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Benefit overview

The military’s Tricare health care system uses a combination of military hospitals, clinics and civilian professionals to treat service members, retirees and family members of both.

Tricare Prime
Prime is the military’s health maintenance organization. It offers lower out-of-pocket costs but restricts an individual’s choice of providers and facilities. Since the wars in Iraq and Afghanistan started, however, there is less available space for retirees to enroll in Prime at many military facilities.

Tricare Extra
Extra is a preferred-provider option, a system that contracts with health-care providers to supply services at discounted fees. Doctors and other providers agree to join a network and see Tricare patients. Extra does not require enrollment or charge premiums. It is an option for Tricare Standard patients, allowing them to lower their costs by using a provider in the Tricare network.

Tricare Standard
Standard is modeled after a traditional fee-for-service health plan. Authorized doctors, hospitals and other providers are paid a specific amount for each service performed. Individuals may choose doctors, but they pay more than they would under other Tricare plans. Also, certain procedures require pre-authorization. For civilian doctor visits, co-payments are a percentage of the allowable charge. Retirees pay 25 percent; all other eligible beneficiaries pay 20 percent.

Tricare for Life
Medicare and Tricare each play a role in health coverage for retirees. Most military retirees are eligible for Medicare at age 65. Medicare Part A covers hospitalization and sometimes nursing home and at-home care. Medicare Part B is an enrollment program for people who are at least 65 and for those who are disabled. Coverage is paid through monthly premiums. The plan covers physicians’ fees, lab fees and other costs.

Tricare Plus
Tricare Plus allows military beneficiaries who aren’t in a health maintenance organization to enroll at a military clinic or hospital for primary care only. They don’t pay a fee and can’t be guaranteed specialty care there. But they are seen according to the same access standards as are Prime patients. Enrollment capacity varies by each clinic or hospital, so enrollment isn’t portable to another facility. The program is managed locally.

Dental, active-duty families
Active-duty dependents and members of the Selected Reserve and Individual Ready Reserve and their family members worldwide are eligible for Tricare Dental Program coverage. Participation is voluntary, and costs vary.

Dental, retirees
Military retirees and their families are eligible to join the Tricare Retiree Dental Program. Eligible members include retired service members entitled to retired pay; members of the Retired Reserve who would be entitled to retired pay but are under age 60; spouses and eligible children of enrolled members and certain non-enrolled members; Medal of Honor recipients and eligible family members; and un-remarried surviving spouses and eligible children of deceased members.

Programs in the military health system and the Department of Veterans Affairs are available to military families with disabled members. A special Tricare initiative called the Program for Persons with Disabilities pays up to $1,000 per month for medical care not otherwise available to some military dependents who are mentally retarded or have serious physical disabilities. The program carries several limitations:

Home health
Tricare offers home health care benefits, including coverage of medical equipment, supplies, certain therapies and nursing care to homebound patients whose conditions make home visits medically necessary.

Tricare covers maternity care, including prenatal care, delivery costs, inpatient care of the newborn and mother, and care of the baby immediately after birth. Inpatient and outpatient delivery is covered.

Mental health
Each of the services has psychiatrists, psychologists and social workers to help with mental health and emotional issues. Therapy programs at military installations range from individual, marriage and group counseling to Al-Anon for relatives of alcoholics.

Pharmacy program
Military beneficiaries can get drugs free at pharmacies at military clinics or hospitals. For a fee of $3 for a generic and $9 for a brand name, they can get a 30-day supply at participating Tricare retail stores.

Supplemental insurance
For military families, supplemental insurance plans are available to pick up expenses left after Tricare pays its share of covered benefits.

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Tricare Terms
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Guard and reserve families

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Retired families

Tricare for life
Medicare and Tricare each play a role in health coverage for retirees. Most military retirees are eligible for Medicare at age 65. Medicare Part A covers hospitalization and sometimes nursing home and at-home care. Medicare Part B is an enrollment program for people who are at least 65 and for those who are disabled. Coverage is paid through monthly premiums. The plan covers physicians’ fees, lab fees and other costs.

