Can I switch from VA care to Tricare?
May 7th, 2012 | TriCare Help | Posted by Military Times
I am a retiree with a 100 percent disability. I have been getting all my medical care through the VA, but they are driving me crazy with delays. Plus, the nearest VA medical center is more than 200 miles away. How can I switch from VA care to Tricare?
The primary qualifying condition for a former uniformed service member’s Tricare eligibility is entitlement to retired, retainer, or equivalent pay. Many retirees with service-connected disabilities opt for equivalent pay in the form of a pension from the Department of Veterans Affairs in lieu of retired pay from their uniformed service. The amount of the VA pension is often greater.
To determine your Tricare eligibility, contact the DEERS Support Office at (800) 538-9552. Be prepared to tell them all the appropriate dates and numbers.
My understanding of the rules regarding a transfer of your coverage from Veterans Affairs to Tricare is that it is an administrative matter that you must resolve through the Department of Veterans Affairs. There may be special circumstances due to your 100 percent disability rating.
In essence, the rules say that a beneficiary must choose whether to receive care through Veterans Affairs or Tricare, but not both, for the same medical condition.
Getting care under Tricare may be more expensive than under Veterans Affairs auspices because of Tricare’s deductible and cost shares. Unless you have a Tricare supplement, or qualify for Tricare for Life by being entitled to Medicare, you could have to pay up to $3,000 out-of-pocket each fiscal year for those items.
How do we know if we’re eligible?
January 30th, 2012 | TriCare Help | Posted by Military Times
My husband is a disabled Army vet and he cannot seem to tell me what Tricare is or if he can get it. I understand it is some kind of insurance. Could we be eligible for it?
There are two programs for which you might be eligible.
You wrote that your husband is a disabled vet. Depending on his disability rating from the Veterans Affairs Department, you may be eligible for care through the VA. If his rating is “100 percent, permanent and total,” he may qualify for free VA medical care for the rest of his life, and his wife and unmarried children under age 18 would be entitled to the program called CHAMPVA.
Alternatively, if your husband is entitled to receive retired pay, he and his family may be entitled to Tricare.
For official information regarding your husband’s Tricare eligibility, he should call the DEERS Support Office, toll-free, at 1-800-538-9552. He must call, himself. Due to provisions of the Privacy Act, that information cannot be given to another person.
Another source of public information regarding Tricare eligibility is at the official Tricare website.
Marrying a veteran who gets VA care; will I be eligible for Tricare?
October 12th, 2011 | TriCare Help | Posted by Military Times
My fiancé served 3 years active Army and 3 years Army reserves back in the 80s. Most recently he served 6 years in the National Guard and his enlistment was up last in September of 2011. He is 40 percent disabled has medical coverage from the VA. I am an independent contractor and am not eligible for employer-sponsored health insurance. When we get married, would I be eligible for any health insurance, either through Tricare or another option?
The information you provide leads me to think that your fiancé did not serve long enough in a uniformed service to be eligible for Tricare. In that case, neither would you, as his spouse, meet the legal criteria for Tricare eligibility. To confirm that, however, and for official information about your and his Tricare eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Why can’t Tricare and Medicare pay for VA care?
March 31st, 2011 | TriCare Help | Posted by Military Times
Q. I just turned 65 and am enrolled in Medicare parts A and B. Where I should go for my future medical care? I know I can use Medicare and TFL will pay second. But I have a service connected disability – glaucoma – and receive all my glaucoma-related care at the VA at no cost. Is there a benefit for me to get all my medical care from the VA? Can the VA bill Medicare and TFL?
The short answer is that TFL cannot pay for care you receive from VA. You should get most of your care from Medicare providers, and see the VA only for your glaucoma care. Here’s why.
Tricare for Life consists of full benefits under Medicare Part A and Part B as your primary insurance, plus Tricare Standard as your free Medicare supplement. You must seek all your medical care from Medicare providers first. A Medicare provider is a health care provider who is registered with Medicare and is authorized file Medicare claims for care rendered to Medicare beneficiaries.
The provider will file a Medicare claim for his services. Medicare will pay its share directly to the provider. Then, Medicare will automatically forward the claim to Tricare which will pay whatever Medicare did not for every service on the Medicare claim that is covered also by Tricare. That will usually be your Medicare copayment and, if applicable on that claim, your Medicare deductible. You will have nothing to pay on those claims. Your care will cost you nothing.
Occasionally it is possible to get a medical service that is covered only by Medicare or only by Tricare. In those cases, the other plan will pay nothing, and you will have to pay any copayments or deductibles for the plan that does pay. That kind of claim is not common. The vast majority of your Medicare claims will be paid in full by the combination of Medicare’s plus Tricare’s payments.
