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.
Q. My husband will turn 65 next year and will enroll in Medicare. Will my Tricare coverage continue until I turn 65 a year later, or should I enroll in my company’s health insurance program for 2014?
A. You may stay on whatever Tricare plan you currently use (most likely Tricare Prime or Standard) until you also reach age 65, at which time you will make the same transition to Tricare for Life. When your husband receives his Medicare card (which usually happens about three months before reaching age 65), he should contact the Defense Enrollment Eligibility Reporting System, the Defense Department’s eligibility portal for Tricare, to update his information file to reflect the fact that he has transitioned to Tricare for Life. He should do the same for you when you go through that process.
He can engage DEERS by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office in California at 800-538-9552.
I just joined the Navy and leave for boot camp in August. My husband is in the Army Reserves. We currently have Tricare Reserve Select, but once I join I believe he will fall under my policy since I’ll be active duty. My question is whether it would be more cost effective for him to be under my policy with Tricare Standard, or should he just stay under his TRS policy as the sponsor?
As a drilling reservist, your husband could choose to remain under TRS even after you enter full-time active duty, but that makes little sense for the simple reason that TRS requires payment of monthly premiums on top of any applicable cost-shares and co-pays for care. If you shift your husband under your active-duty military sponsorship, he can be eligible for any of the regular Tricare programs (Prime, Standard, etc.) without having to pay monthly premiums.
To make that happen, once you are on active duty you will have to register your husband under your military sponsorship in the Defense Enrollment Eligibility Reporting System, the Defense Department’s eligibility portal for Tricare. 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.
Once properly registered in DEERS, your husband will be automatically eligible for Tricare Standard. You and he also can choose to enroll in Tricare Prime. For active-duty families, Prime charges no annual enrollment fee, and its out-of-pocket costs are generally lower than under Tricare Standard.
My husband is medically retired from the Army and we currently have Tricare Prime. We are separating shortly, and I will move to a different Tricare region. My understanding is that my Tricare eligibility will end at 11:59 p.m. on the day the divorce is final, as the 20/20/20 rule does not apply in this case. Until then, how do we change our addresses with Tricare? Will I be assigned a new primary care manager in my new region?
There are two entities with a role in your process – the Defense Enrollment Eligibility Reporting System, which is the Defense Department’s eligibility portal for Tricare, and the managed-care contractors for the Tricare regions involved in your situation.
First, as your military sponsor, your husband must notify DEERS of the impending changes in your situation. He can do that by visiting the ID Card/DEERS office on any military installation or by calling the main DEERS support office at 1-800-538-9552.
Transferring Tricare Prime enrollment to a new region is fairly simple. You can get all the information you need from the managed-care contractor for the Tricare region in which you currently live. They can guide you through what you’ll need to do to get set in your new region.
You will be assigned your own primary care manager once you are settled in your new home. And you are correct that if the 20/20/20 rule doesn’t apply to your case, your Tricare coverage ends on the day the divorce becomes final.
My father is a service-disabled veteran rated at 30 percent. His wife just retired from her job. She will be getting Medicare, but does she also qualify for some kind of Tricare?
Unfortunately, your dad’s wife is not eligible for Tricare. Spouses are eligible for Tricare only if they are married to an active-duty service member or a military retiree (a veteran with 20 or more years of active service). Veterans who leave service short of 20 years are not eligible for Tricare.
Veterans with VA disability ratings for service-connected medical conditions may enroll in the Veterans Affairs Department health care system. However, family members of veterans are not eligible for VA health care except in a handful of very narrow, specific circumstances, none of which appear to apply to your dad’s wife. I believe Medicare is her only option.
I am a retired Navy captain who is getting married this June. My fiancee has a 22-year-old son and a 19-year-old daughter, both in college. Will her two children be covered under my Tricare Standard health care once we are married? What will I need to do to make sure they are?
As of the day you tie the knot, your new wife and her children will be eligible for Tricare.
The daughter is eligible for ordinary Tricare for two more years, until she turns 21. If she’s a full-time college student at that time, she’s eligible until age 23. The son is eligible for another year, as long as he remains a full-time college student.
Once they reach age 23, they are no longer eligible for ordinary Tricare. Their only option at that point is Tricare Young Adult, a relatively new program that requires payment of monthly premiums. That coverage is available until age 26, as long as your step-children remain unmarried and dependent on you for more than half of their support.