Medicare/senior care
Most military retirees become eligible for Medicare health benefits when they turn 65. Some, however, qualify for Medicare much earlier because they have certain disabilities. In either case, Tricare will help pay the balance of medical bills after Medicare has paid its portion.

Veterans benefits
Most military retirees, as well as veterans who did not stay in the military for a full career, must apply for enrollment in the Department of Veterans Affairs health system to receive VA health care under the Uniform Benefits Package. Enrollment applications can be obtained through the nearest VA care facility’s benefits office or by calling toll-free (877) 222-8387.

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Contractors and subcontractors contact numbers

Tricare regions, contractors and contact information
Tricare, the military’s health care program, is divided into three U.S. coverage areas and one overseas area. Each area has a regional contractor that manages the program.

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Tricare Help Hamby's columns

Tricare Help: ID cards are not required for Tricare for Life
Q. When Tricare for Life started, it issued an identification card so a patient could show the doctor he was eligible. Not anymore. Most doctors and their staffs don’t know about Tricare for Life and insist on seeing an “insurance card.” Why doesn’t Tricare for Life go back to issuing ID cards?

Tricare Help: Spread the good word about Tricare
I’ve mentioned several times recently how important word-of-mouth is for telling people they may be eligible for Tricare or Tricare for Life. My concern is that there are many widows, divorcees and elderly people who are eligible but don’t know it. Some may be in desperate need of drugs or medical care they can’t afford.

Tricare Help: Tricare plans differ by where you’re treated
Q. I’m a veterans service officer, and I’m confused when I try to advise veterans regarding Tricare. There is Tricare, Tricare Standard, Tricare Prime, Tricare for Life, Tricare this and Tricare that. How many Tricares are there, and who is eligible for what? Can you explain it to me, or tell me where to find out?

Tricare Help
Q. I know Medicare can’t pay for overseas care, and prescription drugs aren’t covered unless you enroll in a commercial Part D plan. Are there other things Tricare pays for but Medicare does not? Both plans belong to the government, and they were created at about the same time and for the same purpose. So why are there differences in what they cover?

Tricare Help
Q. You should be ashamed to write in your column that everybody should tell everyone they know, especially the elderly, widows, divorcees with children and the like, that certain people may be eligible for Tricare or Tricare for Life and not know it, or not know how to contact the program.

Tricare Help: Similar claims may not mean similar approvals
Q. A short while back, you wrote that Tricare sometimes will cover a medical service for one beneficiary, while another beneficiary getting the same service for the same condition could have a claim denied. I think I understand the reasoning behind that policy, but would you please clarify the rules?

Tricare Help: Tricare won’t cover unproven weight-loss drugs
Q. My doctor says I need to lose maybe 100 pounds. The problem is that he wants to do surgery to make my stomach smaller. I’m scared to death to have the surgery. And I know there are medicines to help people lose weight, so why won’t Tricare pay for them? If I do have the surgery done, will Tricare pay?

Tricare Help: Be sure to call ahead when leaving your region
Q. I was pregnant when my husband was deployed. I went to my sister’s house in another Tricare region so I wouldn’t be alone with my other children when the baby came. I’m under Tricare Prime, so I chose a Tricare-approved provider for my prenatal care and delivery at my new address. Then I started getting bills for my medical care. Tricare took out another deductible and is paying only half the bills. I called and was told it was because I was enrolled in Prime in a different Tricare region. My doctors knew I was leaving and even gave me my medical records to take with me. Why didn’t they tell me this was going to happen?

Tricare Help
Q. My Tricare claim was denied, so I called to complain. The woman who answered the phone was of no help. Tricare is supposed to pay claims for medical care, so why won’t it honor mine?

Tricare Help: Tricare for Life nonpayments uncommon
Q. Your recent column about Tricare supplements didn’t address existing problems with Tricare for Life, a program that leaves much to be desired. I recently had radiation treatments for prostate cancer. My bill came to $18,000, and after Tricare for Life paid, I was still stuck with $1,700. So please enlighten me about a Tricare supplement that would pay the balance left after Tricare for Life pays.

