My friend retired and has gone blind. How can I get him on Tricare?
If your friend is entitled to receive retired pay, he is most likely eligible for Tricare. He needs to be registered with his uniformed service, which can do the paperwork needed to enroll him in the Defense Enrollment Eligibility Reporting System, better known as DEERS, and to issue a current uniformed service identification card.
I believe it is most likely those things were done when your friend retired, but to confirm that, or to receive instructions about doing it, if necessary, please contact the DEERS Support Office, toll-free, at 1-800-538-9552. Be prepared to take notes.
His wife and unmarried children younger than 26 also are Tricare-eligible, but they, also, must be enrolled in like manner.
You may encounter some problems initially in working on your friend’s behalf due to Privacy Act restrictions. DEERS, however, will advise you about working around them.
The uniformed service ID card is used as “proof of insurance” when dealing with providers of medical care. On the back of the card is information regarding eligibility for civilian medical care. The word, “YES” in the appropriate place confirms Tricare eligibility.
Complete information about Tricare can be found at the official Tricare website. For information about filing claims, forms, and addresses, please go to the claims section or call the beneficiary’s Regional Tricare Service Center.
If your friend has not already done so, he should contact the Social Security Administration regarding his disability. That toll-free number is 1-800-772-1213. If he qualifies, he can become entitled to disability payments and, after two years of receiving those benefits, he will become entitled to Medicare.
Enrollment in Medicare Parts A and B will make him eligible for the Tricare plan called Tricare for Life, or TFL. In the absence of other health insurance, TFL is a Tricare plan under which Medicare becomes the beneficiary’s primary health insurance, and Tricare Standard will automatically serve as his free Medicare supplement.
Under TFL, he must get all civilian medical care from Medicare providers only. A Medicare provider is one that is registered with Medicare and is authorized to file Medicare claims for services provided to Medicare beneficiaries. Medicare will process the claim, pay its share to the provider, and automatically forward the claim to Tricare.
For every medical service on the Medicare claim that is covered by both Medicare and by Tricare, Tricare Standard will pay the balance on the Medicare claim (the Medicare copayment and deductible). That done, the provider’s bill will be paid in full. The patient will owe nothing.
Occasionally a Medicare provider will render a service that is not covered by both Medicare and by Tricare. In that case, only one of the two plans will pay. The other plan will deny payment as a non-covered service. In those cases, the patient (or his supplement) is responsible for the unpaid balance on the claim. Such Medicare claims will be relatively uncommon. The vast majority of the medical care will be paid in full under TFL (the combined Medicare plus Tricare payments).
My son is in the Air Force, stationed at Hickam Air Force Base, Hawaii. He applied to have me as a secondary dependent (I am his mother) and it was approved in June. I went to MacDill Air Force Base, Fla., a few weeks ago to get my military ID and to find out about medical care. They told me I couldn’t see a doctor there, but if I saw a civilian doctor and he ordered tests, they could do them on base. I’m sure there is some way for me to get some medical care. Can I join Tricare? Can I go to another military medical facility?
By law, a service member’s parents are not eligible for Tricare. That is true even if the parent is totally dependent on the service member. You can get official confirmation of the above by calling the Defense Enrollment Eligibility Reporting System at 1-800-538-9552.
Dependent parents may be authorized medical services, at varying levels of care, at a military hospital. Depending on the situation at the particular hospital, a parent may get total care there, limited services or no services. The parent has no legal right to care at the military hospital. If granted, it is a matter of courtesy only.
Apparently, that was your experience in that, although you cannot see a military doctor at your hospital, it can provide certain laboratory services for you when ordered by your civilian physician.
The primary consideration for whether a dependent parent can get care is usually the availability of space, personnel, and/or the technical capacity of that hospital to provide the care the parent needs.
The primary mission of military hospitals, by law, is to provide care for active duty military personnel. That must always be the hospital’s primary concern.
The decision to grant or deny a dependent parent’s access to care at the military hospital rests entirely with its Commanding Officer. That decision is based on his or her professional opinion, after consideration of the hospital’s primary mission.
You may want to approach the hospital’s Patient Administration Office or Executive Officer about your concerns.
I plan on marrying a retired Coast Guard pilot next year, but my children and I have since moved in and combined our families into one unit. Can my two kids and I join Tricare prior to the marriage while living with him?
