Tricare Help

Can I get dental under Tricare for Life?

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I am retired military. In the next few months I plan to retire from my full-time job with my local government, where I have dental insurance along with my other medical coverage. When I retire, all that coverage will cease. The only one I am concerned about continuing is the dental insurance: Does Tricare For Life offer dental insurance coverage for my wife and myself? If so, what is the monthly premium, and can it be deducted from my military retired pay?

Tricare dental benefits for military retirees have been provided under a contract with Delta Dental of California since 1998. The plan has a network of more than 100,000 civilian dentists and provides coverage under “basic” and “enhanced” plans in all 50 states, the District of Columbia, U.S. territories and Canada.

There is an annual deductible of $50 per person, up to a cap of $150 total per family. The annual maximum benefit is $1,200 for most covered services, Diagnostic and most preventive services don’t count toward deductibles and maximums.

Premiums are based on five pricing regions and the enrollee’s ZIP code, are adjusted each May 1. In Charleston, S.C., for example, the monthly premium for one person is $35.36, for two people $68.93, and for a family of three or more, $114.64. When you first enroll, you must prepay two months of premiums in advance. Initial enrollment is for 12 months, and then you have the option to continue on a month-to-month basis.

Not only can the monthly premium be deducted from your retired pay, but federal law actually requires such deductions for retirees.

You can find out much more about the program at its official website, www.trdp.org.

Under 20/20/20 rule, will she lose her Tricare if she marries me?

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You have said a former spouse must be married to the same uniformed service sponsor for at least 20 years during which the sponsor accrued military retirement credits. In other words, the sponsor’s active duty and the marriage must have overlapped by at least 20 years. But in another instance, you’ve also said that a spouse’s coverage is not affected by the death of the sponsor, and that the duration of the marriage is not a factor. I have been seeing a lady who is divorced from a military retiree and has Tricare for Life coverage under his name. I am also a military retiree with TFL. I have been told that if we married and I died before her, she already would have lost Tricare benefits through her ex-spouse, and also from me, since we would not have been married for 20 years. Can you advise?

The two situations you cite in your letter involve two distinct sets of circumstances. One situation involves a former spouse, the other involves a current spouse whose retiree sponsor dies.

The so-called “20/20/20 rule” comes into play in divorce cases involving military retirees. A former spouse may retain Tricare benefits after divorce if the marriage lasted 20 years, the military member served on active duty for at least 20 years, and the marriage and active-duty service overlapped for at least 20 years. A former spouse who meets those criteria may retain Tricare coverage for the rest of her life, under one significant condition: she does not remarry. If she remarries, she loses Tricare eligibility under her former husband’s sponsorship. Once lost, it can never be restored under the retiree sponsor’s name, even if the former spouse’s second marriage ends in divorce or death.

The other situation you cited involves a spouse whose military retiree sponsor dies before her. In this case, the 20-year rule does not apply, for the simple reason that they were not divorced. A spouse covered by Tricare whose retiree sponsor dies before her remains eligible for Tricare for the rest of her life, regardless of how long the marriage lasted — again, unless she remarries. If she does, she loses Tricare eligibility for good under that sponsor’s name.

How this applies to your specific situation: If you and your lady friend marry, she would indeed lose eligibility under her divorced husband’s Tricare for Life sponsorship. However, if you were to properly register her in the Defense Enrollment Eligibility Reporting System (DEERS) as your wife, she would then become eligible for Tricare for Life coverage under your sponsorship. If you die before her, but are still married at the time of your death, she would remain eligible for Tricare under your sponsorship. Regardless of how long you had been married, the 20-year rule would not apply if the marriage was still intact at the time of your death. But again, she would lose her coverage under your sponsorship if she were to remarry again.

If you and your lady friend do marry, your first step should be to contact the DEERS support office toll-free at 1-800-538-9552 to get started on registering her for Tricare coverage.

If Tricare and Medicare cover everything, why do I still get billed?

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I have been married for 55 years to a military retiree. You have said many times that when a medical service is covered by both Medicare and Tricare, Tricare acts as a secondary payer and will pay whatever Medicare does not. So I don’t understand why, when I go to the doctor, I receive a bill. On my last doctor’s visit, I was billed $84.07 as my balance. Other times, it has been more. What am I doing wrong?

You state correctly that Tricare acts as a second payer to Medicare. Usually, the Medicare provider will forward your paperwork directly to Tricare to resolve any outstanding balance for the services you received. However, note that I said usually … in certain circumstances, beneficiaries themselves must file the second claim with Tricare. This occurs most often when the health care provider does not formally participate in Tricare (i.e., he/she is not a “Tricare-authorized provider”).

It should be noted that a very limited number of health care services are covered by Medicare but not Tricare, and vice versa. From the documentation you sent me, I can’t say for sure if that is the case in this instance.

I would suggest a couple of things here. First, contact your provider and explain to them that you are married to a military retiree and that you are both eligible for Tricare for Life military health care coverage, then ask whether they forwarded the unpaid portion of your bill to Tricare, and if not, why not.

Then I would gather up copies of all the documentation you received from your provider, including the detailed Explanation of Benefits that they should have sent you, and file a claim yourself with Tricare for the unpaid balance.

Here’s how you file a claim with Tricare as second payer:

    • Complete a Tricare claim form DD2642.
    • Attach a copy of the same itemized bill that was sent to the other plan.
    • Attach a copy of the other plan’s EOB reporting its processing of each of the charges on that bill.
    • Send the claim to the proper Tricare claims processor for the state where you live.

The claims form and all pertinent information about filing Tricare claims is available online.

What do we pay when one spouse switches from Prime to TFL?