Tricare Help: How to investigate your ex-wife’s Tricare claims
Q. My wife and I divorced in 2005. She is no longer entitled to my Tricare benefits, but I think she may still be using them. I asked Tricare, but staff members refused to tell me anything, citing the Privacy Act. Now what do I do?

Tricare Help: Tricare for Life is lowest priority at military hospitals
Q Since I retired from the Air Force, my wife and I have had Tricare Prime most of the time. Now, I’m approaching 65 and Tricare for Life. I’m told I can’t stay under Prime once I’m in Tricare for Life. I also heard that without Prime, I’ve got a snowball’s chance of being able to get care at my nearby military hospital. What do you think?

Tricare Help: Many factors figure into Tricare’s share of bill
Q. I’m retired from the Navy and working for the government. I have a federal employee health insurance policy and Tricare is second payer. Assume I file a claim for $1,000 and the health insurance policy pays $600. How much will Tricare pay?

Tricare Help: Different SSNs help Tricare handle multiple ex-spouses
Q. My second wife, now ex-wife No. 2, has Tricare because of the 20 years we were married when I was on active duty. Now I plan to get married again. I want my new wife to be registered in the Defense Enrollment Eligibility Reporting System and to have Tricare coverage without any hassles.

Tricare Help: Tattoo removal probably not covered by Tricare
Q. My son has gone back to college and will graduate next year. While he was out “doing his thing,” he got some tattoos. Now he’s afraid they will interfere with his ability to get a job after he graduates. Will Tricare pay anything to have them removed?

Tricare Help: Tricare, but not Medicare, extends overseas
Q. My wife and I are planning a second honeymoon to Italy, where we met and were married 60 years ago. We both have Tricare for Life. How should we prepare for our medical care in case we need it while overseas?

Tricare Help: Tell Tricare ASAP if you lose other coverage
Q. A couple of years ago, my wife had just quit her job and lost the health insurance we’d had for several years. A few weeks later, my next Tricare claim was denied because I didn’t file first with my other health insurance. I didn’t think to notify Tricare that my wife’s policy had been canceled. The policy was still reported in our Tricare record as being in force. You need to tell other folks about that little problem so they don’t forget like I did.

Tricare Help: How to determine your spouse’s eligibility
Q. I have Tricare for Life. But my wife, who will be 65 in October, doesn’t have enough work quarters to qualify for Social Security or Medicare. Is there any way I can get her on Tricare for Life when she is 65?

Tricare Help: Here’s the full lowdown on DEERS
Q. I hear a lot about DEERS. What is it, and do I need to join? I am a 59-year-old reservist who will become eligible for retired pay, Tricare and — I presume — DEERS in August.

Tricare Help: Medicare eligibility still is 65
Q. As I understand it, my Tricare eligibility will end at age 65. My problem is that I won’t be eligible for Social Security and Medicare until I am 65 years and (I think) 8 months old. What am I supposed to do for eight months, hope I don’t get sick?

Tricare Help: Tricare benefits beat Medicare Part D
Q. It’s me again, the guy with the brother-in-law who knows everything. Now Sam has me worried about the Medicare Part D prescription drug plan. Sam says if I don’t enroll before May 15, my coverage won’t be effective until Jan. 1, 2007. And he said that if I wait too long to enroll, I’ll have to pay a penalty on the Part D premium for the rest of my life. Is he right?

Tricare Help: Initial Tricare for Life claim can be tricky
Q. I turned 65 on Dec. 16. Everything went just like you say it should: I got my Medicare ID card showing I was enrolled in Part A and B, effective Dec. 1. And as I did not cancel my Part B enrollment, I knew I had Tricare for Life as of that date.

Tricare Help: Tricare for Life will pick up on payments
Q. Medicare for 2006 has a cap on the amount it will cover for treatments such as physical therapy. Under Tricare for Life, will Tricare pick up where Medicare leaves off?

Tricare Help: ‘Ordinary’ pharmacies may not know Tricare
Q. You’ve written many times that under the Tricare Pharmacy Program, I can go to a drugstore and get a 30-day supply of medicine for $3. So why, when I went to my drugstore for my wife’s medicine, did the pharmacist charge me $37 and say he had never heard of a Tricare plan for $3?