No; you’ll have to get married first. You and your children will become Tricare-eligible on the day you marry. Your husband, however, will have to register the family with the Coast Guard and DEERS, and get uniformed service ID cards for you before you can use Tricare. Save all your medical bills until he gets that done.
He should call the DEERS Support Office, toll-free, at 1-800-538-9552, if he needs guidance. His Personnel Section can help him with it immediately if nearby; or, he can try a reserve unit with a personnel shop.
I retired from the Air Force in 1988 and my wife and I have used her employer-provided BCBS insurance since that time. My wife has since retired and her employer will continue to provide medical coverage until we turn 65. As I understand it, when we turn 65, we will need to be enrolled in Medicare, Part A and Part B and in Tricare for Life. Am I correct that both my wife and I will be covered under Medicare, then Tricare for Life?
You will indeed be covered. In fact, you could have been using Tricare all along: When you retired from the service and became entitled to retired pay, you, your wife, and any unmarried children under age 21 became eligible for Tricare. Since that date, provided you properly registered your family in DEERS, you and your family could have been using Tricare as second payer to your wife’s commercial health insurance policy. Tricare would have paid most, or all, of what the commercial policy did not pay on each claim. For example, that plan’s deductibles and copayments.
As you and your wife, individually, reach age 65, you become entitled to free Medicare Part A. And as you enroll in Medicare Part B, each of you, in turn, will become eligible for Tricare for Life.
For official information about eligibility and assistance for enrolling in any Tricare plan, please call the DEERS Support office, toll-free, at 1-800-538-9552.
Tricare for Life, or TFL for short, consists of two, full-service, stand alone health insurance plans provided by the government. Those plans are Medicare Part A and Part B, plus Tricare Standard. Medicare Part A and Tricare Standard are free. You will be responsible for paying only the monthly premium for Medicare Part B. Note that Health Affairs does not recommend enrolling in the Medicare Pharmacy Plan, called Medicare Part D. You are automatically enrolled in the free Tricare Pharmacy Plan already.
Medicare is your primary coverage, and you must seek all civilian medical care from Medicare providers only.
In the vast majority of your Medicare claims, Tricare Standard will act as a free Medicare supplement. On the vast majority of those claims, when each of the services on the Medicare claim is covered by both Medicare and by Tricare, Tricare Standard will pay whatever Medicare did not pay on the Medicare claims for your medical care. Thus, the combined Medicare, plus Tricare payments, will pay the Medicare claim, and the provider’s bill, in full. You will pay nothing.
Occasionally, you will receive a Medicare claim that contains a particular item that is not covered by Medicare. In that case, Tricare will become your only health insurance for that particular item, and you will be responsible for paying whatever Tricare does not pay for that particular item on that particular claim. Your payment, in such cases, will usually be the Tricare deductible and cost share. As noted, such claims will be rare.
My 62-year old mother is in the process of divorcing her husband, who’s retired from the Navy. She is currently covered under his Tricare. They have been married 14 years, only 18 month of which while he was on active duty, so we realize she will not be eligible for Tricare on her own after the divorce. Divorce proceedings may take months, however, and he is threatening to “make a phone call” now and have her dropped from his plan before the divorce is final. Can he do this?
In short, no. Under the law that created Tricare, the benefit flows directly to the beneficiary, not “through” the military sponsor. The sponsor cannot control the beneficiary’s eligibility for Tricare or use of the program. Neither does the sponsor have a legal right to any information about an adult beneficiary’s Tricare claims or medical care without the beneficiary’s written permission. That information is protected by the federal Privacy Act of 1974.
You are correct that your mother’s Tricare eligibility will end when the divorce is final. Tricare will not cover the costs of any medical service she receives after midnight on the day the divorce is final. She and/or her providers, however, may continue to file Tricare claims for medical services received before that time and date. The filing deadline for those claims is one year from the date of the care.
I strongly recommend that you call the DEERS Support Office for official information regarding this matter and confirmation of the information above.The toll-free number is 1-800-538-9552. DEERS can provide official information and guidance about any matter pertaining to Tricare eligibility only. It can’t help with matters concerning Tricare benefits, claims, or payments. Please contact your Regional Tricare Service Center for that information.
