Tricare Help

Employer plan and Tricare, or Tricare and supplemental?

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I am a 60-year-old retiree whose wife is also retired. Our primary coverage is through her former employer, and our secondary coverage is my Tricare Standard. A friend told me that we’d be better off dropping the employer-sponsored plan that costs $390 per month and using Tricare Standard as our primary coverage, with a supplemental plan as a backup.  He said this arrangement will pay essentially the same or more on claims and the supplemental will cost much less than $390 per month. If we drop our current employer-sponsored primary coverage, however, we can’t get it back, since we are retired. What do you think of this idea?

Tricare Help often receives questions like this, but unfortunately there is no definitive answer because the answer will differ for every individual, based on their own unique circumstances and situation. In general, what your friend suggests is probably worth looking into, at least. But you need to shop around for supplementals to get a feel for what they offer, and then you need to carefully compare the costs and benefits of Tricare Standard and a supplemental plan versus your employer coverage with Tricare Standard as a second payer.

One important factor in questions like this is how much health care a beneficiary “consumes” — i.e., whether you and your wife are relatively healthy and don’t need to see doctors that often, or whether you have health conditions that require regular doctor visits and prescription drugs. While Tricare Standard has no enrollment fee, it does charge cost shares and deductibles that may add up over time for beneficiaries who consumer above-average amounts of health care. If that becomes your primary coverage, you could see increased costs from that perspective, although you will have to do your own research to determine how those costs might compare to what you’re paying now under your wife’s coverage.

As you note, if you go with Tricare Standard and a supplemental, Standard will be the primary payer, and the supplemental will be the secondary payer. By law, Tricare is last payer to all other health coverage except in a very few circumstances. One such circumstance is when Tricare is paired with a supplemental plan.

How does Tricare work with our temporary travel insurance?

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My wife and I are Tricare for Life beneficiaries. We are traveling to Europe this winter and realize that while our Medicare will not cover us overseas, Tricare will provide a degree of coverage. We purchased “trip insurance,” which includes a medical portion. The trip insurance says they are the second payer, although I have heard that Tricare is always the second payer by federal law. Which will actually pay first?

You correctly note that by law, Tricare must be last payer to all other health insurance. But there is one exception to that rule: Tricare is first payer to supplemental insurance coverage, a category into which your short-term travel policy falls. Supplemental insurance pays after Tricare pays its portion of the bill, reimbursing beneficiaries for out-of-pocket medical expenses that you paid to civilian providers based on the plan’s policies. All supplemental insurance policies have their own fine print, so you should read your travel insurance policy carefully to make sure you know what it will and will not cover.

You can discuss this further with the managed-care contractor for the Tricare region in which you live. If you contact your managed care contractor, you should also inquire about any emergency guidelines you need to know about while you are outside the U.S.

As your primary coverage while overseas will be the Tricare Standard portion of your Tricare for Life benefit, be prepared to pay up front for urgent or emergency care. You will then have to submit a claim for reimbursement when you return home. Make sure you save all medical bills and receipts to submit with your reimbursement claim. You would file claims through International SOS, the contractor for the Tricare Overseas Program.

Some general tips: Before your trip, make sure that the registry information on you and your wife in the Defense Enrollment Eligibility Reporting System database is accurate and up to date. DEERS is the Defense Department’s eligibility portal for Tricare; you can reach the DEERS main support office at toll-free 1-800-538-9552. Also, while you’re overseas, keep handy the phone number for the Tricare Area Office that covers Eurasia andAfrica. The number is 011-49-6302-67-6314.

Why you shouldn’t worry about those Medicare supplement commercials

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Despite the open season for Medicare being closed, I keep seeing ads for Medicare supplements, Medicare Part D, Medicare advantage, and the like. Those continuing ads make me wonder whether I need any support for my Medicare coverage as the ads suggest. Do I need to bells and whistles the ads keep pushing, or is Tricare for Life really all I need?

Keep in mind that the ads on TV are designed to only sell insurance coverage — more importantly, to sell coverage to the targeted audience, most of whom are civilians.

While civilians may need additional plans such as Medicare supplements or Medicare Advantage plans to have, as some say, complete coverage, that is not a problem for Tricare for Life beneficiaries.

The original Medicare program that most Americans have doesn’t provide full coverage, such as payment of your Medicare deductible, its copayments, or the costs of prescription drugs. Those things are provided free as the Tricare Standard portion of your Tricare for Life coverage. And regarding pharmacy costs, Tricare beneficiaries are automatically enrolled in the free Medicare Pharmacy Program.

Can I upgrade my Tricare Prime?

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I am retired from the Navy and have had civilian medical insurance as my primary coverage and Tricare as secondary. I will soon be retiring again from my civilian occupation. As I am only 55 and my wife is 58, what if anything should I be looking at with regards to a supplement or an upgrade to Tricare Prime?

If you will go to the official Tricare website, you will find a description of each Tricare plan. They do not differ in the medical services they cover, only in the way you get care and amounts of your out-of-pocket expenses.

Tricare Prime, which functions in a way similar to a commercial Health Maintenance Organization, is the least expensive in that way.

