I’m about to get Tricare for Life; what else do I need?
December 29th, 2011 | TriCare Help | Posted by Military Times
I am going to turn 65 in February. I am in the process of enrolling in Medicare Parts A and B. Besides Tricare for Life, do I need to buy other insurance, such as Medicare Part C? My husband is a military retiree.
Tricare for Life was designed especially for Tricare beneficiaries who become eligible for free Medicare Part A and are enrolled also in Medicare Part B. Those beneficiaries also retain their eligibility for all the benefits of Tricare Standard which, as second payer to Medicare, acts as a free Medicare supplement. If they are enrolled in Tricare Prime, it will be converted automatically to Tricare Standard on the date their Medicare coverage becomes effective.
TFL beneficiaries, therefore, are covered by two, full-service, stand-alone, health insurance plans, all for the cost of the monthly premium for Medicare Part B.
You should be cautious also of Medicare Part C, the Medicare Advantage plans. They are the original Medicare plan plus important medical services added by the commercial carriers of the Advantage plans. Advantage plans, however, are designed for civilians who do not have your free Medicare supplement. You should examine the Part C add-ons before buying to see which ones Tricare Standard automatically includes at no additional cost to you. With Tricare Standard, you do not need the Part C add-ons.
You also should not enroll in the Medicare Pharmacy Program, called Part D, because you, like all Tricare beneficiaries are automatically eligible for the free Tricare Pharmacy Program. The Defense Department’s Health Affairs office says, in effect, that you won’t benefit from Medicare Part D unless your income is so low that you qualify for financial aid to pay your Medicare Part B premiums.
Plus, enrollment in Part D will prevent your use of the Tricare Mail Order Pharmacy Plan, where the big savings come in. If you use the mail order plan, you can a 90-day supply of drugs for the same price that you would pay locally for a 30-day supply.
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.
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.
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.
No need for Medicare Part D
November 1st, 2010 | TriCare Help | Posted by Military Times
Q. I’ll get Medicare in January. I know I must enroll in Part A and Part B, but does Tricare require me to enroll in Medicare’s pharmacy plan, Part D?
No. The Pentagon’s Office of Health Affairs is on record as stating that the only Tricare beneficiaries who might benefit from enrollment in Medicare Part D are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums. OHA does not recommend Medicare Part D for most Tricare beneficiaries.
Some Medicare Advantage plans require enrolling in Part D. Tricare is not involved in those requirements. Medicare Part D, however, will be seen as “other health insurance,” and will prevent your using the Tricare Mail Order Pharmacy Plan. You will have to use your Part D plan first, before you can use your Tricare Pharmacy Plan, even for local drug purchases.
If you’re enrolled in Part D, you may file Tricare claims for the costs of drugs that exceed Tricare’s allowances for those drugs. But you must first buy the drugs through your Part D plan.
All Tricare beneficiaries are automatically covered for the free Tricare Pharmacy Program. The coverage, not the drugs, is free.
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.
The right way to deal with a problem with Express Scripts
July 15th, 2010 | TriCare Help | Posted by Military Times
Q. Why is Express Scripts such a frustrating outfit to do business with? They have not responded to two greivance letters. In particular, I do not believe that they have paid out one single dollar for paper-processed claims for reimbursement that I have filed on behalf of my mother. They just recycle the paperwork back to you and they don’t care.
Your communication problems may have to do with the Privacy Act. By federal law, Tricare, Express Scripts, etc. cannot discuss your mother’s claims with a third party (you) without her written consent.
As that is only a guess, however, please send a detailed report of your mother’s problem to Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, Co 80011-9043. Both you and your mother should sign the letter. That way, you can be included in the communications loop. If your mother is unable to sign the letter, please include a statement to that effect.
Include copies of all correspondence and other pertinent documents and a telephone number where you can be reached during the day. Be sure to include your mother’s full name, her military sponsor’s full name, and his Social Security number.
The more information you provide, the more effectively you can be helped. As an example, your letter, above, provided no information I could have used to suggest things you might do to resolve the problem. Surely Express Scripts reported its reasons for not paying the claims. Or perhaps, they didn’t, and said they couldn’t discuss the problem with you because of the Privacy Act. I don’t know, of course.
TMA, above, is a federal agency and the worldwide Tricare Headquarters. That office has the authority to order copies of all your mother’s claims documents and analyze them to get to the root of the problem.
If your mother is enrolled in Medicare Part D Pharmacy Plan (which she does not need unless her income is below the federal poverty line), her problem may be related to the coordination of benefits between two pharmacy benefit plans. Such claims must be filed in a certain order and contain certain documents to be processed and paid smoothly.
Without Part D, all your mother’s prescription services can be handled locally by an Express Scripts network pharmacy, or by mail order where she can get a 90-day supply of her medicines at the same price she pays for a 30-day supply purchased locally. Find information about that on Tricare’s website.
Can disabled adult daughter get TFL?
