Pregnant and engaged; how soon can I get benefits?
February 13th, 2012 | TriCare Help | Posted by Military Times
I am the girlfriend of a soldier, and I am 10 weeks pregnant. We have every intention on getting married, but I want to know if there is a time limit in which we need to wed in order for our unborn child, and me, to receive military benefits.
You will become eligible for Tricare, including maternity care, on the day you are legally married to the baby’s father. You cannot use Tricare, however, until you are legally married and your husband has contacted his Personnel Section to register you for the program. That takes only a few days.
If the baby is born before you are married, the child’s Tricare coverage will begin on the day he is born. There are some administrative requirements to be met before that, but you can get detailed official information about the Tricare eligibility of a child born out of wedlock by calling the DEERS Support Office, toll-free, at 1-800-538-9552. Be prepared to take notes.
I’m diabetic; when I get married, can I get Tricare right away?
January 27th, 2012 | TriCare Help | Posted by Military Times
My fiancé is active-duty military. I am a diabetic and am on the insulin pump, and I have been told that once I get married and go on Tricare, my care will not be what I’m used to. I have seen the same doctor for 17 years, and I heard Tricare won’t let me pick my doctor. I have also been told I may have to give up my insulin pump and go back to shots. Can you confirm or explain any of that? Also, when we get married, my parents will drop me from their insurance. Do I have to wait for an open enrollment date for Tricare, or is there a way that coverage can start right away?
First of all, if medically necessary and appropriate for the diagnosis, symptoms, and history of the particular beneficiary, an insulin pump can be covered by Tricare.
A problem could arise, however, in your choice of providers. Tricare is not an insurance policy; it is a federal health benefits program. Tricare requires that you receive all civilian medical care from Tricare-authorized providers only. Tricare may not pay for any medical services you receive from an unauthorized provider.
In your case, to retain your same providers, it would be necessary for them to be willing to become Tricare-authorized providers. They can learn how to do that here.
There is no open enrollment period for Tricare. You will become legally entitled to Tricare at the moment you are married. To use Tricare, however, your military sponsor (your husband) must contact his personnel office to register you in the Defense Enrollment Eligibility Reporting System and secure for you a uniformed service identification card. Your coverage will be retroactive to the moment of your marriage.
Can fiancee keep seeing same doctors when we get married?
January 11th, 2012 | TriCare Help | Posted by Military Times
I am an active-duty sailor and I am getting married in February. My fiancee has bipolar disorder. She is concerned about being able to keep her same doctors and counselor/therapist when we are married and what hoops we may have to jump through with Tricare to make it work. How can I help her ensure she keeps her current doctors?
Tricare is a federal program, but it has a rule in common with most commercial health insurance companies and policies: In order for Tricare to help pay for medical services, the provider of care must be registered with Tricare and be authorized to be paid by Tricare for covered services rendered to Tricare beneficiaries.
Your bride will become legally entitled to Tricare the moment she is married to you., For her to use Tricare, however, you must register her in DEERS and apply for her military ID card. Your Personnel Section will help you do that.
Tricare has no limits or restrictions on its coverage of pre-existing conditions. Mental health care, including pharmacy services, is a Tricare benefit, subject to existing rules regarding the medical necessity and appropriateness of care for the particular patient’s diagnosis, symptoms, and medical history.
Seamless continuity with your wife’s same providers may be a problem for two reasons:
One is the perennial element of military service in that you are subject to periodic transfer to a new location, perhaps across the world. You have little or no control over that element of military service.
The other is whether your wife’s providers are, or are willing to become, Tricare-authorized providers, as I discussed above. A section of the official website was designed especially to inform providers of care about Tricare and its rules regarding providers. Your wife should make her doctors aware of the web site and its provider section, but the decision of whether to become Tricare authorized providers is voluntary and entirely in their hands.
Will fiancee’s grandson be covered if we get married?
January 6th, 2012 | TriCare Help | Posted by Military Times
I am currently in a relationship and would like to get married. My fiancee has legal custody of her grandson. Once we are married, will this child be eligible for care under my Tricare? Also, will any of my fiancee’s pre-existing conditions be covered, such as diabetes?
