Tricare Help

Can disabled veteran’s wife get Tricare?

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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.

When getting care from both VA and Tricare, who pays?

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I’m a retiree over 65 with Medicare, Tricare for Life, and a disability that rates free care from VA. I get my routine medical care through VA, and they diagnosed me with cancer several months ago. I elected to use Tricare for the radiation treatments since the VA hospital is far from my home. My doctor prescribed a drug he wanted me to take right away. I applied to the VA to fill the prescription, but in the meantime I purchased a two-week supply at a local pharmacy. With whom should I file a claim to get reimbursement for my out-of-pocket payment for the drug? VA has since approved me for the drug and is providing it through their pharmacy.

If the retail pharmacy you used had been a Tricare network retail pharmacy, it should have covered the cost at the time you filled the prescription, without making you submit a claim. The fact that it did not, and left you to file a claim for reimbursement, leads me to believe it was what Tricare calls a non-network retail pharmacy.

Assuming you are not enrolled in a Medicare Part D prescription drug plan (which you don’t need under Tricare for Life, especially since you are also eligible for VA care), you should file for reimbursement with Express Scripts, Tricare’s prescription drug contractor. Contact Express Scripts toll-free at 1-877-363-1303 for more information on filing a claim.

Can disabled vets’ grandchildren get Tricare coverage?

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I am a 100 percent permanently disabled vet. Are my grandchildren eligible for Tricare?

Veterans are not eligible for military health care through the Defense Department unless you served at least 20 years in uniform or you received medical disability retirement short of 20 years of service. If you meet either of those criteria, you and your spouse, if you have one, are eligible for health care under the Defense Department’s Tricare program, as are any children up to age 21, or up to age 23 if they are full-time college students. After those ages, children are eligible until age 26 for a program called Tricare Young Adult, which charges monthly premiums.

Only the military services can make Tricare eligibility determinations; Tricare itself has no authority to do that. Grandchildren generally are not eligible for Tricare coverage unless they are legally adopted by the grandparent/military sponsor, although in some circumstances it’s possible grandchildren may be deemed eligible if the grandparent becomes their legal guardian.

Of course, if your disability is service-related, you are eligible for health care through the Veterans Affairs Department. However, family members are not eligible for VA health care.

You can get more information on your potential eligibility for military health care coverage under Tricare by contacting the Defense Enrollment Eligibility Reporting System support office at (800) 538-9552.

DEERS is the Defense Department’s eligibility portal for Tricare.

Will Tricare cover treatment for mesothelioma?

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After a 30-year Navy career, I have been diagnosed with mesothelioma. I will require surgery and follow up at a distant hospital. We will have to pay for lodging for my surgical recovery and subsequent radiation. Will Tricare Standard cover any of this, or am I on my own?

Tricare generally covers all medically necessary procedures for qualified beneficiaries, including those related to treatment for mesothelioma.
You should be aware that mesothelioma is a condition that may entitle individuals to premium-free Medicare Part A even if they are under age 65, the normal Medicare eligibility age. If you are eligible for Medicare because of your mesothelioma, you can enroll in Medicare Part B and qualify for Tricare for Life, even if you are under age 65.

In addition, assuming you can provide documentation that your condition is a result of your military service, another option for you would be Veterans Affairs Department health care.

Your first move should be to contact the managed-health care contractor for the Tricare region where you live. They can give you more information and guidance.

Can I keep Tricare after leaving the Guard?

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I am currently in the process of being released from the National Guard. I had been on active duty. I have a permanent injury to my shoulder and also suffer from post-traumatic stress disorder. Are there any federal statutes that allow me to keep my Tricare after I have been discharged, even if I have to pay like I do now for Tricare Reserve Select?

Unfortunately, once you are out of the military, you are no longer eligible for Tricare unless you accumulated enough creditable service time to qualify for military retirement benefits.

There is a program called the Continued Health Care Benefit Program that is designed to be a bridge for separating service members until they get set up in their civilian lives and obtain health care coverage through an employer, but CHCBP is quite expensive.

However, if your shoulder injury and PTSD are related to your military service, you are eligible for health care from the Veterans Affairs Department. You can visit any VA Medical Center or clinic to apply for enrollment, or you can apply online.

Between VA and Tricare for Life, I think I’m paying too much

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I am a retiree enrolled in Medicare Parts A and B, and I also have Tricare For Life. I do not use Medicare; instead, I use a VA Medical Center near my home. I an in VA enrollment priority category 8, the lowest priority, so I am billed co-payments for my visits. The VA hospital will not bill TFL and as a result I’m not receiving any benefits from my TFL, even though I am paying $100 a month in premiums for Medicare Part B, which I need to be eligible for TFL. VA hospitals in other parts of the country do bill TFL. Mine won’t do it because they say they have no Tricare agreement. I don’t think it’s fair that I have these co-pays.

As you note, in certain areas of the country, VA medical facilities may become authorized Tricare network health care providers. But there is no requirement for a VA facility to do that. However, I believe the reason you were given for having to pay costs shares – that your particular VA facility is not part of a Tricare agreement – is incorrect. According to the Veterans Health Administration Handbook, TFL-eligible beneficiaries using VA medical facilities may receive all Tricare covered services, but VA services provided through TFL are always subject to cost-sharing requirements, such as applicable annual deductibles and cost shares.

“The amount of the required cost-share payment assessed to the DoD TFL beneficiary depends on the status of the VA facility as a Tricare network or non-network health care provider,” but VA cannot, in either instance, waive TFL beneficiary out-of-pocket cost shares, the handbook states. In other words, the co-pay may vary depending on the VA facility’s Tricare status, but there would be some co-pay either way. Here is the relevant section of the VHA Handbook.

