What kind of plan is TFL considered to be, in relation to Medicare?
July 20th, 2011 | TriCare Help | Posted by Military Times
Q. I am trying to file an insurance claim for my mother, who has Medicare Part A & B and Tricare for Life. The form asks if she has insurance coverage other than Medicare. The options are:
- Coverage under a Medical Plan
- Medicare Supplemental Policy
Which is TFL considered to be?
You want the second option. Tricare for Life consists of coverage by Medicare parts A and B and Tricare Standard, and Tricare Standard acts as a free supplement to Medicare. Here’s a post with more details about how Medicare and Tricare Standard work together under TFL.
What kind of Medicare am I paying for?
June 22nd, 2011 | TriCare Help | Posted by Military Times
Q. I am an Army retiree working in the civil service. I have Medicare deductions taken out of every paycheck, although I have never received any information about what kind of Medicare coverage it is or whether I can use it now. I read that when I turn 65 I must enroll in Medicare Part A and B to get Tricare for Life, but I still don’t know what I am paying for every paycheck — all it states is “Medicare.” Am I already enrolled in some form of Medicare?
A. Medicare is a federal health insurance program created in the mid-1960s. Most Americans become entitled to receive Medicare benefits when they turn 65 years old. If they have properly enrolled for Medicare about 90 days before their 65th birthday, their free Medicare Part A and Part B become effective and begin paying part of their medical bills on the first day of the month of their 65th birthday.
Prior to age 65, all workers contribute to the Medicare fund through deductions from their wages. This is what you’re seeing on your pay stub.
Tricare beneficiaries who are enrolled in Part A and Part B of Medicare become eligible for the Tricare plan called Tricare for Life at the same time their Medicare goes into effect. Part A is free, but you must pay a monthly premium for Part B. The Social Security Administration can provide you with details. The toll-free number is 800-772-1213.
When must I sign up for Medicare Part B?
May 31st, 2011 | TriCare Help | Posted by Military Times
Q. I am retired military, but an active state employee covered by the state health plan. Presently, Tricare is my secondary coverage. In August I will turn 65. I must sign up for Medicare. Because I am still covered by the state health plan, I have an option to sign up for Part A, maintain the state health plan as my primary coverage until I retire from the state, and then sign up for Part B upon that retirement without penalty or loss of coverage. My question comes in regard to Tricare for Life. There appears to be a similar Part B delay provision for anyone still on active duty when they turn 65 – they can delay signing up for Part B without penalty until they retire from the military. However, there does not seem to be any link between the two exceptions for military retirees. In other words, it appears I must sign up for Part B immediately before I retire from the state or lose my eligibility for Tricare for Life. Is that correct?
As all information provided by Tricare Help is unofficial, I advise you to call the DEERS Support Office, toll free, at 1-800-538-9552 to confirm the information in this letter, or to ask other questions about Tricare eligibility. DEERS deals with eligibility issues only. DEERS cannot provide information about the Tricare program, its benefits, or your claims.
If a retiree or Tricare-eligible retiree family member becomes entitled to free Medicare Part A at any age or for any reason, federal law requires him to be enrolled in Medicare Part B on the same date as his Part A coverage becomes effective. Failure to be enrolled in Part B on that date results in the immediate loss of Tricare eligibility. It cannot be restored until the beneficiary has Medicare Part B in effect.
The above is a function of the law that governs Tricare. Medicare also has a law that governs when one must enroll in Part B, but the Tricare law provision, above, takes precedence in the case of Tricare beneficiaries.
If you have no other health insurance, you become a Medicare beneficiary when your Medicare coverage becomes effective. Medicare becomes your primary health insurance.
When you get free Medicare Part A, you automatically become eligible for Tricare for Life, provided you are enrolled also in Medicare Part B and your DEERS record is up-to-date.
Tricare for Life combines full Medicare benefits with full benefits under Tricare Standard. Tricare is always last payer. Under TFL, Tricare Standard will serve as a free Medicare supplement for every medical service that is covered by both Medicare and by Tricare.
In most of those cases, the combined payments by Medicare and Tricare Standard will pay your Medicare claims and the provider’s bill in full.
As you are approaching age 65 and Medicare entitlement, I strongly suggest that you learn about TFL. Most retirees say it is the very best thing Tricare has to offer and provides almost complete freedom from medical bills and claims filings for the rest of your life.
How can I find a doctor who will take TFL?
May 27th, 2011 | TriCare Help | Posted by Military Times
Q. I am switching my coverage from Tricare to Tricare for Life (I have enrolled in Medicare Parts A and B), but I can’t find a doctor who says he will take Tricare for Life. Where can I find a list of doctors who will accept TFL?
