I am currently using Tricare Standard as my secondary insurer; however, as of June 28, I will be separating from my full-time employment and will lose my current insurance coverage with Blue Cross/Blue Shield. How can I make Tricare my primary coverage?
As you are already using Tricare Standard, you don’t need to do anything. Standard requires no enrollment and no referrals for specialty care, so all you have to do is simply make sure you are using doctors who are Tricare-authorized providers and let them know that Tricare Standard is your primary insurance.
You should contact the Defense Enrollment Eligibility Reporting System (DEERS), the Defense Department’s eligibility portal for Tricare, to make sure your information in that database is current. You can do that by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office toll-free at 1-800-538-9552.
I am on active duty as a reservist and covered under Tricare prime. My wife has an Anthem Blue Cross HMO through her employer. We are pregnant and want to use our much better Tricare coverage as primary. Can my wife simply opt out of her primary insurance, update DEERS and convert Tricare from secondary to primary? Our concern is if there is a policy that states that if a spouse’s employer offers medical coverage, she must use it and Tricare will act only as secondary.
There is nothing to stop the spouse of an active-duty member from opting out of her employer coverage and essentially making Tricare her primary coverage by default. Except in very specific and narrow circumstances that don’t apply to you, federal law requires Tricare to be last payer to any other health insurance — but if the beneficiary does not carry any other health insurance, then Tricare is the only payer.
If there is a possibility that your wife will want to go back to her employer coverage as primary insurance in the future, I would suggest that she check with her employer about its particular rules. Some employers require lockout periods, a certain period of time that employees who drop coverage must wait before they are eligible to re-enroll, for example. She also may want to ask whether there are any provisions for suspending her employer coverage, rather than dropping it outright.
As you note, you should check in with DEERS to make sure your wife’s information is up to date in that database. You can do that by visiting the ID Card/DEERS office of any military installation, or by calling the main DEERS support office at 1-800-538-9552.
I am a 51-year-old retiree currently enrolled in Tricare Prime. With four children in their 20s — and aging out of Tricare — my wife and I are thinking of switching to my company’s policy so that all four of our children may be covered until age 26. That would be less expensive than trying to cover all 4 individually under the new Tricare Young Adult program. In about six years, my wife and I would switch back to Tricare Prime after our children are over 26. What can we do to make this transition as smooth as possible?
As a retiree, your eligibility for Tricare, and by extension the eligibility of your family, remains in place regardless of whether or not you use Tricare as your primary insurance. In the presence of other health insurance, the law requires that Tricare always be last payer. So in the scenario you outline here, your company’s insurance would be the primary payer and Tricare would act as secondary payer, if necessary. To avoid the annual Tricare Prime enrollment fee during that period, you simply must disenroll from Prime for however long you are covered by your company’s insurance. Disenrollment is done through the Tricare managed-care contractor for your Tricare region.
When you disenroll from Prime, your coverage automatically shifts to Tricare Standard. When you want to go back to Prime, simply contact the Tricare managed-care contractor for your Tricare region and indicate your desire to re-enroll.
Beneficiaries may voluntarily disenroll from Tricare Prime once per fiscal year (Oct. 1-Sept. 30) without being locked out. If you disenroll for a second time in a fiscal year, you are not allowed to re-enroll in Prime for 12 months. (There is an exception to this lockout rule for family members of active-duty personnel in paygrades E-1 to E-4.)
My husband and I divorced, and I have primary custody of our daughter, although she visits him for a few months in the summer. Per the divorce degree, I provide for her health insurance, but my ex-husband, who is in the Coast Guard, decided he also wants her covered by his Tricare. Tricare has always told me that they will be second payer to the insurance that I provide her. However, my ex is now saying that if she stays with him for more than 30 days, Tricare will become primary, and then it will switch back when she comes home. Is this true?
I’m not sure where your ex-husband is getting his information, but he’s incorrect. As the official custodial parent (specified in your divorce decree), your health insurance is first payer for your daughter and Tricare remains second payer, even during those times that your daughter is staying with your ex. Tricare is always second payer to any other available health coverage.
