Between VA and Tricare for Life, I think I’m paying too much
May 24th, 2012 | TriCare Help | Posted by Military Times
I am a retiree enrolled in Medicare Parts A and B, and I also have Tricare For Life. I do not use Medicare; instead, I use a VA Medical Center near my home. I an in VA enrollment priority category 8, the lowest priority, so I am billed co-payments for my visits. The VA hospital will not bill TFL and as a result I’m not receiving any benefits from my TFL, even though I am paying $100 a month in premiums for Medicare Part B, which I need to be eligible for TFL. VA hospitals in other parts of the country do bill TFL. Mine won’t do it because they say they have no Tricare agreement. I don’t think it’s fair that I have these co-pays.
As you note, in certain areas of the country, VA medical facilities may become authorized Tricare network health care providers. But there is no requirement for a VA facility to do that. However, I believe the reason you were given for having to pay costs shares – that your particular VA facility is not part of a Tricare agreement – is incorrect. According to the Veterans Health Administration Handbook, TFL-eligible beneficiaries using VA medical facilities may receive all Tricare covered services, but VA services provided through TFL are always subject to cost-sharing requirements, such as applicable annual deductibles and cost shares.
“The amount of the required cost-share payment assessed to the DoD TFL beneficiary depends on the status of the VA facility as a Tricare network or non-network health care provider,” but VA cannot, in either instance, waive TFL beneficiary out-of-pocket cost shares, the handbook states. In other words, the co-pay may vary depending on the VA facility’s Tricare status, but there would be some co-pay either way. Here is the relevant section of the VHA Handbook.
All that said, I don’t think it’s fair to say that you’re getting no benefit from TFL. While you may have co-pays, those charges are far lower than the actual costs of the medical services you receive through your VA facility. What you’re not getting any benefit from is Medicare, for which you are paying $100 a month in Part B premiums. Since you are in VA’s Category 8, the lowest-priority category for care, and are already paying for Medicare Part B, you may want to consider simply using Tricare For Life. To do that, you need to find a Medicare provider. Under TFL, in most cases, Tricare will pay for whatever Medicare does not, fully covering your medical costs on the vast majority of your claims.
If I already have Medicare at 60, can I start using Tricare for Life?
May 22nd, 2012 | TriCare Help | Posted by Military Times
I am a “gray area” Army Reserve retiree. My wife and I are both on Medicare. I will soon turn 60 years old. Can we purchase Tricare For Life at that time?
Military retirees become eligible for Tricare For Life when they become eligible for Medicare. In the vast majority of cases, that happens at age 65. However, people with certain disabilities may qualify for Medicare earlier than age 65, which is apparently the case for you and your wife.
The basic eligibility requirement of Tricare For Life is that beneficiaries be enrolled in Medicare Parts A and B. The fact that you and your wife are already on Medicare means that when you cross the initial threshold to become eligible for military health care as a retired reservist at age 60, you will also become eligible for Tricare For Life at that time.
There is no need to “purchase” TFL coverage; the program charges no enrollment fees or deductibles. However, in addition to your Medicare Part B premiums of about $100 a month, retirees also pay some out-of-pocket costs for prescription drugs under TFL.
A couple of months before you reach your 60th birthday, I suggest you call the Defense Enrollment Eligibility Reporting System (DEERS) support office at 1-800-538-9552 and tell them about your imminent change in status. They will help set you up to use TFL.
Could mother still be eligible for Tricare for Life?
May 14th, 2012 | TriCare Help | Posted by Military Times
My mother got CHAMPUS through her second husband. He died in the 1990s, and she became eligible for Tricare as his widow. A few years later she got Medicare, and they canceled her military insurance. An officer friend thinks Tricare was wrong to cancel her insurance. Could she still be eligible?
It sounds like your mother turned 65, became entitled to Medicare, and thus, lost her Tricare eligibility prior to October 1, 2001, when Congress created Tricare for Life.
The best way for her to find out if she is still eligible is to call the Defense Enrollment Eligibility Reporting Service at 1-800-538-9552. They can explain to her exactly how the Tricare eligibility rules apply in her case.
Do Tricare benefits kick in at age 60 or 65?
May 11th, 2012 | TriCare Help | Posted by Military Times
You have said that retired reservists can begin receiving Tricare benefits at age 60. When I retired I was informed that the health benefits are free when you are eligible for Medicare at age 65. Which is correct?
Both statements are correct; you’re talking about two different things. When retirement-qualified reservists reach age 60, they become eligible for military health care benefits in the form of Tricare Prime or Tricare Standard. Tricare Prime charges an annual enrollment fee of $230 for an individual and $460 for a family for those enrolled before Oct. 1, 2011, and $260 for an individual and $520 for families for those enrolled after that date. Prime has no annual deductibles. Tricare Standard does not charge an annual enrollment fee, but retirees must pay annual deductibles of $150 for an individual and $300 for a family.
When retirees reach age 65 and become eligible for Medicare, they transition to the program known as Tricare for Life. At the moment, TFL charges no enrollment fees or deductibles, but the program does require retirees to have Medicare Part B, which carries a premium of about $100 a month.
Retirees also pay some out-of-pocket costs for prescription drugs under all Tricare programs.
Will Tricare cover glasses for macular degeneration?
May 2nd, 2012 | TriCare Help | Posted by Military Times
I am writing for my father, a retired World War II vet. He wants to know whether Tricare for Life will pay for glasses since he has macular degeneration. Would he be covered?
