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.
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.
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.
Do we have to use other health insurance if it’s available?
November 22nd, 2011 | TriCare Help | Posted by Military Times
My husband has Tricare Prime. He is considering a full-time job with full benefits. If health insurance is an optional benefit, does Tricare require that he take it?
No, Tricare does not require or forbid its beneficiaries from enrolling in other health insurance. It is completely up to the beneficiary. However, if he is enrolled in other health insurance, federal law requires that he use (file claims with) that plan first.
After the other health insurance has processed the claim, paid its maximum, and issued an Explanation of Benefits, the beneficiary or the provider may file a Tricare claim for all amounts the other insurance may have left unpaid. Usually, that will be the patient’s copayment and, when applicable, the deductible. That is commonly called the “patient’s share” of the bills.
The Tricare claim must consist of:
- A properly completed Tricare Claim Form DD2642;
- A copy of exactly the same bill(s) that was/were sent to the other health insurance;
- A copy of the other insurance’s EOB reporting its actions on each of the charges on the provider’s bill.
Send the package to the proper Tricare claims processing contractor for your place of residence.
Can I still go to military doctors once I’m on Tricare for Life?
November 11th, 2011 | TriCare Help | Posted by Military Times
I will get Medicare and Tricare for Life on Dec. 1. I live near an Air Force base and have been getting most of my health care from specialists there. I know that under Tricare for Life, I need to get my care from Medicare providers, which is fine, but can they still refer me to the military doctors if necessary?
When most Tricare beneficiaries turn 65, get Medicare and are enrolled in Part B, those who were formerly enrolled in Tricare Prime are automatically transferred from Prime to Tricare Standard, which, along with Medicare, makes up your Tricare for Life coverage. If you are no longer enrolled in Prime, your access to free medical care at your local military treatment facility will likely be curtailed.
Retirees and their family members have priority access to military hospital care as a result of being enrolled in Tricare Prime. Once you are switched from Prime to Standard, you do not have the same priority access.
As there are individual differences among MTFs, however, the facility near your home may still have space and personnel available to allow non-Prime enrollees to access their services. You will need to ask the patient administration office if you can continue to use their facilities, including their pharmacies.
Is there a waiting list for Tricare for Life?
November 10th, 2011 | TriCare Help | Posted by Military Times
I am on Tricare Prime now, but I will become eligible for Medicare in January. Will I get Tricare for Life then, or is there a waiting list?
There is no waiting list for Tricare for Life. Here’s what’s supposed to happen:
Federal law requires you to be enrolled in Medicare Part B at the same time as your Medicare Part A becomes effective (on Jan. 1, according to your letter). You should receive an official Medicare identification card that states what Medicare programs you are enrolled in. It should say your Medicare Part A and Part B coverage were effective on Jan. 1.
If that is true, you have become eligible for Tricare for Life.
While all this is supposed to happen automatically, you should confirm the above by calling the DEERS Support Office, toll-free, at 1-800-538-9552. If those are not the facts, ask DEERS what is your status regarding TFL and whether DEERS reports that you are enrolled in Tricare Standard or in Tricare Prime. You will be speaking with a live person who will be able to answer all your questions. Be prepared to take notes.
Under TFL, you have full coverage by Medicare Parts A and B plus full coverage by Tricare Standard.
Parents are not eligible for Tricare
November 2nd, 2011 | TriCare Help | Posted by Military Times
A while ago, we received notice that we could get Tricare for aging parents who become our dependents or live in our residence. We have Tricare Prime. Can we add on my mother, if we decide to care for her in our home full time?
Dependent parents are not among the categories of persons who are automatically eligible for Tricare. In some cases, when dependency has been officially established through the military sponsor’s service, a dependent parent may become eligible for some level of medical care at government expense.
For official answers to questions about your parents’ Tricare or other eligibility, call DEERS at 1-800-538-9552.
Can I upgrade my Tricare Prime?
