Tricare Help

Does my doctor have to accept TFL payments?

Bookmark and Share

Q. If a doctor accepts Medicare payments, does he also have to accept Tricare for Life payments?

If you are a Tricare for Life beneficiary, Medicare makes its payment directly to the provider of care. Then, it automatically forwards the claim to Tricare, which is your free Medicare supplement. Tricare processes the claim using Medicare’s EOB for information about what Medicare paid. For every medical service on the Medicare claim that is covered also by Tricare, Tricare pays directly to the provider whatever Medicare did not pay, up to the amount you owe. As that is an automatic action, the Medicare claim and the provider’s bill are paid in full. As the doctor is paid in full by the automatic combined Medicare plus Tricare payments, it is not necessary for him to “accept” Tricare. He still gets paid in full, and you owe nothing.

Your Tricare EOB will prove that the bill was paid in full. Save it as proof if there is ever a question.

Pay for Prime, or be covered by husband’s TFL?

Bookmark and Share

Q. My husband is retired military and uses TFL. I’m about to retire from active duty myself, with about 36 years time in serve, but I will be only 55 at my retirement date. I’m told I would have to pay around $480 per year to keep my Tricare. But at that point, couldn’t I be considered my husband’s dependent and pay nothing?

To the very best of my knowledge, and based on the information in your letter, there is no reason why you cannot be registered in DEERS as being eligible for Tricare as your retired husband’s spouse.

I recommend that you call the DEERS Support Office, toll-free, at 1-800-538-9552, to confirm your Tricare eligibility and to get help with the administrative things that must be done for your enrollment. DEERS will answer all your questions about Tricare eligibility.

Can my wife keep Tricare if I drop it?

Bookmark and Share

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.

When you’ve already paid Medicare’s copay

Bookmark and Share

Q. I had cataract surgery in both eyes. I have Tricare for Life, and the eyeglasses are covered under Medicare and Tricare. The eye care provider accepts Medicare and I had to pay the 20 percent copay. What happens when Tricare pays? Does the provider keep both payments? Who returns my copay?
 
As both Medicare and Tricare cover one set of eyeglasses following intraocular lens implant surgery, Tricare will pay the provider whatever Medicare did not pay.  It usually takes a couple of weeks for Tricare to pay the provider what Medicare did not pay. 
 
Contact the eyeglass provider for a refund.  Tricare will send both you and the eyeglasses provider an EOB as proof of payment.

What will happen to my coverage after husband dies?

Bookmark and Share

Q. My husband retired from the Navy in 1992.  He is now 80 years old and uses Tricare as secondary coverage for Medicare.  I am still working at age 51.  We have been married since 1988.  Will I remain a military dependent after my husband is no longer alive? If so, will I be eligible for Tricare when I reach Social Security Retirement age?

Unless you remarry, your husband’s death will have no effect on your Tricare eligibility.  If you remarry, your Tricare eligibility under your present husband’s sponsorship will terminate immediately.  If the second marriage ends in divorce or death, eligibility under your present husband cannot be restored regardless of circumstances.

You can ensure that you are properly registered and eligible for Tricare at this time by calling the Defense Enrollment Eligibility Reporting System (DEERS), toll-free, at 1-800-538-9552. If there is a problem, ask DEERS how to fix it.  It is your responsibility to keep your DEERS record and military identification card up-to-date.

If you become entitled to free Medicare Part A at age 65 and enroll in Medicare Part B, you will become eligible for Tricare for Life, or TFL for short.  Under TFL you will have full benefits of Medicare Parts A and B as your primary coverage and Tricare Standard as a free Medicare supplement for all medical services that are covered by both Medicare and be Tricare.  The vast majority of your Medicare claims will be of that type.

Under TFL, if you receive a medical service that is covered by Tricare but is not covered by Medicare, Tricare will process a claim for that item as if it were your only health insurance.  In that case, all Tricare claims processing rules will apply including the Tricare cost share and, if applicable on that claim, the Tricare deductible.

Some people become eligible for free Medicare Part A before they are 65 under a Social Security plan for disabled persons.  If they enroll in Part B, they become eligible for TFL just as if they were 65.  Call the Social Security Administration about Social Security disability benefits.  Social Security cannot give you official information about Tricare or Tricare for Life.

For more information about Tricare Plans, including TFL, please go the official Tricare website. You will also find contact information for your Regional Tricare Office at that site.