The VA will usually charge you for medical care it provides for non-service connected conditions. In those cases, you will have to pay what the VA does not, because the VA cannot file claims with Medicare and not usually with Tricare. You are better off getting all care from Medicare except the free care for your service-connected condition.
Not all providers will see Medicare patients. When you call for an initial appointment, always tell them that you are a Medicare beneficiary and ask whether the provider sees new Medicare patients. Do not say that you have Tricare for Life. Most providers won’t know what that program is or how it works.
If they ask whether you have other health insurance or a Medicare supplement, tell them it is Tricare. With that information on the Medicare claim form, Medicare will know to automatically forward the claim to Tricare as second payer.
Related: Can Tricare cover me at VA center?
Can Tricare cover me at VA center?
March 28th, 2011 | TriCare Help | Posted by Military Times
I am a retired 30-year Army veteran covered by Tricare for Life. There is a VA Health Care Center near my home. Am I eligible to use that facility, and would it cost me anything? I do not have any service-connected injuries or disabilities.
Your eligibility for medical care from the Department of Veterans Affairs, and the conditions under which care is provided, is subject to rules established by federal law for that agency. It is not related to Tricare in any way.
My understanding is that free care will be provided by Veterans Affairs only for certain service-connected conditions. I believe there is a charge for all other medical services, and claims may not be filed with Medicare or with Tricare for those charges.
The exceptions are only in the case of a certain few VA Medical Centers that have been specifically and individually designated as Tricare-authorized providers. Call the medical center to find that out before you get any care there.
I’m on VA disability – does Tricare have a role?
December 9th, 2010 | TriCare Help | Posted by Military Times
Q. I served in the Army from 1966 to 1969 and received an honorable discharge. In August of this year, I was given a 100 percent service-connected disability rating for prostate cancer linked to exposure to Agent Orange. I have been issued a Department of Defense Uniformed Services ID card. Am I eligible for participation in Tricare?
If you have a 100 percent, permanent and total, service-connected disability, the Department of Veterans Affairs should provide for all your medical care without cost to you.
Tricare should not be involved unless you were medically retired from the service and are entitled to retired or equivalent pay.
As Tricare eligibility is a matter of federal law, however, I will not comment further about it.
Please call the DEERS Support Office, toll-free, at 1-800-538-9552 to inquire about your Tricare eligibility. DEERS deals with eligibility issues only. They will tell you what to do if you are eligible for Tricare. If you are not eligible for Tricare, you need to contact the Department of Veterans Affairs for more information about your status with VA.
Can I just stick with VA care?
August 4th, 2010 | TriCare Help | Posted by Military Times
Q. I retired from the Army with 50 percent disability and the VA handles all of my medical care and medication at no cost. Do I even need to enroll in Tricare? Do I need to apply for Medicare at age 65 or can I simply stay with the VA system?
Your VA disability rating is totally unrelated to your Tricare eligibility. The VA and Tricare are unrelated programs. The VA may file claims with Tricare only for services that you receive from one of the few VA medical centers that is registered with Tricare as an authorized provider.
I believe that you became eligible for Tricare automatically if you became entitled to retired, retainer, or equivalent pay when you retired from the Army. You can confirm your Tricare eligibility by calling the DEERS Support Office, toll-free, at 1-800-538-9552.
If you have a family, your wife and unmarried children under 21, or under age 23 if the child is a full-time college or accredited trade school student, also became eligible at the same time. You must enroll them in Tricare for them to use the program.
Medicare and Tricare also are unrelated programs that were created by, and are governed by, different federal laws. You must call the Social Security Administration for information concerning your Medicare eligibility at age 65. All questions concerning Medicare should be directed to Social Security or Medicare. Medicare cannot officially answer any questions concerning Tricare.
If you become legally entitled to Medicare Part A without cost at any age or for any reason, the federal law that governs Tricare requires you to enroll immediately in Medicare Part B. Failure to be enrolled in Medicare Part B when your Part A entitlement becomes effective will result in the immediate loss of your Tricare eligibility including your free Tricare Pharmacy Program and your becoming ineligible for the Tricare plan called Tricare for Life, or TFL. Your Tricare eligibility cannot be restored until and unless you are enrolled in Medicare Part B. For official confirmation of this rule, please contact the DEERS Support Office, above.
You may be inadequately informed about your health care guarantees under the VA system. As I understand the law, a 50 percent disability rating guarantees you free medical care only for your service-connected conditions. Your other health care needs could be denied or require payment on your part. There is no guarantee that you can continue under the VA system for your other medical care. I strongly recommend that you contact the VA to discuss these things with that office.
You should also contact the Social Security Administration to discuss the consequences of failure to enroll in Medicare at least 90 days before the month when you will be 65 years old.
Important note: Social Security and/or Medicare will provide information under Medicare law about when you must enroll in Medicare Part B. They will provide information that, while true, does not take into account the special circumstances of Tricare beneficiaries.