All that said, I don’t think it’s fair to say that you’re getting no benefit from TFL. While you may have co-pays, those charges are far lower than the actual costs of the medical services you receive through your VA facility. What you’re not getting any benefit from is Medicare, for which you are paying $100 a month in Part B premiums. Since you are in VA’s Category 8, the lowest-priority category for care, and are already paying for Medicare Part B, you may want to consider simply using Tricare For Life. To do that, you need to find a Medicare provider. Under TFL, in most cases, Tricare will pay for whatever Medicare does not, fully covering your medical costs on the vast majority of your claims.

Can I switch from VA care to Tricare?

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I am a retiree with a 100 percent disability. I have been getting all my medical care through the VA, but they are driving me crazy with delays. Plus, the nearest VA medical center is more than 200 miles away. How can I switch from VA care to Tricare?

The primary qualifying condition for a former uniformed service member’s Tricare eligibility is entitlement to retired, retainer, or equivalent pay. Many retirees with service-connected disabilities opt for equivalent pay in the form of a pension from the Department of Veterans Affairs in lieu of retired pay from their uniformed service. The amount of the VA pension is often greater.

To determine your Tricare eligibility, contact the DEERS Support Office at (800) 538-9552. Be prepared to tell them all the appropriate dates and numbers.

My understanding of the rules regarding a transfer of your coverage from Veterans Affairs to Tricare is that it is an administrative matter that you must resolve through the Department of Veterans Affairs. There may be special circumstances due to your 100 percent disability rating.

In essence, the rules say that a beneficiary must choose whether to receive care through Veterans Affairs or Tricare, but not both, for the same medical condition.

Getting care under Tricare may be more expensive than under Veterans Affairs auspices because of Tricare’s deductible and cost shares. Unless you have a Tricare supplement, or qualify for Tricare for Life by being entitled to Medicare, you could have to pay up to $3,000 out-of-pocket each fiscal year for those items.

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How do we know if we’re eligible?

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My husband is a disabled Army vet and he cannot seem to tell me what Tricare is or if he can get it. I understand it is some kind of insurance. Could we be eligible for it?

There are two programs for which you might be eligible.

You wrote that your husband is a disabled vet. Depending on his disability rating from the Veterans Affairs Department, you may be eligible for care through the VA. If his rating is “100 percent, permanent and total,” he may qualify for free VA medical care for the rest of his life, and his wife and unmarried children under age 18 would be entitled to the program called CHAMPVA.

Alternatively, if your husband is entitled to receive retired pay, he and his family may be entitled to Tricare.

For official information regarding your husband’s Tricare eligibility, he should call the DEERS Support Office, toll-free, at 1-800-538-9552. He must call, himself. Due to provisions of the Privacy Act, that information cannot be given to another person.

Another source of public information regarding Tricare eligibility is at the official Tricare website.

Marrying a veteran who gets VA care; will I be eligible for Tricare?

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My fiancé served 3 years active Army and 3 years Army reserves back in the 80s. Most recently he served 6 years in the National Guard and his enlistment was up last in September of 2011. He is 40 percent disabled has medical coverage from the VA. I am an independent contractor and am not eligible for employer-sponsored health insurance. When we get married, would I be eligible for any health insurance, either through Tricare or another option?

The information you provide leads me to think that your fiancé did not serve long enough in a uniformed service to be eligible for Tricare. In that case, neither would you, as his spouse, meet the legal criteria for Tricare eligibility. To confirm that, however, and for official information about your and his Tricare eligibility, please call the DEERS Support Office, toll-free, at 1-800-538-9552.

Why can’t Tricare and Medicare pay for VA care?

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Q. I just turned 65 and am enrolled in Medicare parts A and B. Where I should go for my future medical care? I know I can use Medicare and TFL will pay second. But I have a service connected disability – glaucoma – and receive all my glaucoma-related care at the VA at no cost. Is there a benefit for me to get all my medical care from the VA? Can the VA bill Medicare and TFL?

The short answer is that TFL cannot pay for care you receive from VA. You should get most of your care from Medicare providers, and see the VA only for your glaucoma care. Here’s why.

Tricare for Life consists of full benefits under Medicare Part A and Part B as your primary insurance, plus Tricare Standard as your free Medicare supplement. You must seek all your medical care from Medicare providers first. A Medicare provider is a health care provider who is registered with Medicare and is authorized file Medicare claims for care rendered to Medicare beneficiaries.

The provider will file a Medicare claim for his services. Medicare will pay its share directly to the provider. Then, Medicare will automatically forward the claim to Tricare which will pay whatever Medicare did not for every service on the Medicare claim that is covered also by Tricare. That will usually be your Medicare copayment and, if applicable on that claim, your Medicare deductible. You will have nothing to pay on those claims. Your care will cost you nothing.

Occasionally it is possible to get a medical service that is covered only by Medicare or only by Tricare. In those cases, the other plan will pay nothing, and you will have to pay any copayments or deductibles for the plan that does pay. That kind of claim is not common. The vast majority of your Medicare claims will be paid in full by the combination of Medicare’s plus Tricare’s payments.

The VA will usually charge you for medical care it provides for non-service connected conditions. In those cases, you will have to pay what the VA does not, because the VA cannot file claims with Medicare and not usually with Tricare. You are better off getting all care from Medicare except the free care for your service-connected condition.

Not all providers will see Medicare patients. When you call for an initial appointment, always tell them that you are a Medicare beneficiary and ask whether the provider sees new Medicare patients. Do not say that you have Tricare for Life. Most providers won’t know what that program is or how it works.

If they ask whether you have other health insurance or a Medicare supplement, tell them it is Tricare. With that information on the Medicare claim form, Medicare will know to automatically forward the claim to Tricare as second payer.

Related: Can Tricare cover me at VA center?