I have other health insurance, and when I file with Tricare as second payer, I always have a problem getting copies of the original bills from my doctor’s office. The other plan’s EOB says what medical services I got and the amounts it paid, so why isn’t that enough for Tricare’s use? Why are copies of the original bills required?
The way services are listed on the other plan’s EOB may not report a detailed description of the medical services you actually received. For example, there may be several different services labeled simply as “office visit” on the other plan’s EOB. Tricare and the other plan likely allow different amounts for each service, so the words “office visit” and the amount allowed by the other plan does not tell Tricare exactly what kind of medical service the patient received.
Tricare must know exactly what services you received in order to determine the amount it would have allowed for each of them if Tricare had been your primary coverage. If, as I suspect, the problem arises between you and the office staff, perhaps explaining it to your doctor will remedy the situation.
If I have Tricare, is a private insurance primary? What about a COBRA policy?
Regardless of the source of payment, by federal law, Tricare is always last payer to all other coverage with two exceptions:
This post has more details about filing a claim with Tricare after you file with another insurance plan.
I am in the Army, active duty, and I recently got married. My wife has health insurance through the college she attends. Is there any way she can cancel that and go with Tricare? She paid for the year through September, so that’s about $900 of insurance she doesnt want to use. Any advice? Can I enroll her with two insurances?
Whether you wife can cancel her other health insurance and get a refund is strictly a matter between her and the other plan. Tricare has nothing to do with it.
She can retain the other plan just as it is now and use Tricare as second payer. That is, she must file all claims with the other plan first. Then, when it has paid its maximum, she can file a claim with Tricare which will usually pay the other plan’s deductible and copayment. Tricare makes a good supplement for the other plan in that case, because Tricare Standard is free.
Here’s how she can file a claim with Tricare after filing with the first insurance:
My fiance is on active duty in the Marine Corps. We are getting married in January. I am currently a flight attendant, so I have my own health insurance right now, but I plan to quit in April when I move to Florida to be with him. Once we get married, is there a waiting period for me to be covered under Tricare, or is it automatic after he has enrolled me?
You will become legally entitled to Tricare at the moment you are married. There is no delay.
If you receive medical care while you still have coverage by your present policy, you must file claims with that plan first. After it has completed all processing of the claim and issued an explanation of benefits, you may file a claim with Tricare as second payer. Tricare will pay all, or most, of what the other plan left unpaid — usually your copayment and, if applicable on that claim, your deductible. For instructions, filing address, and to download claim forms, visit the Tricare website or call your Tricare Service Center.
Here’s how you file a claim with Tricare as second payer:
1. Complete a Tricare claim form DD2642.
2. Attach a copy of the same itemized bill that was sent to the other plan.
3. Attach a copy of the other plan’s EOB reporting its processing of each of the charges on that bill.
4. Send the claim to the proper Tricare claims processor for the state where you live.
For you to use Tricare, your husband must contact his Personnel Section to register you in the Defense Enrollment Eligibility Reporting System, better known as DEERS. (Remember the name. You will soon learn that military folks speak in acronyms.)
DEERS maintains a confidential registry of military beneficiaries and the benefits to which each person is entitled by law. Once registered in the confidential DEERS registry, your name will appear on DEERS under your husband’s Social Security number. DEERS will report that you are eligible for Tricare.
When a Tricare claim is processed, the Tricare computer contacts the DEERS computer automatically. It asks whether the person on the claim was eligible for Tricare on the date he or she received the medical service(s) on the claim. If DEERS replies “yes,” the claim will continue processing.
If DEERS replies “no” for any reason, the claim will be denied at that point, and the patient will be sent an explanation of benefits. The Tricare EOB always reports the reason any claim is denied and tells the patient of his/her right to appeal the decision. That reason for denial must be addressed in order for the claim to be paid.
If you receive medical care after you are married but before you are registered in DEERS, save copies of all itemized bills and receipts until your Tricare registration is complete and you have been issued a uniformed service identification card. Then you may file a claim for reimbursement of your costs. Your Tricare coverage will be retroactive to your first minute of eligibility.