Can younger wife get different kind of Tricare?

Bookmark and Share

Q. I am going to get married to a lady who is a lot younger than 65 and was wondering, can I put her on Tricare while I am on Tricare for Life? 

Your wife will become legally eligible for Tricare the moment you are married to her.  Her age and your Tricare for Life eligibility will have no effect of any kind on her Tricare eligibility.
 
Before she can use Tricare, however, you must register her with DEERS and get her a military ID card.  For guidance about doing that, please call the DEERS Support Office, toll-free, at 1-800-538-9552.

Will I still be covered after husband’s death?

Bookmark and Share

Q. My husband retired from the Navy in 1994.  He is now 76 years old and uses Tricare as secondary coverage for Medicare.  I am still working at age 55.  We have been married since 1989.  Will I remain a military dependent after my husband is no longer alive? If so, will I be eligible for Tricare when I reach Social Security Retirement age?

Unless you remarry, you will remain elibible for Tricare/Tricare for Life for the rest of your life.  Your husband’s death will have no effect on your Tricare eligibility.
 
When you become entitled to Medicare and are enrolled in Medicare Part A and Part B, you will automatically become eligible for Tricare for Life under present law.
 
You can confirm the above by calling the DEERS Support Office, toll-free, at 1-800-538-9552.

Important dates for Medicare enrollment

Bookmark and Share

Q. I turn 65 on Sept. 29, 2011.  I’m aware of the 90-day enrollment window for signing up for Medicare Parts A and B in order to ensure timely enrollment in Tricare for Life.  What I’m unclear about is what date to use in counting back the 90 days — my actual birthday, or the first day of September 2011?  For me it makes a difference of almost a full month.

Medicare benefits almost always become effective on the first day of the month of the beneficiary’s 65th birthday.  That said, you need to contact the Social Security Administration in your city and apply for Medicare around the first of June 2011 — 90 days prior to September 1, 2011, when your Medicare Part A and Part B, together with Tricare for Life, will become effective.

Medicare and DEERS share SSN information only (never medical information).  As a result, Social Security is supposed to notify DEERS officially as soon as you are enrolled in Medicare Part B. In that way, DEERS will know to report that you are eligible for TFL effective on September 1, 2011.
 
Sometimes “automatic” things fail, so I suggest that you call the DEERS Support Office near the end of August to make sure SSA notified that office properly about your Part B enrollment.  The toll-free number is 1-800-538-9552.

How will employer’s plan, TFL work for wife?

Bookmark and Share

Q. I am a retired sailor and a federal employee. We have my employer’s health insurance, with Tricare as second payer. My wife is two years older than I am and will be eligible for Medicare this year. How will Medicare, Tricare and my employer’s plan work together for her? What will be the effect on my coverage?

A. At least 90 days before the first day of the month before she turns 65, your wife must apply for Medicare. Because she has Tricare, she is required by federal law to enroll in both Medicare Part A and Part B.

Once she does, she must seek all her care from Medicare providers. Medicare cannot pay for care she receives from a provider who is not authorized to file Medicare claims.

While you are still working for the government, your employer’s plan will remain her primary coverage. She must file first with that plan, just as she does now.

Medicare will be her secondary insurance. And Tricare, by law, is always the last payer. After your federal employees plan and Medicare have processed a claim, she should file a claim with Tricare.

Changes to your wife’s coverage will have no effect on your coverage. You will pass through the same transition when you get Medicare at age 65.

When I get TFL, what happens to my wife’s coverage?

Bookmark and Share

Q. When I am 65, my federal employee plan will convert to Medicare and Tricare for Life. My wife is only 58 and can’t get Medicare yet. Will Tricare be her only insurance?

Your employee plan will not convert to Medicare. Medicare is a separate plan and you must enroll in Part A and Part B at least 90 days before the month when you turn 65.

Both you and your wife will continue to be covered under your federal employees plan, and her Tricare coverage also will continue unchanged.

Your Medicare Parts A and B coverage will become effective on the first day of the month of your 65th birthday. It will be in addition to your federal employees insurance.

If you are no longer working for the government, Medicare will be your primary insurance coverage and the federal employee plan will be secondary. If you are still employed, your employee plan will be primary and Medicare will be secondary.

In either case, Tricare Standard will be your third plan, and you will have to file those claims yourself.