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.
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.
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.
TFL’s Medicare provider rule doesn’t apply overseas
November 14th, 2011 | TriCare Help | Posted by Military Times
You have written that “under Tricare for Life, you must get all your civilian medical care from Medicare providers only.” That’s only if you expect Medicare to pay its portion under Tricare for Life, right? I live overseas and will enroll in both Medicare Part A and Part B when the time comes, precisely so that my current Tricare Standard coverage will continue, under the name Tricare for Life. Of course, Medicare will not pay for any care received outside the U.S., so I won’t expect any reimbursement from Medicare. However, I will still be covered, as I am now, by Tricare Standard, generally getting 80 percent of covered charges reimbursed by Tricare, with essentially the same deductibles and catastrophic cap I have now — right? Or am I confused?
Indeed, if a beneficiary wants Medicare to pay any part of the bill, he must get care from Medicare providers only. True, one who lives overseas — where Medicare coverage does not exist — is not required to use Medicare providers only for his care.
You are correct that, when you become legally entitled to free Medicare Part A (usually at age 65), federal law requires you to be enrolled also in Medicare Part B in order to retain your Tricare eligibility.
Retirees who live overseas have complained for many years about the requirement to be enrolled in, and pay a monthly premium for, Medicare Part B, which they cannot use. The issue has been raised to Congress many times, but Congress has never changed, or even debated changing, that law. My understanding is that the proposal has never made it out of committee.
Your claims must be filed with Tricare Standard, and they are subject to the usual $150 Tricare fiscal year deductible and your 25 percent cost share (for retirees and their family members) of the amount allowed on the claim. They must be processed as if you did not have Medicare. A suitable Tricare supplement may be a good idea for you.
When your other health insurance is under a different name
October 31st, 2011 | TriCare Help | Posted by Military Times
I work in the airline industry and can enroll in my employer’s insurance. I also have Tricare Standard as my secondary insurance — my husband is deceased. However, the Tricare coverage is under my married name, and everything with my employer is under my maiden name. Will this cause a problem when I try to file a claim with Tricare as my secondary insurance? I need to enroll in my employer’s insurance soon.
Your problem is a simple administrative issue requiring an explanatory letter. How quickly it gets resolved depends on who gets the letter and when.
Write to your Tricare claims processing office — the same place where you submit Tricare claims — and explain the situation. Make three or four extra copies. Send the letter to the claims processor now, and send another copy with the first claim you submit to Tricare as second payer.
If it doesn’t take, you will know in a few weeks after you submit your first claim to Tricare as second payer. If your claim is denied, it isn’t a disaster; you just need to file and appeal.
If Tricare simply writes asking for more information, no appeal is needed. Just reply immediately, explaining everything again, and include a copy of the letter Tricare sent you so they know what you’re talking about.
If Tricare denies the claim, then it’s time to file an appeal. The appeal must be in writing and state the specific matter in dispute: For example, “Tricare denied claim number X because I used two different names on the claims. I have attached an explanatory letter.”
Attach a copy of the explanatory letter with the appeal letter. Include also a copy of Tricare’s explanation of benefits showing the claim denial.
Send the appeal letter, the explanatory letter, and Tricare’s EOB showing the denial to the address of the Tricare office that denied the claim. It’s on the Tricare EOB. Be sure to answer all questions Tricare asks, if any. That should resolve the name problem.
How Social Security disability affects your Tricare coverage
October 19th, 2011 | TriCare Help | Posted by Military Times
I am a 61-year-old retired Marine and have been enrolled in Tricare Prime for a number of years. Over the past few years I was treated for stage 4 neck cancer and was awarded Social Security disability that was back dated almost a year. I understand that once you are on SSD for two years you have to enroll in Medicare. I have received my Medicare card for Parts A & B that will be effective Jan. 1, 2012. Will I need to contact Tricare to discontinue my allotment for Prime, or will they receive notification from Social Security? Also, will I fall under regular Tricare or will I convert to TFL? Do I now also need to be issued a new retired military ID card before Jan. 1?
When a Tricare beneficiary becomes entitled to Medicare and is enrolled in Part B, the Social Security Administration is supposed to notify DEERS to report that fact. Sometimes supposed things do not happen. For help with any eligibility issues or problems, see below.
According to your letter, you are already enrolled in Part B although it will not become effective until Jan. 1, 2012. You can call the DEERS Support Office (DSO) toll-free, at 1-800-538-9552, to check the status of your DEERS record.
If your record has not been updated to show your Part B enrollment and the effective date, ask DEERS what action on your part is needed, if any. Ask DEERS also about your military ID card and for guidance, if needed, to renew it when time to do so.
You can contact DEERS whenever you have any questions relating to your eligibility for military benefits of any kind. DEERS deals with eligibility issues only. Although DEERS can tell you the content of laws relating to eligibility and how they affect you, it cannot provide legal advice. Contact a private attorney or a JAG office, as appropriate, if needed.
In the meantime, I suggest that you call your Tricare Prime office now and make arrangements to pay its enrollment fees on a month-to-month basis that will end automatically with the last payment to be for December 2011. In that way, you will not pay in advance for Prime coverage you cannot use after December 31, 2011. That office will provide any guidance you need about the matter.
If your DEERS record is up-to-date and accurately reports that you are enrolled in Medicare Part B, DEERS will automatically switch your Tricare plan from Prime to Tricare Standard at midnight on December 31, 2011. One second later you will become eligible for Medicare Parts A and B, Tricare Standard, and be eligible for Tricare for Life.
TFL consists of coverage by two, full-service, stand-alone, health insurance plans – Medicare Parts A and B plus Tricare Standard. Either plan, alone, will provide adequate health insurance for most people, although a supplement would be recommended, if feasible, to pay the plan’s copayment and deductible. Under TFL, your coverage will be excellent.
Medicare Part A is free. Tricare Standard is free. Medicare Part B costs a monthly premium. If you call Medicare, toll-free, at 1-800-633-4227, you can learn how much Part B will cost in 2012.
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.
What kind of plan is TFL considered to be, in relation to Medicare?
July 20th, 2011 | TriCare Help | Posted by Military Times
Q. I am trying to file an insurance claim for my mother, who has Medicare Part A & B and Tricare for Life. The form asks if she has insurance coverage other than Medicare. The options are:
- Coverage under a Medical Plan
- Medicare Supplemental Policy
Which is TFL considered to be?
You want the second option. Tricare for Life consists of coverage by Medicare parts A and B and Tricare Standard, and Tricare Standard acts as a free supplement to Medicare. Here’s a post with more details about how Medicare and Tricare Standard work together under TFL.
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.