What happens to younger spouse when I get Medicare?
December 5th, 2011 | TriCare Help | Posted by Military Times
I am retired Navy and in another year will turn 65. For the last 15 years my family has been enrolled in Tricare Prime. My plan is to continue with Tricare for Life. My spouse is four years younger than I, however. When I enroll in Medicare, is my wife covered by Tricare for Life until she becomes eligible for Medicare?
As a uniformed service retiree, you will be required by the law that governs Tricare to be enrolled in Medicare Part B on the same date that your Medicare Part A becomes effective. If you are not enrolled in Part B on that date, you will lose all of your Tricare eligibility automatically until you are enrolled in Medicare Part B.
If a beneficiary enrolls in Medicare Parts A and B in a timely manner, his or her Medicare coverage and TFL eligibility will begin on the first day of the month of his or her 65th birthday.
Your wife will not qualify for Medicare or Tricare for Life until she is 65 years old, but she can continue her Tricare Prime coverage until that time.
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.
Is there a waiting list for Tricare for Life?
November 10th, 2011 | TriCare Help | Posted by Military Times
I am on Tricare Prime now, but I will become eligible for Medicare in January. Will I get Tricare for Life then, or is there a waiting list?
There is no waiting list for Tricare for Life. Here’s what’s supposed to happen:
Federal law requires you to be enrolled in Medicare Part B at the same time as your Medicare Part A becomes effective (on Jan. 1, according to your letter). You should receive an official Medicare identification card that states what Medicare programs you are enrolled in. It should say your Medicare Part A and Part B coverage were effective on Jan. 1.
If that is true, you have become eligible for Tricare for Life.
While all this is supposed to happen automatically, you should confirm the above by calling the DEERS Support Office, toll-free, at 1-800-538-9552. If those are not the facts, ask DEERS what is your status regarding TFL and whether DEERS reports that you are enrolled in Tricare Standard or in Tricare Prime. You will be speaking with a live person who will be able to answer all your questions. Be prepared to take notes.
Under TFL, you have full coverage by Medicare Parts A and B plus full coverage by Tricare Standard.
Just found out Dad isn’t signed up for Part B; what now?
October 21st, 2011 | TriCare Help | Posted by Military Times
My father, an Army retiree, turned 65 in April and has not yet enrolled in Medicare Part B. Are there any penalties for late enrollment? He was recently hospitalized, and I need to know the quickest, and easiest way to help him do this right away so as his insurance doesn’t deny all the bills that he recently had.
If a Tricare-eligible retiree or retiree family member becomes legally entitled to free Medicare Part A, federal law requires that he must be enrolled also in Medicare Part B at that same time. Failure to be enrolled also in Part B results in the immediate loss of Tricare eligibility until the beneficiary has Medicare Part B in force.
Your father should immediately contact the Social Security Administration at 1-800-772-1213 for guidance to enroll in Medicare Part B.
The legal provision to which I refer is part of the law that governs Tricare eligibility. It does not apply to active duty family members or to civilians.
Without delay, your father also needs to contact the Defense Enrollment Eligibility Reporting System, better known as DEERS, at 1-800-538-9552 for an official determination of his Tricare eligibility.
If your father is not enrolled in Part B, it is most likely that his Tricare eligibility was automatically terminated on the first day of the month when he turned 65.
It is unlikely that he can get retroactive coverage for care he received while he was ineligible, but DEERS can give you an official answer.
Turning 65; how can I prove I have Tricare?
September 28th, 2011 | TriCare Help | Posted by Military Times
I am retired military and I will turn 65 in December and go on Medicare. Do I need a card to show that I have Tricare coverage?
To continue to be eligible for Tricare after Dec. 1, federal law requires you to be enrolled in both Medicare Part A and Medicare Part B. If you are enrolled in both parts, and if your DEERS record is up-to-date and reports that you are enrolled in Medicare Part B, you will automatically be eligible for the Tricare plan called Tricare for Life.
Under TFL, you must get all your civilian medical care from Medicare providers only. A Medicare provider is one who is registered with Medicare and is authorized to be paid by Medicare for medical care he provides to Medicare beneficiaries. Medicare cannot pay for any medical care you receive from a non-Medicare provider.
The Medicare provider will file a Medicare claim for all the services he provides to you. He will ask whether you have a Medicare supplement or other health insurance. All you need to do is say that you have Tricare and show your military ID card as proof of your Tricare coverage. That information is on the back of the card. There is a statement about your eligibility for civilian medical care. Your card should have the word “YES” typed in that space to show you are eligible for Tricare.
How can I help blind friend get Tricare?
August 22nd, 2011 | TriCare Help | Posted by Military Times
My friend retired and has gone blind. How can I get him on Tricare?
If your friend is entitled to receive retired pay, he is most likely eligible for Tricare. He needs to be registered with his uniformed service, which can do the paperwork needed to enroll him in the Defense Enrollment Eligibility Reporting System, better known as DEERS, and to issue a current uniformed service identification card.
I believe it is most likely those things were done when your friend retired, but to confirm that, or to receive instructions about doing it, if necessary, please contact the DEERS Support Office, toll-free, at 1-800-538-9552. Be prepared to take notes.
His wife and unmarried children younger than 26 also are Tricare-eligible, but they, also, must be enrolled in like manner.
You may encounter some problems initially in working on your friend’s behalf due to Privacy Act restrictions. DEERS, however, will advise you about working around them.
The uniformed service ID card is used as “proof of insurance” when dealing with providers of medical care. On the back of the card is information regarding eligibility for civilian medical care. The word, “YES” in the appropriate place confirms Tricare eligibility.
Complete information about Tricare can be found at the official Tricare website. For information about filing claims, forms, and addresses, please go to the claims section or call the beneficiary’s Regional Tricare Service Center.
If your friend has not already done so, he should contact the Social Security Administration regarding his disability. That toll-free number is 1-800-772-1213. If he qualifies, he can become entitled to disability payments and, after two years of receiving those benefits, he will become entitled to Medicare.
Enrollment in Medicare Parts A and B will make him eligible for the Tricare plan called Tricare for Life, or TFL. In the absence of other health insurance, TFL is a Tricare plan under which Medicare becomes the beneficiary’s primary health insurance, and Tricare Standard will automatically serve as his free Medicare supplement.
Under TFL, he must get all civilian medical care from Medicare providers only. A Medicare provider is one that is registered with Medicare and is authorized to file Medicare claims for services provided to Medicare beneficiaries. Medicare will process the claim, pay its share to the provider, and automatically forward the claim to Tricare.
For every medical service on the Medicare claim that is covered by both Medicare and by Tricare, Tricare Standard will pay the balance on the Medicare claim (the Medicare copayment and deductible). That done, the provider’s bill will be paid in full. The patient will owe nothing.
Occasionally a Medicare provider will render a service that is not covered by both Medicare and by Tricare. In that case, only one of the two plans will pay. The other plan will deny payment as a non-covered service. In those cases, the patient (or his supplement) is responsible for the unpaid balance on the claim. Such Medicare claims will be relatively uncommon. The vast majority of the medical care will be paid in full under TFL (the combined Medicare plus Tricare payments).