The law that governs Tricare has a different requirement concerning when you must enroll in Part B. You must conform to requirements of the Tricare law or lose your Tricare eligibility when you become legally entitled to Medicare Part A. That is, Tricare law requires that all Tricare beneficiaries (except active duty family members and USFHP members) must enroll in Medicare Part B at that time. For most people, that will be on the first day of the month of their 65th birthday.
When you become entitled to Medicare and are enrolled in Medicare Part B, you will become eligible for Tricare for Life, or TFL. Medicare will become your primary health insurance and Tricare Standard will act as a free Medicare supplement for the rest of your life. The vast majority of your Medicare claims and medical bills will be paid in full by their combined payments (Medicare plus Tricare Standard) under TFL. Your only premium costs for TFL will be the monthly premium for Medicare Part B.
I believe you have no such guarantees under the VA system if you do not have a 100 percent, permanent and total, service-connected disability. Most likely it will also be necessary for you to live within a reasonable commuting distance from a functioning VA medical center. You can use Tricare and Tricare for Life nationwide. Without your having a 100 percent disability, the VA will not provide medical services for your family members. Tricare will. Check these things with the VA.
Does getting VA care negate Tricare eligibility?
April 7th, 2010 | TriCare Help | Posted by Military Times
Q. If a military retiree of over 20 years’ service is enrolled/treated at a VA hospital, does that make him/her and spouse ineligible for Tricare for Life? Also, has there been a change in the new medical bill signed by President Obama?
Tricare and VA benefits are unrelated programs governed by totally different federal laws. If a person is otherwise eligible for Tricare, using VA benefits will not negate his Tricare eligibility except that he may not file Tricare claims for any costs incurred by getting care with the VA.
The only exception to that rule is in the case of the very few VA Medical Centers that have special status as Tricare-authorized providers. Your VA center administration can advise you if your center is one of them.
Until DoD legal experts have properly evaluated the new health care law, it is not possible to say what, if any, effects there will be for Tricare. Any changes to Tricare will be widely publicized far in advance of their effective date. None are expected except the possibility of extending the upper age limits of Tricare eligibility of certain children in certain circumstances.
What about hair implants?
February 3rd, 2010 | TriCare Help | Posted by Military Times
Q. Will Tricare cover and pay for hair implant surgery? I’m male, and I had a thick head of hair prior to joining the military. I’m now showing signs of baldness. It’s not hereditary in my family. I feel that lack of sleep, nutrients, stress, missions and shots received while in the military have caused my hair to thin.
I’m sorry, but Tricare is not allowed to pay for medical, surgical or other services performed solely for cosmetic purposes or psychological reasons. Tricare benefits are determined by federal law and regulation.
If you believe your hair loss is a result of your military service, you may want to file a claim with the Department of Veterans Affairs.
How will my service-connected disability affect my coverage?
October 27th, 2009 | TriCare Help | Posted by Military Times
Q. I currently have Medicare Parts A and B, and Tricare for Life. After a two-year fight with the VA, they now say my hearing loss and tinnitus is service connected. My DAV rep thinks I will get either 20% or 30%, depending on the hearing test the VA is giving me. Once I get the service connected disability, will this change any of my health coverage?
Because you have TFL, Medicare is your primary coverage and half of the TFL Program. Your TFL benefits begin when a Medicare provider files a Medicare claim for the services he provides to you. Because the Medicare claim must be filed first, you need to ask Medicare about any effects of your VA rating on your Medicare coverage.
My guess is that Medicare will have the same rule as Tricare about the rating, but only Medicare can tell you about that officially.
The VA rating you mention should have no effect on your or your family’s Tricare coverage. Tricare Help’s reply is always unofficial, however. To get official information, call Tricare.
Tricare Standard is the other half of your TFL coverage. By law, it is second (last) payer. When Medicare finishes processing a claim for a TFL beneficiary, it will pay its share to the provider. Then it will automatically forward the claim to the special Tricare claims processor for TFL. On the vast majority of your claims, Tricare will pay whatever Medicare did not pay for every medical service that is covered by both Medicare and Tricare. As a TFL beneficiary, you will seldom have any out-of-pocket expenses for your medical care. The major exception is the small copayments (cost shares) for your prescription drugs; all Tricare beneficiaries automatically qualify for benefits under the Tricare Pharmacy Program. It’s the best pharmacy plan I know of. That’s why TFL beneficiaries do not need to enroll in the Medicare Part D Pharmacy Plan. For TFL beneficiaries, Medicare Part D is not necessary, and it can cause a lot of hassles for little in return because you have to file two claims to get full reimbursement for your prescription drugs.
A very few VA medical centers have a special arrangement with Tricare that allows them to file a Tricare claim for those charges, but most of them do not. If you get a bill from the VA, call your Tricare Service Center to ask whether you may file a Tricare claim.