There are no Tricare “upgrades” until Medicare can be added to your coverage at age 65 when you can become eligible for the Tricare plan called Tricare for Life. You can explore that plan also at the website.

Note that it is described under provisions of current law. As all Tricare plans are established by federal law, and it is not possible to determine what that plan will be like in ten years when you become eligible for Medicare. Laws are subject to change.

Most of the military associations sell a supplement for Tricare Standard, and it is likely that some also sell a Tricare Prime Supplement. You should request copies of several supplemental policies and read them carefully to determine which one best meets your needs.

With TFL, do we really need a supplemental?

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My spouse and I are both retired military, on Social Security, and we have Medicare Part B and Tricare for Life. For several years we have had a supplemental policy from United Health. But if we have TFL and Part B, do we really need the insurance from United? We wonder if we are paying for something that is already available from TFL.

Nobody but you can decide what health insurance coverage you need. I cannot make that decision for you. But I can tell you the facts about what Tricare for Life offers.

TFL consists of full coverage of all the benefits of Medicare Part A and Part B, plus the full benefits of Tricare Standard without additional cost.

Under TFL, you have full coverage provided by Medicare Part A and Part B. In addition, and as second payer, you have full coverage by Tricare Standard (which is free). Thus, with TFL you have full coverage by two full-service, stand-alone health insurance plans. Either of those plans, by itself, would provide adequate health insurance for an average person’s needs.

Thousands of people have Medicare Parts A and B, or Tricare Standard as their only health insurance. If only one of those is their only coverage, a good supplemental plan to pay the primary plan’s deductibles and copayments is advisable.

Only you can decide whether if, in addition to two full service plans, you need yet another health insurance plan to feel secure in your coverage.

Tips for starting to use Tricare and shopping for supplements

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I am retired from the Army but have never used Tricare. I use health coverage provided by my employer. I will retire in 18 months, however, and my health coverage will end. I will be 58 when I retire. What do I do, and how far in advance should I start converting to Tricare? Do you recommend a supplement?

About 30 days before your last day of coverage by your other health insurance, write to the Tricare Headquarters to advise that you are going to cancel that insurance. The address is Tricare Management Actvity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043. Include your full name, Social Security number, and the full names of any family members who are covered by that plan.

Include with your letter an official statement written by your other plan on its official stationery which states your last date of coverage by that plan. You will need to advise any health care providers as well so they will file appropriately with Tricare.

To use Tricare, your DEERS record must be kept up-to-date and report that you are eligible for Tricare. Please call the DEERS Support Office, toll-free, at 1-800-538-9552 to ensure that your DEERS record is correct and up-to-date so you will have no lapse in coverage. It is most likely that your Tricare coverage is in effect now, provided you have kept your DEERS record and military ID card up-to-date.

People with no health insurance other than Tricare are well-advised to purchase a good Tricare supplement. Most of the military associations sell a Tricare supplement. They vary, however, in their price, what they cover, and their rules for doing it.

I suggest that you request a copy of the policy from several plans and read the fine print carefully. Make sure you buy the plan that best meets your needs and that it is a bona fide Tricare supplement. A bona fide Tricare supplement describes itself as a Tricare supplement in writing in the plan itself. In the policy, look at such things as its policy concerning coverage for pre-existing conditions; how long you must be hospitalized before the plan begins to pay; and whether it has limits on the amount it will pay during a coverage period. Tricare has a helpful list of issues to consider. Do not allow price to be the most important factor in your decision.

What happens to my Tricare Prime when I turn 65?

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How much is Tricare for Life, and do I have to pay for Medicare supplements when I reach 65? (I have Prime now.)

Most Tricare beneficiaries become eligible for the Tricare plan called Tricare for Life (called TFL for short) when they become entitled to free Medicare Part A, are enrolled in Medicare Part B, and are appropriately registered in the database of the Defense Enrollment Eligibility Reporting System, best known by its acronym, DEERS. That usually comes about on the first day of the month when the beneficiary will have his or her 65th birthday.

The Social Security Administration advises potential Medicare beneficiaries to apply for Social Security benefits at least 90 days prior to the first day of the month when he or she will be 65 years old. That gives the agency time to do the required paperwork.

TFL consists of full coverage by Medicare Part A and Part B plus full coverage by Tricare Standard. Beneficiaries registered in Tricare Prime will have that coverage switched automatically to Tricare Standard when they become eligible for TFL. TFL beneficiaries, then, are covered by two full service, high quality federal health benefit plans, each of which acts as a health insurance policy, and one of them is free.

Under TFL, the beneficiary’s primary coverage is Medicare. All care must be received from a provider that is registered with Medicare and is authorized to file Medicare claims for medical services provided to Medicare beneficiaries, as under TFL.

Medicare will process the claim and pay its legally authorized share directly to the provider. That will usually be 80 percent of the amount Medicare approves of the cost of the medical service(s) after satisfaction of the Medicare deductible. The remaining 20 percent is the patient’s copayment.