Tricare Help: Tricare covers only medically necessary dental procedures
Q. I’ve been told that Tricare covers dental care, and I’ve been told it doesn’t cover dental care. I’ve been told Tricare covers dental care sometimes but not others, and that Tricare covers dental care for some people but not for others. I’m confused.

Tricare Help: Gauging a beneficiary’s ‘legal debt’ is complex
Q. When talking about coordinating benefits with other health insurance, you refer to a beneficiary’s “legal debt.” What is that?

Tricare Help: Leaving Medicare Plan D isn’t difficult
Q. You warned us not to sign up for the new Medicare Part D prescription drug coverage, but I’m one of those people who has to learn everything the hard way. You may remember that I’m the guy with a brother-in-law who knows everything. He tells me that now that I’m enrolled in Part D, I’m stuck for a whole year before I can get out. He was wrong last time. How about this time?

Tricare Help: ‘Prime’ puzzle for benefits coordination
Q. I retired recently and went to work for the government. I have federal employees’ health insurance and Tricare Prime. I’ve had nothing but problems, and it’s expensive. What do you think about my dropping Tricare and getting a supplement for my employee insurance?

Wife’s Tricare remains until she remarries
Q. I’m in my mid-50s and planning to marry. I will qualify for reserve retirement and Tricare when I am 60. My coming marriage leads me to some questions about my wife’s future well-being. If I die before I turn 60, will my wife still get Tricare when she is 60? What if I die after I am 60? Will she lose her Tricare eligibility then? How long do we have to be married for her to qualify for Tricare for Life when she is 65?

Lying on your Tricare claim form is fraud
Q. You’re going to think I’m crazy, but I’ve always wondered about something. I figure you’re probably a safe person to ask, but I still won’t sign my name. Here’s my question. The Tricare claim form asks if I have other health insurance, and I always report my other policy. But, if I didn’t report it, I could collect from both policies and offset some things that don’t get paid. So, please satisfy my curiosity. What are my chances of getting caught if I don’t report the other policy, and what would happen if I did?

Resolve to spread news about Tricare programs
I’ve seen many changes in CHAMPUS/Tricare in the past 25 years. And I have also seen some persistent problems that have defied remedy, despite the efforts of the Defense Department’s Office of Health Affairs.

You must file first with Medicare
Q. I’m a Navy retiree who works for the government, divorced, with no children. I’ll be 65 a year from now, and I’ll retire again. I have the federal employees’ health insurance coverage, with Tricare as a supplement. When I get Medicare and Tricare for Life next year, I plan to go with TFL only. Do you think it will provide enough coverage?

ID office likely correct to deny dependent’s card
Q. When I took my daughter for her new ID card, we had her university registrar’s certificate proving she would be enrolled as a full-time student through Dec. 9, 2005, when the quarter ends. The post’s ID card section would certify her Tricare eligibility only through Dec. 9. It was only two weeks more until her 23rd birthday, on Dec. 23, and I know she will lose her Tricare eligibility then. Why was Tricare so picky about only two more weeks?

If sponsor quits, family can’t keep coverage
I’ve heard from several readers who have questions about their coverage under the Federal Employees Health Benefits Program, or FEHBP. In the case of couples with no children, coverage by the FEHBP became an unnecessary expense when one of the spouses became entitled to Medicare and Tricare for Life.

You cannot escape your cost share
Q. My son was in the hospital. Although the bill was about $4,000, Tricare overpaid the hospital with a check for more than $7,000. Then, the hospital sent me a bill for $800, saying it was my cost share. The Tricare explanation of benefits agrees with those figures, but I refuse to pay more until I know why the hospital was paid nearly double what it billed and someone explains to me why I must pay still more.

Medicare Part D is not required for retirees
Q. My brother-in-law knows everything. He said an insurance agent told him that insurance companies have millions invested in Medicare Part D programs. The agent told him that if enough people don’t sign up for Medicare Part D in 2006 so they can earn their money back, their buddies in government will make Part D mandatory starting in 2007. Do you think there’s anything to that?