By federal law, unless you were to legally adopt the grandson, I don’t believe his Tricare eligibility is possible. To confirm that, however, and to explore what other possibilities might exist, call the DEERS Support Office at 1-800-538-9552.
Tricare has no restrictions on its coverage of pre-existing conditions.
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.
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.
Marrying a veteran who gets VA care; will I be eligible for Tricare?
October 12th, 2011 | TriCare Help | Posted by Military Times
My fiancé served 3 years active Army and 3 years Army reserves back in the 80s. Most recently he served 6 years in the National Guard and his enlistment was up last in September of 2011. He is 40 percent disabled has medical coverage from the VA. I am an independent contractor and am not eligible for employer-sponsored health insurance. When we get married, would I be eligible for any health insurance, either through Tricare or another option?
The information you provide leads me to think that your fiancé did not serve long enough in a uniformed service to be eligible for Tricare. In that case, neither would you, as his spouse, meet the legal criteria for Tricare eligibility. To confirm that, however, and for official information about your and his Tricare eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Getting a divorce and just got huge surgery bill – aren’t I still covered?
September 19th, 2011 | TriCare Help | Posted by Military Times
I’m a Navy wife going through a divorce and I recently had to get my appendix taken out. I thought I was still covered until the divorce was final, but I just got an $11,000 bill for the surgery. When I reached my husband, he said he took me off his Tricare. Can he do that? And what can I do about this bill?
Your husband does not have the legal authority to cancel your Tricare eligibility. Tricare benefits flow directly to the beneficiary; the military sponsor has no control over it. You will be eligible for Tricare until midnight of the day your divorce is final.
Also, Tricare will not allow him any access to information about your Tricare claims or medical care. You are protected by the Privacy Act.
The provider of your medical care should file a Tricare claim for his bill. If he will not do that, you should do it yourself. You can find detailed instructions at www.tricare.mil/claims. Remember that the only thing that matters is that you were covered at the time the service was rendered; after your divorce is final, you still have a year from the date the service was rendered to file claims.
How do we decide between Tricare Prime and FEHBP?
September 8th, 2011 | TriCare Help | Posted by Military Times
My husband is retiring from the military and now is eligible for the Federal Employee Health Benefits Program through his new job. He has minimal health issues, but I have a history of cancer and other problems. Should we enroll in FEHBP or use Tricare Prime? The premiums alone for FEHBP equal or exceed Tricare’s yearly $3,000 catastrophic cap. If we had both, could the FEHBP deductibles, copayments and premiums count toward Tricare’s catastrophic cap?
I cannot tell you exactly what you “ought” to do regarding your health insurance coverage; nobody can make that decision except you and your husband. But I can give you as much information as possible about Tricare to help you make that decision.
Tricare Prime functions as a Health Maintenance Organization (HMO). Tricare Prime providers (called network providers) are under contract with Tricare to provide the services mandated by law and regulation to beneficiaries enrolled in Prime.
They have privately negotiated with Tricare the fees they will charge for each of their services, but that’s between Tricare and the provider only. All the patient must be concerned about is the flat rate of $12 he or she must pay per office visit, or the flat rate of $11 per day for hospital stays.
Prime is not available everywhere. It is usually found within a 40- 50-mile radius of a military treatment facility. Tricare beneficiaries enrolled in Prime have priority access, right after active-duty family members, to free care at the MTF.
As with commercial HMOs, you must seek all care, except bona fide medical emergency care, from providers in your local network.
If you take a trip, clear it first with Tricare Prime, because on the road, “routine” care will not be covered inexpensively. There are considerable penalties ($300 deductible, 50 percent cost share) on claims for unauthorized care by non-network providers.
People have exactly the same problems with commercial HMOs under the FEHBP. Personally, I like HMO care except for the limited choice of providers, and the inconvenience if one travels. They are most like military sick call. The big ones have everything — labs, etc. under one roof, plus centralized record-keeping, central appointments, and the like. Big civilian HMOs may even own their own hospital. And their low cost is a big factor.
Like many things in life, it’s a trade-off. Study assiduously; know before you buy. You can download a free Tricare Prime handbook here.
FEHBP deductibles and cost shares do not count for your Tricare catastrophic cap, however. Only Tricare’s deductibles and cost shares count.