Why can’t I ‘turn off’ daughter’s Tricare eligibility?
June 24th, 2011 | TriCare Help | Posted by Military Times
Q. I am retired and my daughter is 18 years old. We are estranged through divorce. She has medical insurance in Ohio, but her claims are being denied because she is eligible for (but not enrolled in) Tricare. How can I make her ineligible for Tricare so she can move on to other insurance? There has to be a mechanism to turn this off.
By federal law, free Tricare benefits flow directly to the beneficiary as a result of the military sponsor’s service. The sponsor does not have the authority to cancel or otherwise affect her Tricare eligibility. Her use of Tricare would not involve you in any way.
If your daughter is unmarried and meets all eligibility requirements, and if she were properly registered in DEERS and with your service, Tricare Standard would act as a free supplement to any commercial insurance, paying all, or most, of what that policy does not pay, such as its deductibles and copayments. Tricare is always last payer to all other health insurance.
Please contact the Defense Enrollment Eligibility Reporting System (DEERS) for an official response to your question, and guidance regarding possible actions, at 1-800-538-9552. DEERS is a federal agency under the auspices of the Defense Department.
How can I find a doctor who will take TFL?
May 27th, 2011 | TriCare Help | Posted by Military Times
Q. I am switching my coverage from Tricare to Tricare for Life (I have enrolled in Medicare Parts A and B), but I can’t find a doctor who says he will take Tricare for Life. Where can I find a list of doctors who will accept TFL?
Once your Medicare coverage becomes effective, usually on the first day of the month you turn 65, you must seek all your medical care from Medicare providers, or it won’t be covered. When you call for an initial appointment, tell the provider you are a Medicare beneficiary. The Medicare claim form asks for the name of your secondary health insurance or Medicare supplement. Write “Tricare.” Do not mention TFL because most providers will not know what that is. Under TFL, however, Tricare Standard will act as your free Medicare supplement.
For every medical service on your Medicare claim that is covered by both Medicare and by Tricare, Tricare Standard will pay whatever Medicare did not pay. Thus, when both Medicare and Tricare cover a medical service, their combined payments will pay the Medicare claim and the provider’s bill in full.
If you receive medical care that is covered by Medicare or by Tricare, but not by both, you must pay that plan’s copayment and deductible yourself. Such claims will be fairly rare. The vast majority of your Medicare claims will be for medical services that are covered by both Medicare and by Tricare.
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.
Why can’t wife get TFL when I do?
April 22nd, 2011 | TriCare Help | Posted by Military Times
Q. My wife has Tricare as a direct result of my wartime military service. Her eligibility is carried in DEERS under my Social Security number, not hers. By the same token, therefore, when I get Medicare and Tricare for Life, should she not get it at the same time although she is only 59?
There are circumstances in which one spouse’s Medicare entitlement confers entitlement on the other spouse, but your circumstances don’t qualify for that purpose. Your wife must meet all the requirements for Medicare entitlement established by federal law.
Additionally, to be eligible for Tricare for Life, your wife must be eligible for Tricare, be legally entitled to free Medicare Part A, be enrolled and have Medicare Part A and Part B in effect, and have her DEERS registration correct and current.
Until she meets those requirements, probably when she gets Medicare at age 65, your wife’s Tricare eligibility most likely will continue as it is at present.
To confirm those rules, and for official answers to all questions about Tricare eligibility, please call the DEERS support office at 800-538-9552.
It’s important to note that the rules for Tricare eligibility are established by law; DEERS does not have the authority to change them or to make exceptions.
For official information about the requirements for your wife’s Medicare entitlement, please contact the Social Security Administration.
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.
With TFL, do we really need a supplemental?
April 4th, 2011 | TriCare Help | Posted by Military Times
My spouse and I are both retired military, on Social Security, and we have Medicare Part B and Tricare for Life. For several years we have had a supplemental policy from United Health. But if we have TFL and Part B, do we really need the insurance from United? We wonder if we are paying for something that is already available from TFL.
Nobody but you can decide what health insurance coverage you need. I cannot make that decision for you. But I can tell you the facts about what Tricare for Life offers.
TFL consists of full coverage of all the benefits of Medicare Part A and Part B, plus the full benefits of Tricare Standard without additional cost.
Under TFL, you have full coverage provided by Medicare Part A and Part B. In addition, and as second payer, you have full coverage by Tricare Standard (which is free). Thus, with TFL you have full coverage by two full-service, stand-alone health insurance plans. Either of those plans, by itself, would provide adequate health insurance for an average person’s needs.
Thousands of people have Medicare Parts A and B, or Tricare Standard as their only health insurance. If only one of those is their only coverage, a good supplemental plan to pay the primary plan’s deductibles and copayments is advisable.
Only you can decide whether if, in addition to two full service plans, you need yet another health insurance plan to feel secure in your coverage.
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 I switch kids to Tricare Prime against ex-wife’s wishes?
