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.
Do we still need Tricare Prime Plus under Tricare for Life?
January 25th, 2012 | TriCare Help | Posted by Military Times
My wife and I just qualified for Medicare and Tricare for Life. We were both enrolled in Tricare Prime. We are also enrolled in Tricare Prime Plus at a military treatment facility. Do we need to continue paying the annual enrollment fee to use Tricare Prime Plus?
If a person is enrolled in Tricare Prime when they become eligible for Medicare and Tricare for Life, his or her Prime enrollment is terminated. On the effective date of Medicare coverage, it is automatically changed to Tricare Standard, which becomes a free supplement to Medicare. The person is no longer eligible for Tricare Prime. He no longer has priority access to free care at a military hospital, and any Tricare Prime enrollment fees paid in advance are lost; they cannot be refunded.
Would I still have Tricare for Life after husband’s death?
January 16th, 2012 | TriCare Help | Posted by Military Times
I have been married to a retired Army man for six years. He has Tricare for Life, and since I have a DEERS ID card and Medicare parts A and B I know I am eligible for it too. If my husband dies before me, will I still be eligible for TFL, or would I have to be married to him for 20 years?
Your husband’s death would have no effect on your Tricare or Tricare for Life eligibility if he should predecease you. The duration of the marriage is not a factor.
The only exception would be if you remarry. In that case, you would immediately lose all Tricare eligibility under his sponsorship. That eligibility could not be restored even if the second marriage were terminated by divorce or the death of your second husband.
Please confirm the above by calling the DEERS Support Office, toll-free, at 1-800-538-9552.
Will Tricare cover my second PSA test?
January 9th, 2012 | TriCare Help | Posted by Military Times
I am 66 and have Tricare for Life. Medicare covers only one PSA test a year. I just had a PSA test and it was high. The biopsy showed cancer. They are going to remove the prostate. After 3 months I am going to need another PSA to see if they got it all. Will tricare cover the test?
Federal law requires Tricare to always be last payer to all other coverage. Claims must always be submitted to any other coverage first.
Under Tricare for Life, Medicare has become your primary health insurance. All claims must be filed with Medicare first. Tricare is second payer on all claims.
When a medical service is covered by both Medicare and by Tricare, Tricare will act as your free Medicare supplement and will pay whatever Medicare did not pay.
It is important for you and your providers to understand that, regardless of whether or not Medicare will cover the second test, all claims for the second test still must be submitted to Medicare first. That is true even if Medicare will deny payment on that claim.
If you diagnosis is made a part of your Medicare claim, I feel certain that it will be paid. Regardless of whether Medicare covers the second PSA or not, Tricare will cover it if the claim, including your diagnosis, is submitted properly to Medicare first.
Even if Medicare denies payment, it will still forward the claim to Tricare just as it always does. That’s the way Tricare for Life works.
Beware rumors: Tricare for Life is not being shut down in 2012
January 2nd, 2012 | TriCare Help | Posted by Military Times
I just heard from a friend that TFL will not be granted to anyone not already enrolled after Oct. 1, 2012. Is there any truth to that?
In a word, no.
I understand your concerns. There is a lot of insecurity right now, and more than a few people feel that they can’t trust their government and their elected officials. But, you have to be careful about whom to believe. Most of those who say the sky is falling have a few wires crossed.
Remember, creating Tricare for Life took an act of Congress. Congress had to write, and pass, a special amendment to the law that governs Tricare. Only Congress can create or change a federal law.
At this time, there are nearly 10 million Tricare beneficiaries. If a there were a major change in federal law to curtail their benefits, it wouldn’t be a rumor passed by word of mouth – it would be in every newspaper an on every TV channel in the country.
And there is no planned termination or major change to TFL eligibility. There may be changes or adjustments due to changing situations, but not of the scope you were told.
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.
Do we also need Medicare Advantage Plan coverage?
December 21st, 2011 | TriCare Help | Posted by Military Times
My wife and I have Tricare for Life and Medicare Parts A and B. I keep seeing commercials for Medicare Advantage Plans. Should we get one of those as a backup?
Don’t be seduced by ads for Medicare Advantage Plans. Those ads are written for civilians who don’t have two full-service insurance plans, as you and your wife have under TFL. Most of the extras, if not all of them, are yours through Tricare Standard which comes free with TFL. Under TFL, Tricare Standard acts as a free Medicare supplement.
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.
Why are Medicare and Tricare telling me opposite things?
December 7th, 2011 | TriCare Help | Posted by Military Times
My employer provides a Medicare-approved health insurance policy. I’ll be 65 soon, and Medicare tells me I don’t have to enroll in Part B as long as I continue to work for that company. On the other hand, Tricare tells me I must enroll in Part B as soon as I turn 65 and get Medicare. Two government health insurance plans are telling me exactly opposite things, and both say they are right. I’m caught in the middle. Can you help me?
Both Medicare and Tricare are correct in what they told you. They are talking about different rules that exist for unrelated purposes.
Both rules concern requirements for Medicare Part B enrollment.
One of the two is a Medicare rule concerning a penalty for late enrollment in Part B after becoming entitled to Part A. The rule says you may delay Part B enrollment in some circumstances. You hear about this rule from Medicare.
The other is a Tricare rule. It concerns the federal law requiring Part B enrollment when you become eligible for Part A entitlement in order to retain Tricare eligibility. The Tricare rule says you must enroll in Part B “now.” You hear about this rule from Tricare. (It does not apply to active-duty family members.)
Under the Medicare rule, those who become entitled to Medicare Part A have a grace period during which they must enroll in Part B or face a penalty that increases their Part B premiums for the rest of their lives. The penalty adds 10 percent to the Part B premium for each year someone delays Part B enrollment after becoming entitled to Part A. However, there is a situation in which Medicare can waive that late-enrollment penalty.
Some companies sponsor health insurance and even pay a part of the employee’s insurance premium. If Medicare determines that the company’s insurance plan provides benefits that are at least as good as Medicare’s, it is called a creditable plan.
The Medicare rule says employees enrolled in an employer’s creditable plan can delay enrolling in Part B without penalty as long as they work for that employer.
Once they leave that employer, they have a grace period during which they must enroll in Part B to escape the late-enrollment penalty.
Nothing in this Medicare rule applies to Tricare; the Tricare rule is quite different.
The law that governs Tricare has a provision to the effect that a Tricare beneficiary who becomes entitled to Medicare Part A must be enrolled in Part B to retain Tricare eligibility.
Tricare beneficiaries who become entitled to Medicare Part A must be enrolled in Part B or lose all Tricare eligibility until they are enrolled in Part B.
Shortly before your Medicare entitlement becomes effective, you’ll get a letter advising you of your Medicare award. It will contain a Medicare ID card showing that you are enrolled in Part A and Part B. At that point, you’re a Medicare beneficiary.
In the same packet, you will receive a form allowing you to opt out of Part B. I strongly recommend that you do not opt out; if you do, you will find yourself with no Tricare benefits of any kind.