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.
Married to a brand-new service member: How do I enroll?
July 18th, 2011 | TriCare Help | Posted by Military Times
Q. My husband left last week for Navy Basic Training, and I was wondering if I’m eligible to be on his health insurance plan as a dependent spouse. Neither of us knows what to do to enroll me.
Your husband is responsible for enrolling his family for military benefits, including Tricare. Tell him to go to his Military Personnel Section ASAP to do that. That office will know everything that needs to be done. Until you are properly enrolled in the program, please save copies of all your medical bills and copies of any other documents pertaining to your medical care. You will need that information to file Tricare claims when you are enrolled. You became eligible for Tricare on the first day your husband entered active duty.
In the meantime, both of you need to start learning about your Tricare plan. Depending on where you live, you will be able to enroll in either Tricare Standard or Tricare Prime. If you will live on or very near a military facility (it is not required that it be a Navy facility), your best option is probably Tricare Prime because (1) it is the least expensive for you; and, (2) it allows you to have priority access to a nearby military hospital to get free medical care.
If you live more than 40 miles from a military hospital, or if it would be difficult for you to get there for care, your other option is Tricare Standard. Under Standard, you will get care from Tricare-authorized civilian doctors and hospitals. I strongly advise those who are enrolled in Standard to consider buying a Tricare supplement from one of the retired military associations. A supplement will pay most or all of what Tricare does not. Usually that will be your Tricare deductible and copayment.
You must get any civilian medical care from Tricare-authorized providers only — those who are registered with Tricare and are authorized to be paid by Tricare for medical care rendered to Tricare beneficiaries. Tricare cannot pay for care received from a provider that is not Tricare-authorized.
If your doctor or other provider is not Tricare-authorized and wants to become an authorized provider, tell him that Tricare.mil maintains an entire section to inform providers about the program. There, the provider can learn about Tricare authorization, Tricare coverage, and how Tricare pays providers.
What happens if my husband passes away?
April 26th, 2011 | TriCare Help | Posted by Military Times
Q. My husband retired from the Air Force in 1995 and immediately started another career with a firm with great benefits. As a result, we did not enroll in Tricare Prime and have used Tricare as our secondary insurance in only a handful of situations. Now he is losing his battle with cancer and will soon die. At that time, I will lose all my health benefits. Since I am only 60, I will not qualify for Medicare for several more years.
My question is: How do I enroll in Tricare Prime? Who should I contact and what documentation will I need?
As a widow, you will retain your eligibility for Tricare for the rest of your life unless you remarry. If you remarry, you will forever lose your eligibility under your present husband’s sponsorship, even if the second marriage ends by death or divorce.
From the present time until you become entitled to Medicare at age 65, you can be enrolled in either Tricare Standard or Tricare Prime. Tricare Prime is not available everywhere, however. It is usually available only within a 40-50 mile radius of a military hospital.
When you become entitled to Medicare at age 65, you will become eligible for Tricare for Life. Tricare for Life, or TFL, is a Tricare plan that combines the full benefits of Medicare Part A and Part B with the full benefits of Tricare Standard. Tricare Standard will act as a free Medicare supplement for the rest of your life. Tricare for Life members are not eligible for Tricare Prime. They must be enrolled in Tricare Standard as their companion to Medicare under Tricare for Life.
In the meantime, for official information about Tricare eligibility for widows, and for guidance about becoming enrolled in Tricare Standard or Tricare Prime, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Remarrying after retirement: Will new wife get Tricare?
April 11th, 2011 | TriCare Help | Posted by Military Times
Q. I plan to retire soon. I have over 20 years of active-duty service and am divorced. If I remarry after I retire, will my spouse be eligible for Tricare?
Your new wife will become legally eligible for Tricare the moment you kiss the bride.
Before she can use Tricare, however, you have to contact your Personnel Section to get her registered in DEERS and have a military ID card issued to her.
I strongly suggest that you teach her the ropes about DEERS, ID cards, and Tricare. Once you decide whether to enroll her in Tricare Standard or Tricare Prime, call your regional Tricare Service Center and request a free Handbook for the plan she is enrolled in. If she will be living with you near a military hospital, Tricare Prime is the recommended plan.
For answers to any questions about Tricare eligibility that your Personnel Section can’t answer properly, please call the DEERS Support Office, toll-free, at 1-800-538-9552. DEERS can’t help you with information about the Tricare program or your wife’s Tricare claims. DEERS deals with eligibility issues only.
For program or claims questions or problems, call your regional Tricare Service Center.
Doctor says she will stop taking Medicare – and Tricare
March 18th, 2011 | TriCare Help | Posted by Military Times
Q. My wife is 60 and enrolled in Tricare Prime. Her doctor has recently notified her that she will soon stop seeing Medicare patients, and since the law requires that if she accepts Tricare she must also accept Medicare, she will also stop seeing her Tricare patients. One option is to find another doctor in the Prime network. My wife prefers to stay with her doctor, who offered the option of continuing to see her if we pay her out of pocket for her services. Can we switch to Tricare Standard, pay out of pocket, and file for reimbursement from Standard without invoking the link between Tricare and Medicare? Would the doctor be limited by Tricare billing/reimbursement limits? Or would we be denied Tricare reimbursement because the doctor wants nothing to do with Medicare?
I believe your wife’s doctor is confused about the requirements of law regarding Medicare and Tricare participation. I believe the law she is thinking of is the one that requires hospitals that accept Medicare patients to also accept Tricare patients. If we are talking about the same law, note that it applies only to hospitals. It does not apply to individual providers such as physicians. To the best of my knowledge, there is no requirement for Tricare Authorized Providers to accept Medicare patients.
There is a rule that physicians must be registered with Tricare as authorized providers. If you get medical care from a doctor who is not authorized by Tricare, Tricare cannot pay for his or her services.
It is very important for your wife’s doctor to write very soon to the Tricare Headquarters so she can get the correct information officially and learn exactly and officially where she stands. The address is Tricare Management Activity, 16401 E. Centretech Parkway. Aurora, CP 80011-9043. That office manages the Tricare Program worldwide. It is a federal agency and part of the Office of the Assistant Secretary of Defense for Health Affairs.
Just in case your doctor doesn’t want to write, then you should do it. Tell Tricare what your doctor believes and get an official answer.
Can my husband prevent me from getting Tricare?
March 17th, 2011 | TriCare Help | Posted by Military Times
I am currently separated from my husband, who is a member of the National Guard. He recently came off active duty orders, and we lost our Tricare Prime. He is signing up our two children and himself for Tricare Reserve Select but is refusing to allow me to be covered. Can he do that?
I am not an attorney, and your letter has legal implications that I am not able to address.
To the best of my knowledge, the legal spouse of an active duty, retired, or deceased uniformed service member is legally eligible for Tricare. The law that created Tricare determines eligibility, and the service member (the sponsor) has no control over the spouse’s eligibility.
I do not know, however, how that would apply in your situation when your husband is not on active duty.
I suggest that you call the DEERS Support Office for information regarding your legal eligibility for Tricare. DEERS cannot give you legal advice, but it can tell you what your rights are and it may be able to advise you how to seek legal help for your problem.
If you live near a uniformed service facility of any branch, you have the right to seek free legal assistance from its Office of the Judge Advocate General (JAG).