Once your Medicare coverage becomes effective, usually on the first day of the month you turn 65, you must seek all your medical care from Medicare providers, or it won’t be covered. When you call for an initial appointment, tell the provider you are a Medicare beneficiary. The Medicare claim form asks for the name of your secondary health insurance or Medicare supplement. Write “Tricare.” Do not mention TFL because most providers will not know what that is. Under TFL, however, Tricare Standard will act as your free Medicare supplement.
For every medical service on your Medicare claim that is covered by both Medicare and by Tricare, Tricare Standard will pay whatever Medicare did not pay. Thus, when both Medicare and Tricare cover a medical service, their combined payments will pay the Medicare claim and the provider’s bill in full.
If you receive medical care that is covered by Medicare or by Tricare, but not by both, you must pay that plan’s copayment and deductible yourself. Such claims will be fairly rare. The vast majority of your Medicare claims will be for medical services that are covered by both Medicare and by Tricare.
All you need to know to transfer to Tricare for Life
May 25th, 2011 | TriCare Help | Posted by Military Times
Q. What do I need to do to transfer from Tricare to Tricare for Life?
Becoming enrolled in Tricare for Life, is an automatic process that comes about as a result of your becoming entitled to Medicare and being enrolled in Part A and Part B of Medicare. If you apply in a timely manner, Medicare coverage becomes effective on the first day of the month when you turn 65.
At least 90 days prior to that date, contact the Social Security Administration at 1-800-772-1213. Tell them you need to apply for Medicare Part A and Part B. They will tell you how to do it. It involves going to the SSA office and filling out a form. You may need an appointment, and that is why you should call first.
When Social Security enrolls you in those two programs, it will automatically notify the Defense Enrollment Eligibility Reporting System (DEERS) that you are entitled to Medicare and that you are enrolled in Medicare Part B. When DEERS receives that official notification, it will update your DEERS registration to report your Part B enrollment and TFL eligibility.
When you get your Medicare identification card, call the DEERS Support Office at 1-800-538-9552 to make sure your DEERS record has been updated and that it reports you are enrolled in Medicare Part B and are eligible for TFL. If there is a problem, ask DEERS what you must do to fix it.
Here is an important warning for Tricare-eligible retirees and their family members who get Medicare. The law that governs Tricare requires that they must be enrolled in both Medicare Part A and Medicare Part B on the effective date of their Medicare coverage. If they are not enrolled in Part B, they cannot become eligible for TFL, and they lose their Tricare eligibility until they have Part B in effect.
I know I need Medicare parts A and B; what about Part D?
May 11th, 2011 | TriCare Help | Posted by Military Times
Q. Must I also enroll in Medicare Part D (prescription coverage) in order to have Tricare prescription coverage? Or, would Tricare cover my prescription needs without the need to enroll, and pay for, Medicare Part D?
Social Security wants you to apply for coverage at least 90 days before the first day of the month when you will have your 65th birthday. The first of that month is the effective date of your Medicare coverage and the start date of your Tricare for Life eligibility.
When you become entitled to Medicare and are enrolled in Part A and Part B, you will automatically become eligible for Tricare for Life (TFL) if your DEERS record is up-to-date. (To check the status of your DEERS record and to make any corrections needed to update it, call 1-800-538-9552.)
You are not required, and do not need to enroll in the Medicare Pharmacy Program (Medicare Part D). As a Tricare beneficiary, you are automatically eligible for, and are enrolled in, the Tricare Pharmacy Program.
Health Affairs advises that the only Tricare beneficiaries who might receive a financial advantage by enrolling in Medicare Part D are those whose income is so low that they qualify for financial aid to help pay their Medicare Part B premiums. The vast majority of Tricare for Life beneficiaries do not need Medicare Part D.
Why can’t wife get TFL when I do?
April 22nd, 2011 | TriCare Help | Posted by Military Times
Q. My wife has Tricare as a direct result of my wartime military service. Her eligibility is carried in DEERS under my Social Security number, not hers. By the same token, therefore, when I get Medicare and Tricare for Life, should she not get it at the same time although she is only 59?
There are circumstances in which one spouse’s Medicare entitlement confers entitlement on the other spouse, but your circumstances don’t qualify for that purpose. Your wife must meet all the requirements for Medicare entitlement established by federal law.
Additionally, to be eligible for Tricare for Life, your wife must be eligible for Tricare, be legally entitled to free Medicare Part A, be enrolled and have Medicare Part A and Part B in effect, and have her DEERS registration correct and current.
Until she meets those requirements, probably when she gets Medicare at age 65, your wife’s Tricare eligibility most likely will continue as it is at present.
To confirm those rules, and for official answers to all questions about Tricare eligibility, please call the DEERS support office at 800-538-9552.