June 29th, 2010 | TriCare Help | Posted by Military Times
Q. I am retired from the Air Force and would like to get my 37-year-old daughter on Tricare for Life. She was diagnosed with fibromialgia about 10 years ago and had to go on full disability two years ago. She had to sell her home and move in with us. She has never been married and Social Security disability is her only source of income. She has Medicare parts A, B and D and a supplemental policy. I want to get her on TFL so I won’t have to pay for Part D and the supplemental policy. How can I do this?
I’m sorry to learn of your daughter’s disability, but it’s good to know, at least, that she qualifies for Social Security disability benefits and Medicare.
Unless her disability was discovered before she was 21 years old, I doubt that your daughter will be found to be eligible for Tricare. For official information about Tricare eligibility, you should contact the DEERS Support Office, toll-free, at 1-800-538-9552. Though she will likely not be found eligible, DEERS will discuss with you what federal law may allow in her case. If it is possible that she is eligible for Tricare, DEERS will provide instructions and any help needed to enroll her in the program.
Tricare eligibility is established by federal law and regulation. Tricare, however, does not have the authority to make individual eligibility determinations. Only the uniformed services have the authority to determine whether a particular person meets the legal criteria for Tricare eligibility, to register an eligible person in DEERS, and to issue a uniformed service identification card which can be used as proof of Tricare eligibility.
If she has not done so already, it might be of benefit for her to contact your state’s Social Services office to learn whether there may be additional benefits available, including Medicaid.
Social Security says retirement is at 66; Tricare says 65. Which is it?
May 14th, 2010 | TriCare Help | Posted by Military Times
Q. According to Social Security, if you were born between 1943 and 1955, full retirement age is 66. But doesn’t Tricare say that by time we reach age 65 we have to go to Tricare for Life and have medicare Part D? How can this happen when we can’t get it until age 66? Didn’t Tricare adjust the age as did Social Security?
Medicare and Tricare were created by, and continue to be governed by, different and unrelated federal laws.
Initially, one became entitled to receive monthly Social Security benefit payments and Medicare at age 65. Several years ago, Congress changed that law. Now, the age for entitlement to receive monthly benefit payments depends on one’s year of birth.
Congress did not change the age for Medicare entitlement. A Social Security beneficiary still becomes eligible for Medicare benefits at age 65.
The law I refer to is the one that created and governs Social Security and Medicare. It is not related to Tricare.
If a person applies for Medicare in a timely manner, he or she will become entitled to Medicare on the first day of the month of his 65th birthday. If he was born on the first day of that month, his Medicare entitlement will begin on the first day of the previous month. That is true regardless of when he becomes eligible to receive monthly Social Security benefit payments.
Thus, if a Tricare beneficiary is properly enrolled in Medicare Part A and Part B, and if his DEERS registration is properly updated to show those enrollments, DEERS will report his eligibility for Tricare for Life effective on the same date as his Medicare entitlement is effective.
Medicare will bill the beneficiary every 90 days for his Medicare Part B monthly premium. If he fails to pay, his Part B enrollment, and his Tricare eligibility, will be terminated until payment is made. That can cause administrative hassles and delays to fix it and to restore his TFL eligibility. Tricare may not pay retroactively the costs of medical care received while his Tricare eligibility is suspended.
When the Social Security beneficiary becomes old enough to receive monthly benefit payments, the Part B premium will be deducted as an allotment to pay his Part B monthly premium.
The law governing Medicare does not require enrollment in a Medicare Pharmacy Plan, known as Medicare Part D. Neither does Tricare require Medicare Part D enrollment.
In fact, Health Affairs is on public record for saying that the only Tricare beneficiaries likely to receive a financial advantage by enrolling in Medicare Part D are those whose incomes are below the federal poverty line, and who qualify to receive financial aid to pay their Medicare Part B monthly premium. In other words, do not enroll in Medicare Part D. You do not need it.
Note that the carriers of some Medicare Advantage Plans require Part D enrollment, but that is not related to any requirement by Tricare.
Every Tricare beneficiary is automatically eligible for, and is automatically enrolled in, the free Tricare Pharmacy Program. It is probably one of the very best prescription drug plans in the country. It needs no help.
Why most beneficiaries have no need for Medicare Part D
March 29th, 2010 | TriCare Help | Posted by Military Times
Q. I’m in the process of signing up for Medicare. I know that I have to enroll in Part A and Part B to become eligible for Tricare for Life. My sister says her Medicare plan required her to sign up for Medicare Part D, the Medicare pharmacy plan. She has no military connections. Does that apply to me as well?
Unless you were to enroll in a Medicare Advantage plan that has Part D as a requirement, as in your sister’s case, you have no obligation to enroll in Medicare Part D, the pharmacy plan. To the contrary, as I mentioned above, it is not recommended.
Under Tricare for Life, you will have full coverage with Medicare Part A and Part B plus full coverage by Tricare Standard. All Tricare beneficiaries are eligible for the free Tricare Pharmacy Plan; it is probably the best pharmacy plan in the country. It needs no help to meet all your pharmacy needs.
For more information about the Tricare Pharmacy Plan, you can read about it online or call Express Scripts Inc. toll free at (866) 363-8779. I also suggest that you download a free Tricare for Life Handbook.