TFL might be a better deal than federal plan
Q. I’m a military retiree and a federal employee. My wife and I are enrolled in the Federal Employees Health Benefits Program, but she will be 65 in February and eligible for Tricare for Life. I’m debating whether to continue her on the FEHBP or switch her to Tricare for Life. I haven’t been able to find a clear definition of the benefits under that program. Can you help?

Tricare for Life should ease care worries
Q. When I retired from the military, I didn’t enroll in Tricare Prime because it was not available where we lived. Now, my company is going to move us close to a military hospital. I know that retirees get turned away from military hospitals every day because they are not enrolled in Prime, and I plan to enroll my wife and myself as soon as we get settled in our new house. My wife and I are the same age (born in the same month), so what will happen in four years when I retire at age 65, and we both become eligible for Medicare?

Third-party liability check is standard policy
Q. My 13-year-old daughter wanted to go skating at the park and asked me to go with her. I used to be a pretty good skater, so it seemed easy to grab my son’s skates and go.

VA plan may help ex-wife regain coverage
Q. My wife was married to her first husband for more than 25 years. After he died, she was able to keep her Tricare coverage as his widow. She lost her Tricare coverage from her first husband when she married me, but she got it back right away because I’m retired Army.

DoD still lacks alternative to Social Security number
Q. I’ll be eligible for Tricare for Life next May when I get Medicare. I know I must enroll in Part B. My wife is several years younger than me. Although she never served in the military, she became eligible for Tricare when I turned 60. Will she also become eligible for Tricare for Life when I do at age 65?

Use caution when picking Rx plan
Several times in the past few months, I have responded to questions from Tricare for Life beneficiaries regarding the new Medicare Part D prescription plan, reporting to you the sparse information I could glean from various sources.

You can file claims yourself if need be
Q. My wife has been referred to a high-powered, big-city surgeon. He wants nothing to do with any government program, so he does not participate in Medicare or Tricare. He will not file claims, either. My wife’s only health insurance is Tricare for Life. What can we do?

New contractor may order reauthorization
Q. We recently moved to a new Tricare region. I have been receiving respiratory therapy for more than a year for sleep apnea. The equipment was covered by my previous Tricare contractor with no problems once it was approved and authorized. Now the new regional contractor tells me can’t continue the therapy without going through the testing and authorization process again.

Looking for tricks? Check the fine print
Q. I got an offer for very cheap cancer insurance that will pay me $100 per day when I am hospitalized for cancer. How would that policy affect my Tricare for Life coverage? Is it on the up and up?

Some reservists can get Tricare Reserve Select
Q. Some members of my unit will be demobilizing and going back to their reserve status. They will want to join Tricare Reserve Select. Few of us know anything about it or how to join.

All authorized providers don’t participate in Tricare
Q. What is the difference between an authorized provider and a participating provider?

Drug price hikes not taken lightly
Q. I’m concerned that the new $22 price category for some Tricare drugs is a stealth approach to a general price increase. Some wag called Viagra a “recreational drug,” and a couple of months later, Viagra ends up in the higher price category. Is that somebody’s idea of humor? Erectile dysfunction is a serious medical condition that deserves proper consideration and treatment.

DEERS is a database, not a benefit
Q. Is DEERS a Tricare supplement? How much does it cost, and what do I need to do to sign up?

Part B necessary to keep care
Q. My 59-year-old wife receives Social Security Disability Insurance payments. In October, she will become entitled to Medicare. We are now under Tricare Prime. Will she have to sign up for Medicare Part B now, or can she wait until she is 65?

Medicare drug plan voluntary — for now
Q. Can you please explain the Medicare Part D prescription drug benefit and whether it will remain voluntary or become mandatory for participation in Tricare for Life’s drug plan?

You may have to wait for care at military hospital
Q. When I turned 65 and got Tricare for Life, my military hospital told me I wouldn’t be able to get care there anymore. I always thought retirees had a lifetime guarantee of free medical care at military hospitals. What went wrong?

Medicare required for Tricare eligibility abroad
Q. When it passed the Tricare for Life law, was it the intent of Congress that military retirees living overseas pay both the Tricare Standard premium and the Medicare Part B premium?

