Can disabled adult son get Tricare and dental coverage?
February 3rd, 2012 | TriCare Help | Posted by Military Times
I am a retired, 100 percent disabled Navy officer. I have a 41-year-old son who is disabled and receives SSDI from Social Security. Does he qualify for Tricare and dental coverage?
To begin an inquiry concerning the possibility of your disabled son’s Tricare eligibility, please call the DEERS Support Office, toll-free at 1-800-538-9552.
If your son is determined to be entitled to Tricare, and if he is enrolled in free Medicare Part A, and in Medicare Part B, he will be entitled to the Tricare program called Tricare for Life. To use TFL, he must be properly registered in DEERS.
Under TFL, Medicare Parts A and B becomes the beneficiary’s primary health insurance, and Tricare Standard, as second payer, acts as a free Medicare supplement. The TFL beneficiary, thus, has coverage by two, full-service, stand-alone health “insurance” plans. The second plan, Tricare Standard, is provided without additional cost.
Under TFL, the vast majority of the beneficiary’s medical expenses will be paid in full by the combined coverage of Medicare plus Tricare. The only cost for Tricare for Life coverage is the monthly premium for Medicare Part B. That is somewhat more than $100 per month in 2012.
Tricare does not have a dental benefit. It does, however, provide for enrollment in a commercial dental insurance plan available to Tricare beneficiaries at group rates. There is a plan for active-duty personnel and their Tricare-eligible family members, and there is a similar plan for retirees and their families. You can get more information about the Tricare Retiree Dental Plan here.
How Social Security disability affects your Tricare coverage
October 19th, 2011 | TriCare Help | Posted by Military Times
I am a 61-year-old retired Marine and have been enrolled in Tricare Prime for a number of years. Over the past few years I was treated for stage 4 neck cancer and was awarded Social Security disability that was back dated almost a year. I understand that once you are on SSD for two years you have to enroll in Medicare. I have received my Medicare card for Parts A & B that will be effective Jan. 1, 2012. Will I need to contact Tricare to discontinue my allotment for Prime, or will they receive notification from Social Security? Also, will I fall under regular Tricare or will I convert to TFL? Do I now also need to be issued a new retired military ID card before Jan. 1?
When a Tricare beneficiary becomes entitled to Medicare and is enrolled in Part B, the Social Security Administration is supposed to notify DEERS to report that fact. Sometimes supposed things do not happen. For help with any eligibility issues or problems, see below.
According to your letter, you are already enrolled in Part B although it will not become effective until Jan. 1, 2012. You can call the DEERS Support Office (DSO) toll-free, at 1-800-538-9552, to check the status of your DEERS record.
If your record has not been updated to show your Part B enrollment and the effective date, ask DEERS what action on your part is needed, if any. Ask DEERS also about your military ID card and for guidance, if needed, to renew it when time to do so.
You can contact DEERS whenever you have any questions relating to your eligibility for military benefits of any kind. DEERS deals with eligibility issues only. Although DEERS can tell you the content of laws relating to eligibility and how they affect you, it cannot provide legal advice. Contact a private attorney or a JAG office, as appropriate, if needed.
In the meantime, I suggest that you call your Tricare Prime office now and make arrangements to pay its enrollment fees on a month-to-month basis that will end automatically with the last payment to be for December 2011. In that way, you will not pay in advance for Prime coverage you cannot use after December 31, 2011. That office will provide any guidance you need about the matter.
If your DEERS record is up-to-date and accurately reports that you are enrolled in Medicare Part B, DEERS will automatically switch your Tricare plan from Prime to Tricare Standard at midnight on December 31, 2011. One second later you will become eligible for Medicare Parts A and B, Tricare Standard, and be eligible for Tricare for Life.
TFL consists of coverage by two, full-service, stand-alone, health insurance plans – Medicare Parts A and B plus Tricare Standard. Either plan, alone, will provide adequate health insurance for most people, although a supplement would be recommended, if feasible, to pay the plan’s copayment and deductible. Under TFL, your coverage will be excellent.