When Medicare completes processing and pays its share, it will automatically forward the claim to Tricare Standard. For all services that are covered by both Medicare and by Tricare, Tricare will pay the balance on the Medicare claim (whatever Medicare did not pay — usually the patient’s Medicare deductible and copayment). Medicare’s payment plus Tricare’s will pay the patient’s Medicare claim in full. As a result the TFL beneficiary has no out-of-pocket expenses for his or her Medicare- and Tricare-covered medical services. Claims of that type constitute the vast majority of a TFL beneficiary’s health care claims.

If the beneficiary receives care that is covered by only one of his two plans — that is, a service covered only by Medicare or covered only by Tricare — the beneficiary must pay out-of-pocket the part of the claim that plan does not pay. That is, if a service is covered only by Medicare but not by Tricare, as for example, chiropractic care, the patient must pay whatever Medicare does not pay, such as the Medicare deductible and copayment on that particular claim because Tricare, in that case, may pay nothing. Such claims will be uncommon.

Under TFL, the patient is primarily a Medicare beneficiary. He must get all his care from Medicare providers only. As last payer, Tricare will act as a free Medicare supplement. No other supplement is needed. As Medicare Part A is free and Tricare Standard is free, the only cost for TFL coverage is the monthly premium for Medicare Part B. That premium must be paid by all Medicare beneficiaries who are enrolled in Medicare Part B. To learn the premium amount for 2011, call Social Security.

Federal law requires the vast majority of TFL beneficiaries to be enrolled in Medicare Part B. The only people excluded from that rule are certain active-duty family members who become entitled to Medicare under Social Security rules for certain disabled persons.

For official information about a given individual’s Tricare and/or TFL eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552. For information regarding Medicare eligibility, please call the Social Security Administration.

We have TFL; do we need a supplement too?

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Q. My spouse and I are both retired military and on Social Security. We have Medicare Part B and TFL. For several years we have had a supplemental policy from United Health. My question is, if we have TFL do we really need the insurance from United? What happens if United fails to pay; does TFL pick up as a second payer?

Nobody but you and your husband can decide what health insurance coverage you need. I cannot advise you as to what you should do. That is a choice only you can make after considering the alternatives.

Tricare for Life consists of full coverage of all the benefits of Medicare Part A and Part B, plus the full benefits of Tricare Standard without additional cost.

Under TFL, you have full coverage provided by Medicare Part A and Part B. In addition, and as second payer, you have full coverage by Tricare Standard (which is free). Thus, with TFL you have full coverage by two, full service, stand-alone, health insurance plans. Either of those plans, by itself, would provide adequate health insurance for an average person’s needs.

Thousands of people have Medicare Parts A and B, or Tricare Standard as their only health insurance. If only one of those is their only coverage, a good supplemental plan to pay the primary plan’s deductibles and copayments is advisable.

Only you can decide whether if, in addition to two full service plans, you need yet another health insurance plan to feel secure in your coverage.

Can my wife keep Tricare if I drop it?

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Q. I’m over 65 and am enrolled in Tricare for Life. My wife is 63 and enrolled in Tricare Prime. If I decide to drop TFL and go with a private carrier supplement, can my wife continue to be enrolled in Tricare Prime until she’s 65?

Yes. Regardless of what you do, your wife can retain her Tricare Prime coverage until she becomes entitled to Medicare and Tricare for Life, probably at age 65.

Switching to Tricare and shopping for supplements

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Q. I am retired from the Army but have never used Tricare.  I use health care provided by my employer, but in 18 months I will retire and my health coverage will stop. I will be 58 when I retire.  Do you recommend a supplement?  What do I do and how far in advance should I start converting to Tricare.
 
About 30 days before your last day of coverage by your other health insurance (OHI), write to the Tricare Headquarters to advise that you are going to cancel your OHI.  The address is Tricare Management Actvity, 16401 E. Centretech Parkway, Aurora, CO 80011-9043.  Include your full name, Social Security number, and the full names of any family members who are covered by that plan.
 
Include with your letter an official statement written by your other plan on its official stationery which states your last date of coverage by that plan.  You will need to advise any health care providers as well so they will file appropriately with Tricare.
 
To use Tricare, your DEERS record must be kept up-to-date and report that you are eligible for Tricare.  Please call the DEERS Support Office, toll-free, at 1-800-538-9552 to ensure that your DEERS record is correct and up-to-date so you will have no lapse in coverage.  It is most likely that your Tricare coverage is in effect now, provided you have kept your DEERS record and military ID card up-to-date.
 
Those with no health insurance other than Tricare are well-advised to purchase a good Tricare supplement.  Most of the military associations sell a Tricare supplement.  They vary, however, in their price, what they cover, and their rules for doing it. 
 
I suggest that you request a copy of the policy from several plans and read the fine print carefully. Make sure you buy the plan that best meets your needs and that it is a bona fide Tricare supplement.  A bona fide Tricare supplement describes itself as a Tricare supplement in writing in the plan itself.  In the policy, look at such things as its policy concerning coverage for pre-existing conditions; how long you must be hospitalized before the plan begins to pay; whether it has limits on the amount it will pay during a coverage period.  Do not allow price to be the most important factor in your decision.