To ‘opt out,’ don’t file a claim
Q. Can a military retiree “opt out” of Tricare?

Tricare for Life pays most costs, but not all
Q. I had health insurance from my job and took it with me when I retired. Now I’m going to become eligible for Tricare for Life. You have written that Medicare plus Tricare will pay all my medical bills in full. Can I cancel my employer’s health insurance policy and rely on Tricare for Life to pay all my bills for the rest of my life?

Forgiving cost share can get a doctor into legal trouble
Q. Tricare won’t allow my doctor to “forgive” my cost share any longer. If it’s his business and his bill, how can Tricare interfere? Why does it matter to Tricare?

Prime-TFL is ‘apples, oranges’ comparison
Q. What is the difference between Tricare Prime and Tricare for Life? Both seem to pay all your medical expenses and Tricare Prime is cheaper.

Deployed reservists must enroll kids
Q. My daughter and her husband are reservists. They are going to be deployed, and we’ll have their children while they are gone. What do we have to do to use Tricare for the children’s medical care?

Don’t assume Medicare enrollment is automatic
Q. I am 62 and retired from the Army. Tricare Standard is second payer to my civilian employer’s health insurance policy. I was told that I am automatically enrolled in Medicare Part B. As I didn’t apply for it, I don’t know when that happened, or even if it is true. I know I must be enrolled in Part B to continue with Tricare when I am 65, but beyond that, I don’t understand what is going on or what I am supposed to do.

Catastrophic cap puts limit on expenses beneficiary must pay
Q. What is the Tricare catastrophic cap and how does it work? Are pharmacy co-payments included in the cap?

Foreign pharmacy benefits limited
Q. I’m retired in Mexico, and I’m having problems with my Tricare pharmacy benefits. Can you tell me what kind of pharmacy coverage I have in Mexico?

Tricare for Life requires you meet 5 criteria
Q. In June, I will turn 65 and get Tricare for Life. My wife won’t be 65 until November. Will she get Tricare for Life when I do, or does she have to wait until she is 65?

Active-duty members enjoy some perks over retirees
Q. Active-duty family members get preferential Tricare coverage over retirees and our families. That’s discrimination. We made our own sacrifices in serving our country, and we did it for 20 years. Why is Tricare allowed to discriminate against retirees?

Military hospitals collect from multiple coverage
Q. Why does my military hospital require me to have a card saying I have other health insurance?

Two plans cover most of TFL bill
Q. You write that Tricare for Life will pay for the “vast majority” of my health care. What does “vast majority” mean? Why doesn’t Tricare for Life pay the whole bill all the time?

Overseas move will affect your Tricare for Life
Q. I plan to retire in Germany in the near future. What coverage can I expect from Tricare for Life and Medicare? Other than my disability pension, what coverage can I expect from the Department of Veterans Affairs?

Osteopathic therapy is a covered service
Q. You wrote that Tricare refuses to pay for chiropractic services for retirees. Some military hospitals provide chiropractic services, and I read that Department of Veterans Affairs hospitals will do the same.

Coverage will stay intact in small town
Q. My husband and I have Tricare for Life. We plan to move to a small town, but none of the doctors there want to take Tricare — although they all take Medicare. We’ve been told we will need to drive almost 70 miles for medical care. What can we do?

Health plan doesn’t require Medicare Part B
Q. My wife and I are enrolled in the Uniformed Services Family Health Plan. I have heard we can continue our membership after age 65 without having to enroll in Part B of Medicare. Is that true? How does it work?

At times, doctor may order brand-name drugs
Q. Why does Express Scripts require people to take only generic drugs? I’ve heard generics are not as good as the real thing. I’d be glad to pay $9 for brand names rather than $3 for second-best. Why does my doctor have to go through a song and dance for me to get good medicine?

Specialist care for birth defect can be covered
Q. My son has a birth defect. He has had several surgeries and has been attended by specialists since birth. I’m a retired reservist who will turn 60 next year, and my family and I will become eligible for Tricare. Can my son receive care from his same specialists under Tricare?

