Tricare Help

If doctor stops taking Medicare, can we go to an MTF instead?

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I am retired Army and my wife and I use Tricare for Life. Recently, one of our providers stopped taking Medicare. My wife needs a treatment that would cost $3,500 out of pocket. If we relocate near MacDill Air Force Base, Fla., could we get all our medical needs met at the military treatment facility there? If so, what would it cost us?

Unfortunately, once beneficiaries transition to Tricare for Life and lose eligibility for Tricare Prime, they have no expectation of access to military treatment facilities for their health care. They’re generally expected to seek all their medical care from Medicare providers, with Tricare Standard as a backup secondary payer.

It is possible that you could be granted access to an MTF at MacDill, but Tricare has nothing to do with that; such decisions are strictly up to each local MTF commander, and those decisions are based on the MTF’s available capacity, staff and resources. You will need to contact the patient administration office, discuss your situation, let them know that you and your wife are in TFL, and see what they have to say.

In the specific case of your wife’s near-term treatment, your best bet would be to find another nearby provider that does take Medicare. You should also check on whether Tricare Standard, as secondary payer, will cover that cost. However, since this is a case of a specific provider refusing to participate in Medicare not a case of Medicare itself refusing to cover the treatment I think Tricare likely will tell you that you first need to look for another provider who does take Medicare.

You should contact the Tricare managed-care contractor for the Tricare region in which you live to further discuss this matter.

I don’t like military facility doctors; can I opt out of Tricare Prime?

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I’m trying to switch from military facility doctors to a private family physician. I have Tricare Prime and don’t care for the services offered at our local Army clinic. What can I do?

If you’re unhappy with Tricare Prime, your most fundamental alternative is Tricare Standard.

You should be aware that Prime offers lower out-of-pocket costs than Standard. However, Standard allows a much wider choice of health care providers, which is what you seem to be seeking. Standard is widely available, has no enrollment fee, and allows beneficiaries to also use Tricare Extra. That option is for Tricare Standard beneficiaries who want to save on out-of-pocket expenses by making an appointment with a Tricare Prime network provider (doctor, nurse practitioner, lab, etc.). The appointment with the in-network provider would cost 5 percent less than it would with a non-network provider. In addition, Tricare Standard beneficiaries are not assigned a primary care manager, so beneficiaries generally can refer themselves for specialty care without prior authorization. Standard charges annual deductibles.

Your first step is to disenroll from Tricare Prime. Make sure you fill out the form for the Tricare region where you live, and mail it to the Tricare contractor for your region.

It will take about seven to 10 business days for your Prime disenrollment form to be received and processed. Once you are confirmed as being disenrolled in Prime, that’s all you should have to do. You’ll receive a Tricare Standard handbook covering pertinent information regarding your benefits and eligibility for medical services.

The patient administration office at your local military treatment facility also can help you with this.

Tricare for Life, Prime or Plus: Which is best for us?

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My wife, who is not eligible for Medicare part A, turned 65 last November. When I retired in 1995 we opted for Tricare Prime. We got a letter from DEERS prior to her birthday informing us of the requirement for her to apply for Medicare. After the Social Security Administration determined she was not eligibile for Medicare Part A, she was enrolled in Medicare Part B with a monthly premium. Tricare Prime continues to bill us at the family rate of $460 per year. I will not turn 65 until 2017. I am getting conflicting information as to what program we should be under — Tricare Prime, Tricare for Life or Tricare Plus. What are our options?

Since your wife is now 65 and is enrolled in Medicare Part B, she is covered under Tricare for Life. As you probably know, you will not be eligible for TFL until you turn 65 yourself. Until then, you will remain under Tricare Prime. However, you should not have to continue paying the family rate for Prime, since only you are now using that option. You should contact the managed-care contractor for your region.

From your note, it sounds as if DEERS is already aware of your wife’s change in status (to Tricare for Life), but it couldn’t hurt to make sure the registration information for you and your wife is correct int he DEERS database. You can reach the DEERS support office at toll-free 1-800-538-9552.

Under Tricare Plus, beneficiaries who normally can get care at a military treatment facility only on a space-available basis can access primary care at the MTF the same as beneficiaries enrolled in a Tricare Prime option. For example, if Plus available at their local MTF, retirees and retiree family members using Tricare for Life can enroll in Tricare Plus and be guaranteed a routine appointment within one week, the same access standard as beneficiaries enrolled in a Prime option.

Tricare Plus is available only at certain MTFs, and the local MTF commander may limit enrollment to specific categories of beneficiaries. Tricare beneficiaries enrolled in Prime are not eligible to enroll in Tricare Plus, so in your case this option would be available only to your wife. The patient administration office at your local MTF can give you more information on the availability of Tricare Plus at that facility.

Will Tricare cover delivery of soldier’s baby?