Bear in mind that I am not an attorney; while I can tell you what a law or regulation says, I am not qualified to tell you how it applies to a particular person or situation. Only a qualified attorney or official agency can do that.
I have been married to my husband for 17 years and we are in the process of getting a divorce. He is stationed in another state. I am a veteran too, but I left the military to raise my children. I know the children will be covered after we divorce, but is there anything I can do to keep Tricare coverage for myself?
The information in your letter leads me to think that you will lose your Tricare eligibility if you divorce your husband. For a spouse to retain eligibility after divorce, he or she must have been married to the same military sponsor for at least 20 years during which time the sponsor accrued retirement credits.
You are three years short of that requirement, according to your letter. If that is correct, you will lose your Tricare eligibility at midnight of the day the divorce is final.
You are correct that the Tricare eligibility of your husband’s natural or adopted children will not be affected by the divorce. Their Tricare eligibility can continue until they are 26 years old under proper circumstances established by law.
Please call the DEERS Support Office, toll-free, for official information and guidance regarding all matters of Tricare eligibility. Your lawyer can also call that office. The toll-free number is 1-800-538-9552.
Q. I’m a disabled veteran and both my children are currently covered by my Tricare. My daughter thinks that if she gets married, she will still be able to use my Tricare until she’s 26. I don’t think that’s correct. Who’s right?
You are. Under both Tricare’s original 1966 legislation (as amended) and the new law extending children’s eligibility under the parents’ insurance, children lose Tricare eligibility if they marry.
Remember that Tricare eligibility is established by federal law; Tricare does not have the authority to determine whether a given individual meets all the legal criteria for Tricare eligibility. Only the services have that authority by law.
To confirm that with an official source, please contact the DEERS Support Office, toll-free, at 1-800-538-9552.
Q. My father is retired from the military, and I had coverage up until my last doctor’s appointment, when they took my ID card away because it was expired. My father went to try to get me another one, and they told him since I am not a student, I am not eligible for Tricare. I am pregnant now. Am I still not eligible for Tricare?
There is a new Tricare program available for certain unmarried children of active duty, retired, or deceased uniformed service personnel who do not meet the age or student status requirements of the older programs.
It is called the Tricare Young Adult Program. You can find complete, official information about the program here. Unlike the older programs, it is more restrictive of eligibility, and it is more expensive.
For official answers to all questions about Tricare eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552. DEERS is a federal agency. It deals with Tricare eligibility issues only. It cannot provide information about Tricare plans, benefits, payments, or claims.
Q. My husband died on active duty in 2007. Our two sons and I use Tricare. I don’t plan on marrying for a couple of years, but what if I get pregnant? I know the baby, once born, wouldn’t be covered under Tricare, but would it cover my pregnancy, labor and delivery? Can I be penalized for it?
As the un-remarried widow of a deceased active duty uniformed service member, you are eligible for Tricare. Under present law, you will continue to be eligible for Tricare through your deceased sponsor for the reminder of your life, unless you marry again. If you remarry, your Tricare eligibility under that sponsorship will terminate at midnight of the day before your remarriage.
The above means that your maternity care can be covered by Tricare for as long as you remain eligible. There are no penalties of any kind. Your baby, however, will not be eligible for Tricare because he is not the child of your deceased sponsor.
In order for you and your present children to continue to use Tricare while you remain eligible, you must keep your DEERS registration and military identification cards up-to-date.
For official confirmation of the above, please call the DEERS Support Office, toll-free, at 1-800-538-9552.
Q. My wife has issues with sleeplessness, weight gain and possible hormone imbalance issues. She’s been seen at our local base hospital a dozen times by both women’s clinic doctors and family practice doctors. The docs continue to bounce here back and forth with no resolution of the problem and will not send her off base for another opinion or possibly to see a specialist who works with female hormone problems. How can we get a Tricare referral? We’re almost to the point of paying for off base care out of pocket if necessary, but it’s hard to believe Tricare wouldn’t cover this problem.
Tricare is unrelated to military health services. It has no authority to require or even recommend that the military refer a patient to civilian care or specialists.
If you and your wife have a complaint about care she received at the military hospital, go through the chain of command at that hospital first. If unsuccessful, then ask for guidance about the next step for filing a complaint.
You may want to ask for advice from the Tricare Headquarters. That address is Tricare Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. TMA does not have an e-mail address or telephone number suitable for public contact.