Would Tricare pay for new wife’s nursing home care?
May 4th, 2012 | TriCare Help | Posted by Military Times
I retired from the Army in 1975 and I have Tricare for Life. My wife of 52 years passed away in 2010 and now I am thinking of getting remarried. I am concerned about how to protect my children’s inheritance if my new wife has to go to a nursing home for a long period of time. What benefits does Tricare offer?
Like Medicare, Tricare makes no provisions for long-term care such as in a nursing home.
While there is no upper age limit for active medical care designed to make a patient “well” and able to live more or less independently, Tricare cannot cover long-term care in a protected and secure environment with assistance with the activities of daily living, such as eating, dressing and bathing. That is called custodial care. Both Tricare and Medicare are specifically forbidden by federal law to cover that kind of care.
As a result, you must look to the private sector for such benefits.
How can I make sure my surgery is covered?
April 18th, 2012 | TriCare Help | Posted by Military Times
I’m married to an active-duty airman. I have an ovarian cyst that must be removed ASAP. Does Tricare cover this kind of surgery?
Tricare does cover medically necessary care, including surgery, for your condition. If you live near a military hospital, make an appointment to be seen by military physicians. If you do not live near a military facility, you must find a civilian physician who is, or who is willing to become, a Tricare-authorized provider, to provide the care you need.
Tricare may provide coverage only if you use a military hospital, or a civilian physician who is authorized by Tricare to attend its beneficiaries.
Under 20/20/20 rule, will she lose her Tricare if she marries me?
March 30th, 2012 | TriCare Help | Posted by Military Times
You have said a former spouse must be married to the same uniformed service sponsor for at least 20 years during which the sponsor accrued military retirement credits. In other words, the sponsor’s active duty and the marriage must have overlapped by at least 20 years. But in another instance, you’ve also said that a spouse’s coverage is not affected by the death of the sponsor, and that the duration of the marriage is not a factor. I have been seeing a lady who is divorced from a military retiree and has Tricare for Life coverage under his name. I am also a military retiree with TFL. I have been told that if we married and I died before her, she already would have lost Tricare benefits through her ex-spouse, and also from me, since we would not have been married for 20 years. Can you advise?
The two situations you cite in your letter involve two distinct sets of circumstances. One situation involves a former spouse, the other involves a current spouse whose retiree sponsor dies.
The so-called “20/20/20 rule” comes into play in divorce cases involving military retirees. A former spouse may retain Tricare benefits after divorce if the marriage lasted 20 years, the military member served on active duty for at least 20 years, and the marriage and active-duty service overlapped for at least 20 years. A former spouse who meets those criteria may retain Tricare coverage for the rest of her life, under one significant condition: she does not remarry. If she remarries, she loses Tricare eligibility under her former husband’s sponsorship. Once lost, it can never be restored under the retiree sponsor’s name, even if the former spouse’s second marriage ends in divorce or death.
The other situation you cited involves a spouse whose military retiree sponsor dies before her. In this case, the 20-year rule does not apply, for the simple reason that they were not divorced. A spouse covered by Tricare whose retiree sponsor dies before her remains eligible for Tricare for the rest of her life, regardless of how long the marriage lasted — again, unless she remarries. If she does, she loses Tricare eligibility for good under that sponsor’s name.
How this applies to your specific situation: If you and your lady friend marry, she would indeed lose eligibility under her divorced husband’s Tricare for Life sponsorship. However, if you were to properly register her in the Defense Enrollment Eligibility Reporting System (DEERS) as your wife, she would then become eligible for Tricare for Life coverage under your sponsorship. If you die before her, but are still married at the time of your death, she would remain eligible for Tricare under your sponsorship. Regardless of how long you had been married, the 20-year rule would not apply if the marriage was still intact at the time of your death. But again, she would lose her coverage under your sponsorship if she were to remarry again.
If you and your lady friend do marry, your first step should be to contact the DEERS support office toll-free at 1-800-538-9552 to get started on registering her for Tricare coverage.
What do we pay when one spouse switches from Prime to TFL?
March 21st, 2012 | TriCare Help | Posted by Military Times
I will turn 65 in 2014. My husband won’t turn 65 until 2021. I know I must sign up for Medicare Part B at $99.90 per month and will enroll in Tricare for Life. Will I have to continue to pay the annual Tricare Prime fee at the family rate so my spouse will still be covered until he reaches 65? And once he can get Tricare for Life, will we each have to pay $99.90 per month?
Once you become eligible for Tricare for Life, your spouse can continue in Tricare Prime, and you should be able to shift from the family rate to the individual rate for him. Once your spouse turns 65, you will both have to pay the monthly Medicare part B premium; that cost is a standard rate per individual.
For the most definitive response to these kinds of eligibility questions, you should contact the Defense Enrollment Eligibility Reporting System (DEERS) support office, toll-free, at 1-800-538-9552.
Can new wife use Tricare with other insurance?
February 25th, 2012 | TriCare Help | Posted by Military Times
I am in the Army, active duty, and I recently got married. My wife has health insurance through the college she attends. Is there any way she can cancel that and go with Tricare? She paid for the year through September, so that’s about $900 of insurance she doesnt want to use. Any advice? Can I enroll her with two insurances?
Whether you wife can cancel her other health insurance and get a refund is strictly a matter between her and the other plan. Tricare has nothing to do with it.
She can retain the other plan just as it is now and use Tricare as second payer. That is, she must file all claims with the other plan first. Then, when it has paid its maximum, she can file a claim with Tricare which will usually pay the other plan’s deductible and copayment. Tricare makes a good supplement for the other plan in that case, because Tricare Standard is free.
Here’s how she can file a claim with Tricare after filing with the first insurance:
- Complete a Tricare claim form DD2642.
- Attach a copy of the same itemized bill that was sent to the other plan.
- Attach a copy of the other plan’s EOB reporting its processing of each of the charges on that bill.
- Send the claim to the proper Tricare claims processor for where you live.
Do we both have to pay for Medicare Part B?
February 22nd, 2012 | TriCare Help | Posted by Military Times
I retired from the Air Force in 1996. Next month I will turn 65. Since my retirement I have been enrolled in Tricare Prime. I recently signed up for Medicare including Medicare Part B. I was told I will now have to pay Medicare premiums of $99.90 per month. Is this true? My wife will turn 65 in April. Will we have to pay an additional $99.90 per month for her coverage or is the premium per family?
The Tricare plan called Tricare for Life consists of the combination of Medicare Part A and Part B coverage, plus complete coverage by Tricare Standard. Tricare Standard acts as a free Medicare supplement and pays for most of the things Medicare does not cover – at no additional cost to you.
The total cost to the beneficiary for TFL is the monthly premium for Medicare Part B. The other two parts of TFL, Medicare Part A and Tricare Standard, are free. Note that you will no longer have to pay the Tricare Prime enrollment fees.
Like all Medicare Part B beneficiaries, your wife, also, will have to pay its monthly premium.
How soon may wife use Tricare Prime?
February 17th, 2012 | TriCare Help | Posted by Military Times
I am retired Air Force and I just got married. I want to enroll my wife in the Defense Enrollment Eligibility Reporting System so she can be covered under my Tricare Prime, since we live near a military hospital that accepts military retirees for care. How long after enrollment in DEERS will my wife need to wait for benefits?
Your wife’s Tricare coverage became effective on the same day as you were married. For her to use Tricare, however, you must enroll her in DEERS and get her a military ID card. She can use Tricare as soon as her DEERS registration is complete. See your personnel section for help to do those things.
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.