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I am having a baby with a soldier. We are not married. Will Tricare cover the delivery? My insurance through my employer was terminated in my seventh month and I can’t get coverage from another insurance company.

Unless you are married to the soldier, you are not eligible for any health care under Tricare, to include maternity care, delivery of the baby and any necessary post-natal care. The child, however, will be covered from the moment of birth as the military dependent of the soldier.

There is a possibility, though a slim one, that the local military hospital at the installation where your soldier is stationed would agree to handle the birth, depending on the facility’s staffing and patient load. Contact the patient administration office at the hospital to inquire about this.

You can confirm the Tricare eligibility status of you and your baby by calling the Defense Enrollment Eligibility Reporting System support office at toll-free 1-800-538-9552. DEERS is the Defense Department’s eligibility portal for Tricare.

How can I make sure my surgery is covered?

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I’m married to an active-duty airman. I have an ovarian cyst that must be removed ASAP. Does Tricare cover this kind of surgery?

Tricare does cover medically necessary care, including surgery, for your condition. If you live near a military hospital, make an appointment to be seen by military physicians. If you do not live near a military facility, you must find a civilian physician who is, or who is willing to become, a Tricare-authorized provider, to provide the care you need.

Tricare may provide coverage only if you use a military hospital, or a civilian physician who is authorized by Tricare to attend its beneficiaries.

How do I change my military treatment facility after a move?

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How do I change my military treatment facility? I moved from North Carolina to Texas over a year ago, and apparently the outpatient clinic I go to now to keep up with my VA appointments is not classified as my military treatment facility. All this time, I had assumed that kind of information would have changed as I moved and enrolled in a different medical center. Whom should I contact to straighten this out?

In moving from North Carolina to Texas, you have moved from the Tricare North region to the Tricare South region (unless you are in the El Paso area; that single, specific area of Texas is in the Tricare West region). Without knowing more details about your situation — your beneficiary status and which Tricare plan you are covered under, for example — I can only suggest you contact the regional contractor or one of the Tricare regional service centers for your region and ask them for guidance.

Can I sign up elderly mother for Tricare?

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My 82-year-old mother is a recent legal immigrant to the U.S. She lives with us and is our dependent. How can I get her signed up for Tricare?

Dependent parents and parents-in-law are not eligible for Tricare. Under certain circumstances, however, the uniformed services may determine a parent or parent-in-law to be the dependent of an active duty member or retiree. In those circumstances, the parent or in-law may be allowed to use a military treatment facility, subject to the availability of space, personnel, and technical capacity.

You must apply with your service for your mother to be designated, legally, as your dependent. Then you may apply with your MTF for her to be allowed to use its facilities. Ask whether she can be eligible for Tricare Plus, which will give her the same access rights to free MTF care as are enjoyed by Tricare Prime members. She will not have Tricare Prime health care coverage, but the medical care she will get will be just as good.

Can I keep my doctor after I switch to Tricare for Life?

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I will be 65 and get Medicare in August. However, I have finally found a doctor I like at my military hospital. He explains things to me and never rushes. How can I keep seeing him after I get Tricare for Life?

I’m afraid I don’t have good news for you: You currently have priority access to the military hospital, and your doctor, under Tricare Prime. But when you turn 65 and get Medicare and Tricare for Life, the Tricare Prime part of your coverage will automatically convert to Tricare Standard. That, along with Medicare Parts A and B, comprise your health coverage. Medicare will become your primary payer, with Tricare paying whatever Medicare does not. You will have to find a new, Medicare-authorized, doctor – hopefully one who communicates as well as your current physician.

Do we still need Tricare Prime Plus under Tricare for Life?

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My wife and I just qualified for Medicare and Tricare for Life. We were both enrolled in Tricare Prime. We are also enrolled in Tricare Prime Plus at a military treatment facility. Do we need to continue paying the annual enrollment fee to use Tricare Prime Plus?

If a person is enrolled in Tricare Prime when they become eligible for Medicare and Tricare for Life, his or her Prime enrollment is terminated. On the effective date of Medicare coverage, it is automatically changed to Tricare Standard, which becomes a free supplement to Medicare. The person is no longer eligible for Tricare Prime. He no longer has priority access to free care at a military hospital, and any Tricare Prime enrollment fees paid in advance are lost; they cannot be refunded.

Can girlfriend give birth in military hospital?

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I’m an active-duty soldier and my girlfriend and I are getting ready to have a baby. She doesn’t have health care at the moment. I know the baby can be covered as my dependent, but my question is, can she have the baby in a military hospital?

Whether your girlfriend can give birth at a military hospital does not fall under Tricare’s authority. Only your military hospital can decide. Contact the hospital’s Patient Administration Office for an official answer.

Of course, the problem is instantly resolved if you get married. She would be covered under Tricare.

The baby will be covered after birth either way, however. Call the DEERS Support Office, toll free, at 1-800-538-9552, to discuss that matter.