Medicare Part A is free. Tricare Standard is free. Medicare Part B costs a monthly premium. If you call Medicare, toll-free, at 1-800-633-4227, you can learn how much Part B will cost in 2012.
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).
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.
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.
Covered by Standard and federal plan – what happens when I turn 65?
June 28th, 2010 | TriCare Help | Posted by Military Times
Q. This September I will be 65 years old and eligible for Medicare. I am retired from the Navy, and have Tricare Standard for myself and my family. I am also retired from federal service, and I am enrolled in the Government-wide Service Benefit Plan (BlueCross BlueShield) for government retirees. This is my primary health insurance. My wife will not be eligible for Medicare for another seven years.
What should I do about my health insurance needs when I turn 65 and go on Medicare? I know I will have Tricare for Life, and I realize I need to get Part B of Medicare. Am I correct to assume that my wife and child (20 years old) will still be eligible for Tricare Standard, and I will have TLF and Medicare? What should I do about my government retiree plan?
In your case, unfortunately, your transition from “ordinary” Tricare to TFL will be expensive for you. Here’s why.
Your transition to TFL will have no effect of any kind on your family’s eligibility for “ordinary” Tricare Standard. And, they will continue to need other health insurance – the federal employees plan (FEP) — in addition to Tricare, just as they do now. Your family’s coverage will not change in any way.
Your FEP premium is at the family rate — two or more family members. That will not change, because you will still have the FEP plan.
You cannot leave the FEP plan. You, the former employee and sponsor, must also be enrolled in the FEP in order for your family to have FEP coverage. You will have to pay the FEP monthly premium at the family rate just as you do today for two or more family members.
Now about your TFL. You know that federal law requires you to be enrolled in Medicare Part B when your free Medicare Part A becomes effective. That means you will have to pay a monthly premium for Medicare Part B in addition to the FEP premium.
Your own personal costs for health insurance will increase by the amount of the Part B premium. Your first payment will be due on August 1. You will pay for Part B one month in advance. For the remainder of this fiscal year, which ends on September 30, it’s around $100. You can arrange for the premium to be taken from your OPM pension.
For your family, the FEP will be primary and Tricare will act as a free supplement (second payer) for it, just like today. Nothing will change for them.
For you, Medicare will become primary on Sept. 1, the FEP will be secondary, and Tricare, by law, is always last. Your Medicare coverage, Part A and Part B, will be effective on Sept. 1. You will get a Medicare ID card in August that shows Sept. 1 as the date for your Part A and Part B to become effective.
Social Security wants people to apply for benefits at least 90 days prior to the effective date of their coverage. You must apply for Part B at that time according to the law that governs Tricare. That is a different law from the one that governs Medicare.
As of Sept. 1, you must seek all your civilian medical services from Medicare providers. That is, providers that will file Medicare claims for their services. Do not use any provider who cannot, or will not, file Medicare claims for your bills. If you do, Medicare will deny payment on the claim.
When the provider asks about your secondary insurance or Medicare supplement, tell them it is your FEP plan. Show them your FEP ID card. After Medicare pays a claim, it will automatically forward the claim to the FEP as second payer.
FEP will be primary and Tricare will be your second payer for all medical care you receive until midnight on Aug. 31.
When Medicare and the FEP are both done with a claim, and both have sent you EOBs, it’s time to file a Tricare claim, even if there is nothing left to pay. You should always file a Tricare claim as third payer in order to get family credit on your Tricare Catastrophic Cap.
Call your Tricare Service Center for help with filing the Tricare claim the first two or three times until you learn how to do it yourself. Your FEB will not forward the claim to Tricare. You must file it.
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.
Does Social Security eligibility change affect Medicare, TFL?