I wish I had better news for you. Tricare’s benefits are determined by federal law, which specifically excludes eyeglasses and contact lenses from its benefit, with one exception. One pair of spectacles will be covered following cataract surgery to remove the eye’s natural lens and the placement of an approved artificial lens.
If surgery is covered, why did the hospital send a bill?
May 1st, 2012 | TriCare Help | Posted by Military Times
My father is retired Air Force and just recently had retinal re-attachment surgery. He has Medicare as well as Tricare for Life, so I don’t understand why he received a bill from the hospital for over $300. Does Tricare not cover the surgery?
Ordinarily there should be no unpaid balance under Tricare for Life; the combination of payments by Medicare (primary coverage) plus those by Tricare should have paid the Medicare claim and all providers’ bills in full.
The balance most likely results from an error in the way the Medicare claim was filed or processed.
Your father will need to research the matter by comparing the itemized bills for the balance with the explanations of benefits from Medicare and Tricare. He can find contact information for help on the Tricare website.
Do I need Part D when I turn 65?
April 26th, 2012 | TriCare Help | Posted by Military Times
I am a Navy retiree who will turn 65 next year. Like many of your readers, I understand the basics of Tricare, and what it does and does not cover. What I have never seen addressed is “Part D,” or coverage for prescriptions. Can you briefly address that?
Our Tricare Help column has addressed that topic a number of times in the past. But Part D is not a Tricare program — it’s the prescription drug program under Medicare. The consistent advice from the Defense Department’s Office of Health Affairs is that virtually no one who is eligible for Tricare for Life — which you will be when you turn 65 — needs Medicare Part D prescription drug coverage.
Out-of-pocket co-pays for prescription drugs under Part D are usually higher than under Tricare for Life. Moreover, enrollment in Part D will preclude your use of the Tricare Mail Order Pharmacy program, under which you can get a 90-day supply of drugs for the same price that you would pay for a 30-day supply from a local retail pharmacy.
The Defense Department advises that the only people who may benefit from Part D coverage are those whose incomes are so low that they qualify for financial aid to pay their Medicare Part B premiums.
Can veteran dump inferior plan and go with Tricare instead?
April 23rd, 2012 | TriCare Help | Posted by Military Times
I have a friend who is an aging, retired Army colonel. After his long military service, he worked in the legal department of an insurance company from which he is also now retired – with truly lousy retirement benefits. My wife and I told him about the benefits we get from Medicare and Tricare For Life. Can he “renounce” that other retirement health plan that has such skimpy benefits, and enroll in Tricare For Life?
The short answer is yes, your friend can give up his current plan and use Tricare for Life. Not only can he do that, he should do that.
As with any health care plan, Tricare has complex rules that can sometimes be frustrating to deal with. But there is no question that Tricare provides robust health care coverage and is one of the lowest-cost health care plans in the nation, particularly for Medicare-eligible beneficiaries over age 65.
As you mentioned, for Medicare-eligible military retirees, Tricare For Life acts as a virtually free supplement to Medicare (although as many retirees are quick to point out, TFL is not entirely free, since you must be enrolled in Medicare Part B, and paying the monthly Part B premiums, to be eligible for TFL).
Moreover, TFL beneficiaries can take advantage of the Tricare Mail Order Pharmacy program, under which they can receive a 90-day supply of drugs for the same price of a 30-day supply obtained at local retail pharmacies.
There’s one potential wrinkle in your friend’s case: You don’t say exactly how old he is, but you indicate that he is over age 65. If he did not sign up for Medicare when he first became eligible at age 65, he will have to pay a penalty to enroll late in Medicare Part B. The penalty adds 10 percent to the Part B premium for each year that the individual delayed Part B enrollment after becoming entitled to Part A, and that penalty must be paid for life.
Your friend should contact the Defense Enrollment Eligibility Reporting System (DEERS) support office at toll-free 1-800-538-9552 for more information and to get started on registering for TFL.
Can I use TFL outside the U.S.?
April 19th, 2012 | TriCare Help | Posted by Military Times
How does a Tricare for Life beneficiary get reimbursed for hospital and doctor bills when traveling outside the continental U.S.?
From the moment you leave U.S. territory, you will have no coverage by the Medicare portion of Tricare for Life. Federal law does not allow Medicare to pay for foreign medical care. Your only coverage will be Tricare for any medical care received outside the US and its territories.
Thus, you must carefully save copies of all medical bills, receipts, doctors’ statements, prescriptions, and the like until you return home. You will need them at that time to file Tricare claims.
I’m on Tricare for Life, but my doctor won’t take Medicare
April 11th, 2012 | TriCare Help | Posted by Military Times
I am going to get Medicare and Tricare for Life soon. The problem is that the doctor I have used for several years does not take Medicare. I don’t want to change doctors if I can help it. Is there anything I can do?
Medicare cannot pay for any services received from a health care provider who has opted out of the Medicare program. Although you can continue to use his services, you could not receive any payment from Medicare for his services.
You could file a Tricare claim. Tricare can calculate the amounts it would have paid if Medicare had paid the doctor’s claim. Tricare will pay you that amount only. At the most, that would be the amounts the Medicare copayment and Medicare deductibles would have been.
Unless you can persuade your doctor to become a Medicare provider, your dollar-wisest choice will probably be to change physicians.
If you will contact your Tricare Service Center, you can get a list of Medicare providers in your area. That will help if you decide to change physicians.