Once you are married, you need to register your step-children in the Defense Enrollment Eligibility Reporting System, the Defense Department’s eligibility portal for Tricare. You can do that by visiting the ID Card/DEERS office of any military installation or by calling the main DEERS support office toll-free at 1-800-538-9552.
Once your step-children are properly registered in DEERS and have valid uniformed services dependent ID cards, they are authorized to begin using Tricare Standard — no further enrollment steps or other actions are necessary.
I’m a retiree who will turn 65 in September. Can I join the U.S. Family Health Program? Would this transition affect my wife when she turns 65?
The U.S. Family Health Program is a unique Tricare Prime option that operates in six specific areas of the country. Those regional networks are built around former U.S. Public Health Service hospitals that the Public Health Service gave up years ago.
For years, beneficiaries who enrolled in the USFHP could stay in that plan and keep Tricare Prime indefinitely, even when they turned 65 and became eligible for Medicare, when most other beneficiaries are required to shift to Tricare for Life. However, Congress recently ordered a major change to USFHP eligibility. As of Oct. 1, 2012, the USFHP cannot accept any new enrollees over age 65; they must use Tricare for Life. Those over 65 who were already enrolled in the USFHP before that date can stay in that program indefinitely. As such, if you want to get into the USFHP, you have only a few months to look into that before you turn 65 and are permanently locked out of that option.
Otherwise, at age 65 you will shift to Tricare for Life if you intend to continue using military medical facilities for any portion of your health care. One of the bedrock requirements for Tricare for Life eligibility is enrollment in Medicare Parts A and B and payment of the monthly Part B premiums, currently about $100 a month for most beneficiaries.
Under Tricare for Life, Medicare acts as the primary payer on health care claims, and Tricare Standard is an automatic secondary backup payer.
Tricare beneficiaries are strongly advised to sign up for Medicare Part B as soon as they become eligible, because Medicare charges a penalty to those who are eligible for Part B but, for whatever reason, delay enrollment. The penalty is equal to 10 percent of the Part B premium for each year an individual was eligible to sign up for Part B but did not.
All the same guidelines will apply to your wife when she turns 65. She will also shift to Tricare for Life and will have to enroll in Parts A and B and pay the Part B premiums.
My husband is an Army retiree and uses Tricare. I am an Army veteran and a teacher in our local school district. Because we live over 120 miles from the nearest military installation, we have always had myself and our children on my Premera Blue Cross that I purchase through my school district. It has come to my attention that I could also be using Tricare as my secondary insurance. Is this possible?
Yes, it is. By law, Tricare is always last payer to any other insurance. As a Tricare beneficiary under your husband’s sponsorship, you are free to use your employer insurance as primary payer and Tricare as secondary payer. In fact, as beneficiaries under your husband’s sponsorship, you and your children are already eligible for Tricare Standard. Alternately, you may also pay an annual enrollment fee to be covered by Tricare Prime.
Many beneficiaries use other health insurance as a primary payer and Tricare as a secondary payer. In your case, you would file your claims with Premera, and if there are outstanding charges once Premera processes the claim, you may submit them to Tricare.
However, unless there are specific features in the Premera plan that you don’t want to give up, you could just as easily abandon that insurance completely and use Tricare as your primary insurance, just as your husband does. You don’t need to live near a military installation in order to use Tricare; the program maintains a network of private-sector doctors across the nation.
When I turn 65 and become eligible for Tricare for Life and Medicare, will I continue to make Tricare Prime premium payments for my younger wife and family?
Yes, when you transition to Tricare For Life, your family may stay under Tricare Prime, and you would continue to pay the Prime annual enrollment fee and network co-payments.
Your wife may stay in Prime until she also turns 65 and transitions into Tricare for Life. Your dependent children may stay in Prime until they reach age 21, or age 23 if they are full-time college students. At that time, they may transition into a relatively new program called Tricare Young Adult, which carries its own separate premiums, and stay in that program until they reach age 26 as long as they remain unmarried and have no other health care coverage, such as through an employer of their own.
I am an Air Force retiree. After being divorced for 19 years, I will be remarried in August. My fiancée has had her tubes tied, but we would like to try to have a baby together. After we get married, will Tricare pay for her to have her tubes untied? And will it pay for her to become a mom?
I have bad news and good news. Tricare covers voluntary sterilization procedures (vasectomy for men and tubal ligation for women), but it does not cover reversal of these procedures. However, assuming that your bride-to-be has other insurance and can get her tubal ligation reversed on her own, she will be fully covered by Tricare for maternal care, and any children you may have together will be fully covered for their health care needs as well.