December 31st, 2009 | TriCare Help | Posted by Military Times
Q. I am currently 61. Tricare states I have to enroll in Medicare Part B upon reaching age 65. Since the Social Security rules changed and I can’t draw social security until age 67, how is this going to happen?
A few years ago, the Social Security law was indeed amended to make eligibility to receive Social Security payments depend on the beneficiary’s year of birth. The age for entitlement for Medicare, however, remained unchanged at 65.
Medicare will bill the beneficiary every 90 days for the Medicare Part B premium until he or she reaches the statutory age to receive Social Security payments. From that time on, the Part B premium will be deducted from the monthly benefit check.
Since Tricare for Life began in 2001, federal law requires all except active duty family members and Tricare beneficiaries enrolled in the US Family Health Plan to be enrolled in both Medicare Part A and Part B on the effective date of their Medicare coverage. Failure to be enrolled in Part B on that date causes the loss of Tricare eligibility until Part B enrollment is in force.
Is my wife covered by Medicare yet?
November 2nd, 2009 | TriCare Help | Posted by Military Times
Q. I retired from the Army in 2004, I’m now 57 and my wife just turned 60. When must my wife sign up for Medicare Part A or B?
The legal age for Medicare eligibility for most people is 65, unless they qualify for Social Security disability benefits before then. Social Security wants people to apply for Social Security and Medicare at least 90 days before the first day of the month when they will turn 65. At that time, your wife should apply for Social Security benefits, including Medicare parts A and B. To learn more, call Social Security at 1-800-772-1213.
You should also call the Defense Enrollment Eligibility Reporting Service (DEERS) Support Office at 1-800-538-9552 to ensure that you and your wife are properly registered in that database. Ask whether you and your wife are eligible for Tricare. As you are a uniformed service retiree, your wife should be eligible for Tricare Prime or Tricare Standard coverage now.
In the meantime, visit the Tricare web site and make a note of the contact information for your regional office. You can read overviews for Standard and Prime, as well. Tricare Standard is free; Tricare Prime costs $460 per year for a family of two people or more. Both plans can be used to supplement any other health insurance you have. Tricare Standard, however, is the recommended plan for people with other health insurance. It will pay all, or most, of the deductible and copayment from your other health insurance.
On disability for a year; what happens to my coverage?
October 23rd, 2009 | TriCare Help | Posted by Military Times
Q. I am a 59-year-old military retiree. I’m enrolled in Tricare Prime, was recently treated for cancer and have applied for Social Security disability. The Social Security disability, if approved, will probably be for no more than one year. If it’s granted, do I have to disenroll from Tricare Prime and enroll in Medicare Part B, and revert to Tricare Standard as I would not be eligible for TFL? Also, I do plan on returning to the work force once I am off disability. Will I then have to re-apply to Tricare to go back on Tricare Prime? Also, if company that you work for offers health care with a premium that is deducted from your pay, am I required to use that health plan primarily and Tricare as the secondary?
People who qualify for Social Security disability benefits become entitled to Medicare only after receiving disability benefits for 24 consecutive months. Unless and until you become entitled to Medicare (whether for disability or by reaching age 65) there will be no consequences of any kind for your Tricare coverage.
If your employer sponsors a health insurance plan for employees, regardless of who pays the premium, it will have no effect on your Tricare coverage unless you enroll in that plan. Tricare will not require you to enroll in your employer’s plan.
If you do enroll in the plan, by federal law it will be primary to Tricare. You must file all claims with your employer’s plan first. After that plan completes processing the claim and issues an Explanation of Benefits, you may file a claim with Tricare for the same bills. Tricare will pay part, or all, of what the other health insurance did not pay for every medical service on that claim that is covered also by Tricare. That will usually be the other health insurance’s deductible, if applicable, and your copayment.
I do not recommend Tricare Prime for people with other health insurance because of duplication of services, additional expenses, difficulties with which plan must pay first, and problems with coordination of benefits. To avoid those problems, I recommend Tricare Standard for those with other health insurance.