March 10th, 2011 | TriCare Help | Posted by Military Times
Q. I am active duty and recently divorced. Our separation agreement states that I am to provide health insurance for my minor children. I am also to pay 80 percent of out-of-pocket expenses. The children live with their mother in a Tricare Prime eligible location. At the time of divorce they were enrolled in Tricare standard, and my ex-wife has been seeking treatment for them at non-network providers even though there are other options, leaving me with extreme medical bills. I would like to switch the children to Tricare Prime, since it is available. Neither my separation agreement or divorce decree mandate that the children must remain on Tricare standard, all it says is that I am to provide health insurance. Can I switch the children to Tricare Prime, even against my ex-wife’s wishes? Also she refuses to provide me with any current medical updates on the children, just receipts. Can I legally contact the physicians treating my children for medical updates once they are treated in a military facility? I would like to see my children get the best care possible and feel that being enrolled in Prime, and treated at a nearby military facility would be in their best interest.
By federal law, your children will be eligible for Tricare until they marry or turn 21 years old. They are automatically eligible for Tricare Standard, or you can enroll them in Tricare Prime if they live in an area where Prime is available. For them to use Tricare, however, you must register them with your uniformed service. Because your wife is no longer eligible for Tricare, each child must have his/her own uniformed service identification card which only your service can issue. I suggest that you talk with your Personnel Section as soon as possible.
In order for Tricare to pay any part of their medical care, they must see a Tricare-authorized provider. An authorized provider is one who is registered with Tricare and is authorized to be paid by Tricare for medical services rendered to a Tricare Beneficiary. To use Tricare Prime, they must go to a physician that is registered as a Tricare Prime provider.
If they get care from an unauthorized provider, Tricare cannot pay for it.
There is nothing Tricare can do to make your former wife use a proper physician. That is something your lawyer will have to take care of on your behalf. It may take a court order to make her cooperate.
Whether you can switch your children to Prime depends on whom has legal custody of the children. That is something else you must discuss with your lawyer. The same holds true for your getting any information about the children’s medical care or Tricare claims. Tricare cannot release that information to you unless you have, or share, legal custody of the children. That is because of the Privacy act. Again, talk with your lawyer.
If your lawyer needs to know anything about the laws that govern Tricare, please ask him to write a letter with his questions to the Tricare Headquarters. That address is Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. He must include with his letter the full name of each child, your full name, and your Social Security number.
When Tricare Standard becomes your primary coverage
March 4th, 2011 | TriCare Help | Posted by Military Times
Q. I am 62 years old and have been retired from the Navy for 21 years. I have worked at my current job for 18 years and have been covered by my employer’s insurance, with Tricare as my secondary insurance. Now, due to health complications, I have had to cut back on my work hours, and I no longer have my employer’s insurance. Will Tricare Standard take over as my primary insurer? If so, what do I need to do? How much will it cost? How can I get my prescriptions filled? I don’t live near a military base.
You probably already know that you must keep your DEERS registration and your military ID card up to date in order to have Tricare coverage. You can update your DEERS record by calling the DEERS Support Office, toll-free, at 1-800-538-9552. That office will also provide any guidance you need to update your ID card.
It may be, however, that you need some information about how to handle the effects of the loss of coverage by your employer’s health insurance plan. You will be told in advance when your coverage under that plan will end.
You must get an official letter from that insurance company that reports the last date that you will have coverage under that plan. That is, a report of the last date that plan will pay for your medical care. Call DEERS and ask to whom you should send a copy of that letter, together with a brief explanation of the reason the policy will be canceled — whom should you notify and when.
If you have made proper notification, DEERS and Tricare will know the last date of your other coverage. Tricare Standard will automatically become your only health insurance effective on the following day.
When Tricare Standard is your only coverage, you will become responsible for paying the $150 yearly Tricare deductible and your 25 percent cost share of the amount allowed on each Tricare claim. Otherwise, Tricare Standard is free; it has no monthly premium. All Tricare beneficiaries are automatically eligible for the Tricare Pharmacy Program at no cost other than the small copayments for drugs.
A month or two before you lose your employer’s plan, you may want to begin to research the coverage offered by one of the several Tricare supplement plans. Most of the retiree associations offer such a plan.
Write to several associations and request a copy of their Tricare supplemental policy. In that way, you can compare several to find the plan that best meets your needs. Check carefully the policy’s coverage of pre-existing conditions.
I suggest, also, that you contact the Social Security Administration to research possible coverage under the Social Security Disability Program.
If you qualify for that program, you will become eligible for Medicare after receiving disability benefits for 24 consecutive months. Otherwise, you will have to wait until you are 65 to qualify for Medicare and Tricare for Life.
Will Standard cover my cataract surgery?
February 28th, 2011 | TriCare Help | Posted by Military Times
I am supposed to have cataract surgery in May. My husband is my Tricare sponsor. I am 62 and not eligible for Medicare yet, but I have a supplemental policy. Will Tricare Standard pay for my surgery?
When medically necessary and appropriate for the particular Tricare beneficiary, the costs of surgery to remove and replace the eye’s natural lens is covered by Tricare, as is one pair of spectacles following the surgery if medically necessary in the particular case.
The fact that the procedure is an authorized benefit does not guarantee Tricare’s payment in a given case. That can be determined only after the service is performed and Tricare claims are filed.
Note that Tricare may cover the procedure only when performed by a Tricare-authorized provider. An authorized provider is one that is registered with Tricare and is approved to be paid by Tricare for covered medical services provided to Tricare beneficiaries. Tricare may not pay for any health-related services received from an unauthorized provider.