Tricare Help

Tricare Prime after age 65

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Q. I’m an Army retiree. My wife is still on active duty. I’m enrolled in Tricare Prime as her dependent. Can I continue in Prime at age 65 as an active-duty dependent?

A. You’re no longer eligible for Tricare Prime once you turn 65 and become eligible for Medicare, regardless of whether you’re registered in DEERS as your active-duty wife’s dependent or as your own sponsor. At age 65, Prime beneficiaries must shift to Tricare for Life (Medicare plus TricareStandard).

There’s one exception: Retirees enrolled in Prime under the U.S. Family Health Plan prior to Oct. 1, 2012, may remain in Prime past their 65th birthday, as long as they remain in the USFHP and have no break in coverage. The USFHP is a special Tricare option offered in six specific areas of the country. Retirees enrolled in the USFHP on Oct. 1, 2012, or later must shift to Tricare for Life when they become Medicare-eligible.

Assuming you’re not covered under the USFHP … if your wife serves long enough to become eligible for health care as a retiree herself, you may remain registered in DEERS as her dependent once you turn 65 and shift to Tricare for Life, although that will make no difference in your health care costs. Alternately, since you’re eligible for health care as a retiree in your own right, you may register for Tricare for Life in DEERS under your own sponsorship.

If your wife doesn’t serve on active duty long enough to qualify for retirement benefits, then you, as a retiree, can become the sponsor for your family and she can become your dependent for Tricare purposes.

Tricare and HSAs

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Q. You recently responded to a question about Health Savings Accounts and Tricare Standard and Prime. The short answer was that neither Standard nor Prime reach the HSA “high deductible” threshold. Is the same true for Tricare Reserve Select, since that program requires payment of premiums?

A. No Tricare plan qualifies as a high-deductible health plan for HSA purposes. As such, Tricare and HSAs simply don’t mix.

Spouse living apart from sponsor

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Q. If my wife decides to move back home for the duration of my new permanent change-of-station assignment, how does Tricare cover her?

A. As an active-duty member, you must be enrolled in Tricare Prime. However, family members can use Prime or Tricare Standard. If your spouse is now enrolled in Prime, that program has a “split enrollment” option under which a family’s military sponsor can be enrolled in one region, and the spouse can be enrolled in another region.

If your wife is using Tricare Standard, which requires no enrollment, she can simply visit any Tricare-authorized provider in her area.

How does Tricare Standard billing work?

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Q. When we used to be covered under Tricare Prime, we had a co-pay of usually $12 per doctor visit and a premium payment. We transitioned to Tricare Standard on Oct. 4. When I went for my yearly exam, I had no co-pay, but was billed from my doctor’s office. Will this be the case on every doctor visit under Standard?

A. In most cases, medical providers directly file claims on behalf of Tricare Standard beneficiaries. It’s not possible to readily explain why that did not happen in this particular instance. Reasons that a Standard beneficiary may be directly billed include receiving care while traveling away from home, or using what Tricare calls a “non-participating” health care provider. In such cases, you should send your claim form to Tricare as soon as possible for reimbursement.

The managed-care contractor for the Tricare region in which you live can help guide you through this kind of situation.

OHI and Tricare deductibles

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Q. When Tricare Standard/Extra is used as secondary payer with other health insurance as the primary payer, must I still meet the Tricare Standard/Extra annual deductible of $300 per family? Also, if I remain enrolled in Prime but have OHI as my primary payer, I’m under the impression that I would be using the Tricare Prime point-of-service option and would not have to pay the co-pays and deductibles. Correct?

A. On your first question, yes, when Tricare Extra/Standard is used as secondary payer with OHI as the primary payer, the beneficiary must still meet the Tricare Standard/Extra annual deductible. On your second question, you are correct. Beneficiaries who are enrolled in Prime and who have OHI as the primary payer do not have to pay the co-pays and deductibles.

Coverage for step-children

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Q. My boyfriend has been in the Navy for two years. I have a child from a previous relationship. Is it possible for his Tricare benefits to cover a child that does not belong to him?

A. The only way to obtain Tricare coverage for the child is for you to marry your boyfriend, so that he, as the military sponsor, becomes the child’s step-parent. In such cases, Tricare covers the child for as long as the military sponsor is married to the step-child’s biological parent and provides more than half of the step-child’s financial support.

It would not be enough even for you and your boyfriend to live together; Tricare does not cover nonbiological children of military sponsors unless the sponsor is married to the child’s biological parent.

Tricare for gray-area reservists

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Q. My wife and I use Tricare Reserve Select. I will be retiring from the Reserves when I am about 58; she is three years older than I am. Will we have any options between my retirement and my 60th birthday? Will my wife need to wait for coverage until I turn 60? And when she turns 65, will she go on Tricare for Life while I remain on Tricare Standard?