My employer provides a Medicare-approved health insurance policy. I’ll be 65 soon, and Medicare tells me I don’t have to enroll in Part B as long as I continue to work for that company. On the other hand, Tricare tells me I must enroll in Part B as soon as I turn 65 and get Medicare. Two government health insurance plans are telling me exactly opposite things, and both say they are right. I’m caught in the middle. Can you help me?
Both Medicare and Tricare are correct in what they told you. They are talking about different rules that exist for unrelated purposes.
Both rules concern requirements for Medicare Part B enrollment.
One of the two is a Medicare rule concerning a penalty for late enrollment in Part B after becoming entitled to Part A. The rule says you may delay Part B enrollment in some circumstances. You hear about this rule from Medicare.
The other is a Tricare rule. It concerns the federal law requiring Part B enrollment when you become eligible for Part A entitlement in order to retain Tricare eligibility. The Tricare rule says you must enroll in Part B “now.” You hear about this rule from Tricare. (It does not apply to active-duty family members.)
Under the Medicare rule, those who become entitled to Medicare Part A have a grace period during which they must enroll in Part B or face a penalty that increases their Part B premiums for the rest of their lives. The penalty adds 10 percent to the Part B premium for each year someone delays Part B enrollment after becoming entitled to Part A. However, there is a situation in which Medicare can waive that late-enrollment penalty.
Some companies sponsor health insurance and even pay a part of the employee’s insurance premium. If Medicare determines that the company’s insurance plan provides benefits that are at least as good as Medicare’s, it is called a creditable plan.
The Medicare rule says employees enrolled in an employer’s creditable plan can delay enrolling in Part B without penalty as long as they work for that employer.
Once they leave that employer, they have a grace period during which they must enroll in Part B to escape the late-enrollment penalty.
Nothing in this Medicare rule applies to Tricare; the Tricare rule is quite different.
The law that governs Tricare has a provision to the effect that a Tricare beneficiary who becomes entitled to Medicare Part A must be enrolled in Part B to retain Tricare eligibility.
Tricare beneficiaries who become entitled to Medicare Part A must be enrolled in Part B or lose all Tricare eligibility until they are enrolled in Part B.
Shortly before your Medicare entitlement becomes effective, you’ll get a letter advising you of your Medicare award. It will contain a Medicare ID card showing that you are enrolled in Part A and Part B. At that point, you’re a Medicare beneficiary.
In the same packet, you will receive a form allowing you to opt out of Part B. I strongly recommend that you do not opt out; if you do, you will find yourself with no Tricare benefits of any kind.
I work in the airline industry and can enroll in my employer’s insurance. I also have Tricare Standard as my secondary insurance — my husband is deceased. However, the Tricare coverage is under my married name, and everything with my employer is under my maiden name. Will this cause a problem when I try to file a claim with Tricare as my secondary insurance? I need to enroll in my employer’s insurance soon.
Your problem is a simple administrative issue requiring an explanatory letter. How quickly it gets resolved depends on who gets the letter and when.
Write to your Tricare claims processing office — the same place where you submit Tricare claims — and explain the situation. Make three or four extra copies. Send the letter to the claims processor now, and send another copy with the first claim you submit to Tricare as second payer.
If it doesn’t take, you will know in a few weeks after you submit your first claim to Tricare as second payer. If your claim is denied, it isn’t a disaster; you just need to file and appeal.
If Tricare simply writes asking for more information, no appeal is needed. Just reply immediately, explaining everything again, and include a copy of the letter Tricare sent you so they know what you’re talking about.
If Tricare denies the claim, then it’s time to file an appeal. The appeal must be in writing and state the specific matter in dispute: For example, “Tricare denied claim number X because I used two different names on the claims. I have attached an explanatory letter.”
Attach a copy of the explanatory letter with the appeal letter. Include also a copy of Tricare’s explanation of benefits showing the claim denial.
Send the appeal letter, the explanatory letter, and Tricare’s EOB showing the denial to the address of the Tricare office that denied the claim. It’s on the Tricare EOB. Be sure to answer all questions Tricare asks, if any. That should resolve the name problem.