It’s important to note that the rules for Tricare eligibility are established by law; DEERS does not have the authority to change them or to make exceptions.
For official information about the requirements for your wife’s Medicare entitlement, please contact the Social Security Administration.
With TFL, do we really need a supplemental?
April 4th, 2011 | TriCare Help | Posted by Military Times
My spouse and I are both retired military, on Social Security, and we have Medicare Part B and Tricare for Life. For several years we have had a supplemental policy from United Health. But if we have TFL and Part B, do we really need the insurance from United? We wonder if we are paying for something that is already available from TFL.
Nobody but you can decide what health insurance coverage you need. I cannot make that decision for you. But I can tell you the facts about what Tricare for Life offers.
TFL consists of full coverage of all the benefits of Medicare Part A and Part B, plus the full benefits of Tricare Standard without additional cost.
Under TFL, you have full coverage provided by Medicare Part A and Part B. In addition, and as second payer, you have full coverage by Tricare Standard (which is free). Thus, with TFL you have full coverage by two full-service, stand-alone health insurance plans. Either of those plans, by itself, would provide adequate health insurance for an average person’s needs.
Thousands of people have Medicare Parts A and B, or Tricare Standard as their only health insurance. If only one of those is their only coverage, a good supplemental plan to pay the primary plan’s deductibles and copayments is advisable.
Only you can decide whether if, in addition to two full service plans, you need yet another health insurance plan to feel secure in your coverage.
How do I keep coverage for younger husband when I get TFL?
March 25th, 2011 | TriCare Help | Posted by Military Times
Q. I’m a retired reservist and retired federal employee with employees’ health insurance. I have a civilian husband who is three years younger, but no children. I’ll be 65 in August and get Medicare and Tricare for Life. What can I do at that time to ensure I still have coverage for my husband?
When you transition to Tricare for Life on Aug. 1, your husband’s federal employee plan and Tricare coverage will continue unchanged until he gets Medicare at age 65 — assuming you keep your own coverage under the federal employees plan. Family members can’t be covered unless the former employee also is covered. Confirm this with the Office of Personnel Management.
For your own transition, you should apply for Medicare Part A and Part B at least 90 days before Aug. 1. If you enroll properly, your coverage will be effective on that date. If your Defense Enrollment Eligibility Reporting Service record reflects your Part B enrollment, you will retain your Tricare eligibility and become eligible for TFL.
TFL consists of full coverage by Medicare Parts A and B plus Tricare Standard. Because you must retain your federal employee plan coverage for your husband’s benefit, however, that plan — not Tricare — will be second payer on your Medicare claims. Tricare Standard will be last payer, and you must file those claims yourself.
Call the DEERS support office at 800-538-9552 to check the accuracy of your and your husband’s DEERS records.
What will happen to my coverage after husband dies?
January 7th, 2011 | TriCare Help | Posted by Military Times
Q. My husband retired from the Navy in 1992. He is now 80 years old and uses Tricare as secondary coverage for Medicare. I am still working at age 51. We have been married since 1988. Will I remain a military dependent after my husband is no longer alive? If so, will I be eligible for Tricare when I reach Social Security Retirement age?
Unless you remarry, your husband’s death will have no effect on your Tricare eligibility. If you remarry, your Tricare eligibility under your present husband’s sponsorship will terminate immediately. If the second marriage ends in divorce or death, eligibility under your present husband cannot be restored regardless of circumstances.
You can ensure that you are properly registered and eligible for Tricare at this time by calling the Defense Enrollment Eligibility Reporting System (DEERS), toll-free, at 1-800-538-9552. If there is a problem, ask DEERS how to fix it. It is your responsibility to keep your DEERS record and military identification card up-to-date.
If you become entitled to free Medicare Part A at age 65 and enroll in Medicare Part B, you will become eligible for Tricare for Life, or TFL for short. Under TFL you will have full benefits of Medicare Parts A and B as your primary coverage and Tricare Standard as a free Medicare supplement for all medical services that are covered by both Medicare and be Tricare. The vast majority of your Medicare claims will be of that type.
Under TFL, if you receive a medical service that is covered by Tricare but is not covered by Medicare, Tricare will process a claim for that item as if it were your only health insurance. In that case, all Tricare claims processing rules will apply including the Tricare cost share and, if applicable on that claim, the Tricare deductible.
Some people become eligible for free Medicare Part A before they are 65 under a Social Security plan for disabled persons. If they enroll in Part B, they become eligible for TFL just as if they were 65. Call the Social Security Administration about Social Security disability benefits. Social Security cannot give you official information about Tricare or Tricare for Life.
For more information about Tricare Plans, including TFL, please go the official Tricare website. You will also find contact information for your Regional Tricare Office at that site.