A. Yes, you do have another option, a relatively new Tricare plan called Tricare Retired Reserve. Like Tricare Reserve Select, Tricare Retired Reserve is a voluntary, premium-based plan for “gray-area” reservists who are no longer in drilling status but are not yet age 60 — exactly what you will be.

There’s one eligibility caveat to Tricare Retired Reserve: You cannot use TRR if you are eligible for Federal Employees Health Benefits coverage.

You can learn more about Tricare Retired Reserve here:

www.tricare.mil/Welcome/Plans/TRR.aspx

Once you turn age 60, you and your wife can be covered under ordinary Tricare Prime or Tricare Standard. Once your wife hits age 65, she will indeed transition to Tricare for Life (Medicare as first payer, Tricare Standard as second payer) while you remain on Prime or Standard until you also reach age 65 and make the same transition. Note: Enrollment in premium-based Medicare Part B is a bedrock requirement for Tricare for Life eligibility.

Baby born while on deployment

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Q. I’m an active-duty member deployed to Afghanistan. I am separated from my wife and will be finalizing my divorce in April. I’m having a child with another woman and she is due in February, around the same time i will be returning from Afghanistan. My baby has heart complications and will require at least three surgeries after birth, the first being within his first seven days. My questions:

1) Will my child be covered under Tricare Prime after birth, before I enroll him in DEERS?
2) Will the fact that I’m not married to the mother affect my child’s coverage immediately after birth, before enrolling him into DEERS?
3) If my child will suffer a gap in medical coverage due to this, what can I do to make sure he is covered as soon as possible?
4) Because my return date from my deployment is so close to my child’s due date, if I am unable to be there for the birth of my child, can the mother enroll him in DEERS?
5) Is there any paperwork i can fill out now that can help expedite enrolling my child in DEERS when I return?

A. Normally, newborn babies of active-duty members are automatically covered under Tricare Prime (the same program that covers active-duty members and spouses) for up to 60 days after birth. If not registered in DEERS within that 60-day window, the baby’s coverage shifts to Tricare Standard. If newborn babies are not registered in DEERS within one year after birth, they lose all Tricare eligibility until they are registered in DEERS.

The fact that you are not married to the mother does not affect the baby’s eligibility for Tricare coverage; that eligibility extends from your status as an active-duty member and the baby’s military sponsor.

Ordinarily, the above timelines for coverage of a newborn would not create any reason to rush the baby’s enrollment in DEERS. But your deployment does complicate things a bit if the baby is born before you get back home. You would have an issue with the mother trying to enroll the child in DEERS in your absence, since she’s not married to you and does not have a military ID. Your best option may be to look into arranging a power of attorney for the mother. That’s something you would have to work through your unit’s personnel and legal offices.

Once you are back home, registering the child in DEERS is a relatively simple matter. You can engage DEERS by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office at 800-538-9552.

Good luck and congratulations on the baby.

Does Tricare cover invitro fertilization?

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Q. Since gays are now allowed to serve openly in the military, will Tricare at some point change its policy to cover invitro fertilization?

A. It’s impossible to predict what future changes may be made in Tricare coverage or policy. At the moment, Tricare does not cover IVF or any other services related to what are called “noncoital reproductive technologies,” a category that also includes artificial insemination.

What Tricare does cover in the infertility arena:

–Diagnostic services to identify physical illnesses or injuries to the reproductive system (for both men and women). Infertility treatments, corrective treatments and surgeries for women are also covered. However, efforts to correct male infertility may be cost-shared with the beneficiary; that’s decided on a case-by-case basis.

–Therapies such as hormonal treatment, corrective surgery, antibiotics, administration of human chorionic gonadotropin (HCG) or radiation therapy are covered for both sexes.
–Medically necessary and appropriate medical care for erectile dysfunction that is to biologically organic — not psychological or psychiatric — causes.

The importance of DEERS registration

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Q.  My active-duty husband and I have been married less than two months, and I have not had a chance to enroll in DEERS. He will take leave at the end of this month so we can that all taken care of.  However, I’ve been very sick the last week and have missed a lot of work. I’m not getting any better and am not sure what is wrong. I am wondering, if I go to the ER, will Tricare reimburse me for the cost later, after I am enrolled, or will we be stuck with what could be a very high medical bill?

A. Tricare will not pay for any care received for family members who are not enrolled in DEERS, the Defense Department’s eligibility portal for Tricare. You cannot have obtained a military dependent ID card if you are not yet enrolled in DEERS, and you need to show that ID card when you seek medical care under Tricare.

As the military sponsor for your family, it is your husband’s responsibility to properly register you in DEERS and get you a Defense Department ID card. This is not a laborious or time-consuming process. He can square you away by visiting the ID Card/DEERS office on any military installation. You can get more information by calling the main DEERS support office in California at toll-free 800-538-9552.