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I will turn 65 in 2014. My husband won’t turn 65 until 2021. I know I must sign up for Medicare Part B at $99.90 per month and will enroll in Tricare for Life. Will I have to continue to pay the annual Tricare Prime fee at the family rate so my spouse will still be covered until he reaches 65? And once he can get Tricare for Life, will we each have to pay $99.90 per month?

Once you become eligible for Tricare for Life, your spouse can continue in Tricare Prime, and you should be able to shift from the family rate to the individual rate for him. Once your spouse turns 65, you will both have to pay the monthly Medicare part B premium; that cost is a standard rate per individual.

For the most definitive response to these kinds of eligibility questions, you should contact the Defense Enrollment Eligibility Reporting System (DEERS) support office, toll-free, at 1-800-538-9552.

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.

Doctor wants to see Tricare for Life card; where can I get one?

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Several times I’ve had doctor’s office give me a blank look when I tell them my health insurance is Tricare for Life. They say they’ve never heard of it, and they want to see a Proof of Insurance card. Where can I get such a card?

Under Tricare for Life, your primary insurance is Medicare. I know it seems awkward when you know you are a Tricare beneficiary, and your health insurance is called Tricare for Life. But look at it this way. Under TFL, Tricare acts as a free Medicare supplement.

Providers usually don’t care which Medicare supplement you have because they will look to you for payment of what Medicare does not pay. What you owe is your 20 percent Medicare copayment and maybe some Medicare deductible. Whether you have a supplement to pay it for you, or whether it comes out of your own pocket, you, the patient, are responsible.

So, when asked about your health insurance, just say you have Medicare. That’s the important word. If they ask about a Medicare supplement, then you can say you have Tricare.
TFL doesn’t have an identification or proof-of-insurance card because. Just show your Medicare card and your military ID card.

And, any time you go to a new provider of any health care service, whether it’s a doctor, or a hospital, or a physical therapist, or a medical supply and equipment vendor, or anything related to health care, always ask if the provider files Medicare claims, before you incur a debt.

If a provider does not, or cannot file Medicare claims, it is an indication that the provider is not an authorized Medicare provider. That doesn’t mean there is something wrong with the provider. It means, however, that neither Medicare nor Tricare will pay for any services you get from that provider.

I know divorce ends eligibility, but what about death?

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I have read that Tricare for Life will end for a spouse who divorces a sponsor. My question, is will my wife still have her eligibility if we are still married and I pass away?

If your wife is eligible for Tricare at the time, your death will have no effect on her eligibility. Unless she remarries, she can continue to have Tricare coverage for the rest of her life.

Do we both have to pay for Medicare Part B?

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I retired from the Air Force in 1996. Next month I will turn 65. Since my retirement I have been enrolled in Tricare Prime. I recently signed up for Medicare including Medicare Part B. I was told I will now have to pay Medicare premiums of $99.90 per month. Is this true? My wife will turn 65 in April. Will we have to pay an additional $99.90 per month for her coverage or is the premium per family?

The Tricare plan called Tricare for Life consists of the combination of Medicare Part A and Part B coverage, plus complete coverage by Tricare Standard. Tricare Standard acts as a free Medicare supplement and pays for most of the things Medicare does not cover – at no additional cost to you.

The total cost to the beneficiary for TFL is the monthly premium for Medicare Part B. The other two parts of TFL, Medicare Part A and Tricare Standard, are free. Note that you will no longer have to pay the Tricare Prime enrollment fees.

Like all Medicare Part B beneficiaries, your wife, also, will have to pay its monthly premium.

What happens to wife’s coverage if I die before 60?

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I am a 57-year-old gray-area reservist. What will happen to my wife’s Tricare and Tricare for Life eligibility if I die before I am 60?

The death of the military sponsor has no effect on the Tricare or Tricare for Life eligibility of family members.

On your 60th birthday, you will become entitled to retired pay. If you submitted the required applications through your reserve component, you and your family will become eligible for Tricare.

If you die before that time, your eligible survivors will become Tricare beneficiaries on the day you would have turned 60, again contingent upon proper application through your reserve component.

If your widow remains unmarried, if her Defense Eligibility Enrollment Reporting System registration is up to date, and if she is enrolled in Part B of Medicare, she will become entitled to Tricare for Life when her Medicare entitlement begins at age 65.

Can disabled adult son get Tricare and dental coverage?

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I am a retired, 100 percent disabled Navy officer. I have a 41-year-old son who is disabled and receives SSDI from Social Security. Does he qualify for Tricare and dental coverage?

To begin an inquiry concerning the possibility of your disabled son’s Tricare eligibility, please call the DEERS Support Office, toll-free at 1-800-538-9552.

If your son is determined to be entitled to Tricare, and if he is enrolled in free Medicare Part A, and in Medicare Part B, he will be entitled to the Tricare program called Tricare for Life. To use TFL, he must be properly registered in DEERS.

Under TFL, Medicare Parts A and B becomes the beneficiary’s primary health insurance, and Tricare Standard, as second payer, acts as a free Medicare supplement. The TFL beneficiary, thus, has coverage by two, full-service, stand-alone health “insurance” plans. The second plan, Tricare Standard, is provided without additional cost.

Under TFL, the vast majority of the beneficiary’s medical expenses will be paid in full by the combined coverage of Medicare plus Tricare. The only cost for Tricare for Life coverage is the monthly premium for Medicare Part B. That is somewhat more than $100 per month in 2012.

Tricare does not have a dental benefit. It does, however, provide for enrollment in a commercial dental insurance plan available to Tricare beneficiaries at group rates. There is a plan for active-duty personnel and their Tricare-eligible family members, and there is a similar plan for retirees and their families. You can get more information about the Tricare Retiree Dental Plan here.