September 27th, 2011 | TriCare Help | Posted by Military Times
I am retired from the Navy and have had civilian medical insurance as my primary coverage and Tricare as secondary. I will soon be retiring again from my civilian occupation. As I am only 55 and my wife is 58, what if anything should I be looking at with regards to a supplement or an upgrade to Tricare Prime?
If you will go to the official Tricare website, you will find a description of each Tricare plan. They do not differ in the medical services they cover, only in the way you get care and amounts of your out-of-pocket expenses.
Tricare Prime, which functions in a way similar to a commercial Health Maintenance Organization, is the least expensive in that way.
There are no Tricare “upgrades” until Medicare can be added to your coverage at age 65 when you can become eligible for the Tricare plan called Tricare for Life. You can explore that plan also at the website.
Note that it is described under provisions of current law. As all Tricare plans are established by federal law, and it is not possible to determine what that plan will be like in ten years when you become eligible for Medicare. Laws are subject to change.
Most of the military associations sell a supplement for Tricare Standard, and it is likely that some also sell a Tricare Prime Supplement. You should request copies of several supplemental policies and read them carefully to determine which one best meets your needs.
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.
How does having other insurance affect my Tricare coverage?
July 25th, 2011 | TriCare Help | Posted by Military Times
I am a military spouse, and I work as a nurse, so I have Tricare as well as my employer’s insurance. My employer and the Tricare Outpatient Clinic I visit told me that Tricare would be my secondary insurance, but neither explained what that means. I continued to see my Tricare provider and they referred me to outside doctors when their own staffing was low at the military treatment facility. Triwest is now asking all providers they had previously authorized to pay them back, and sending me notices that I owe for services they authorized with these providers. They claim they did not know I had another insurance when I had previously filled out papers at the Tricare clinic when I started coverage under my employer’s plan. How does having another insurance affects my benefits through Triwest?
When a Tricare beneficiary has other health insurance, federal law requires that Tricare must always be the last payer. That means all claims for civilian medical care must be filed first with the OHI. When the OHI has paid its maximum and has issued the beneficiary an Explanation of Benefits (the report you get from an insurer showing all of its actions in paying your claim), you may file a Tricare claim.
The Tricare claim must consist of (1) a properly completed Tricare Claim Form DD2642; (2) copies of exactly the same itemized medical bills as were sent to the OHI; and, (3) a copy of the OHI’s EOB showing the way it processed (paid or denied) each of the charges on the medical bills. You must send the completed package to the Tricare claims processor for your state or ZIP code.
(You can download official claim forms and look up the filing address here.)
As last payer, Tricare will pay all, or most, of whatever the OHI did not pay for the medical services on the bills.
You didn’t mention if you have Tricare Standard or Tricare Prime. Tricare Standard is free; Tricare Prime costs $230 per year for one person, or a maximum of $460 for a family of two or more people.
Your mention of using a military treatment facility leads me to think you have Tricare Prime. Unlike Tricare Standard, Tricare Prime functions like a Health Maintenance Organization (HMO). You may use only the health care providers that are enrolled in Tricare Prime’s Provider Network unless you are referred to other providers by Tricare Prime. According to your letter, that was the case with your medical care.
As you report, Tricare is requesting that you refund its payments made in error. According to the information in your letter, Tricare paid in error because you failed to report that you had OHI, and did not file first with the OHI as required by law. No, the cops are not going to come knocking on your door.
But, you do have some problems with having to return payments made in error by Tricare. Pursuant to that, you need more help than Tricare Help can give you.
Please write to the Tricare Headquarters about this matter. The address is Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043.
With your letter, please explain the problem in detail, include your full name as it appears on your military ID card, your husband’s name and his Social Security number, and a telephone number where you can be reached during the day. Include copies of any correspondence, bills, EOBs, and the like, that pertain to the problem. The more information you can provide, the more efficiently Tricare can serve you.