Medicare determines how much you owe
Q. I’m still confused about Tricare for Life payments. My doctor charged me $400 for his services. Medicare paid only $240 and sent the claim to my supplement, which paid $60. I sent both explanations of benefits to Tricare, which refused to pay anything. It said Medicare and my other health insurance had paid in full.

Reasons unclear for excluding chiropractic care
Q. Medicare pays for chiropractic services. Why doesn’t Tricare?

Switch at age 65 automatic if your records are current
Q. I will be 65 and eligible for Medicare in July. I started drawing Social Security payments when I was 62. What do I need to do to start Medicare when I am 65, and how do I enroll in Part B?

Tricare Help
Q. I received emergency treatment in a German hospital. When I was discharged, the doctor gave me a prescription, which I had filled at a local pharmacy. I am concerned that Tricare won’t pay for it because it is not an American drug approved by the Food and Drug Administration. What can I do if that happens?

Tricare Help
Q. I’m concerned that part of the information you reported in your Dec. 6 column is incorrect. You wrote that an active-duty service member has a 120-day grace period to report the birth of a child to the Defense Enrollment Eligibility Reporting System. You failed, however, to report that the rule was to change Jan. 1.
(For subscribers only)

Tricare Help
Q. My wife is five years older than I. She will turn 65 early this year. She didn’t work enough quarters to qualify for Medicare in her own right. Does she have to enroll in Part B of Medicare when she is 65 to continue to have Tricare? Or will she lose her Tricare eligibility until she qualifies for Medicare under my entitlement in 2010? Tricare plus a supplement is our only health insurance.
(For subscribers only)

Right steps can keep coverage uninterrupted
Q. My wife is five years older than I. She will turn 65 early this year. She didn’t work enough quarters to qualify for Medicare in her own right. Does she have to enroll in Part B of Medicare when she is 65 to continue to have Tricare? Or will she lose her Tricare eligibility until she qualifies for Medicare under my entitlement in 2010? Tricare plus a supplement is our only health insurance.

You still have 120 days to add child to coverage
Q. I’m concerned that part of the information you reported in your Dec. 6 column is incorrect. You wrote that an active-duty service member has a 120-day grace period to report the birth of a child to the Defense Enrollment Eligibility Reporting System. You failed, however, to report that the rule was to change Jan. 1.

If payment is denied, file appeal
Q. I received emergency treatment in a German hospital. When I was discharged, the doctor gave me a prescription, which I had filled at a local pharmacy. I am concerned that Tricare won’t pay for it because it is not an American drug approved by the Food and Drug Administration. What can I do if that happens?

Participating providers save on costs
Q. I’m confused by the idea of participating versus nonparticipating providers. I thought all providers who see Tricare patients were participating providers.

Amount allowed vs. amount paid
Q. You wrote that Tricare does not pay less than Medicare, but that’s not true. Tricare really does pay less. How do you account for that?

Activated reservist can register family for health benefits
Q. I am a reservist who will deploy soon. My family is supposed to become eligible for Tricare when I go on active duty. How do I make that happen?

Dispelling payment myths
Q. I have heard from several sources that the reason doctors won’t see Tricare patients is that the program pays so little. The sources claim Tricare usually pays much less than Medicare — sometimes less than half as much, and often even less than Medicaid. What are the facts?

Ex-spouse should clarify eligibility for benefits
Q. My former husband is a retired reservist. When he applied for retirement benefits, he reported me as his wife, not his ex-wife. I have a valid military dependent’s ID card, showing me to be eligible for Tricare. My former husband insists that our divorce has no effect on my eligibility for military benefits because we were married when he earned them. I have serious doubts about that. What can I do?

Tricare Help
Q. This is a composite of many letters I have received. I replied to them individually, but there appears to be enough confusion to warrant public treatment of the issue:

Citizenship not needed for Medicare
Q. I am the widow of a retiree and have a valid military dependent’s ID card. I have worked in this country for more than 30 years. Now, I am nearing age 65 and Tricare for Life entitlement. I was told I will not become eligible for Medicare because I am a German citizen. Is that true? How will that affect my Tricare for Life entitlement?

Denied charges don’t apply to cap
Q. You wrote that Tricare will not cover many of the charges for nursing-home care. Won’t Tricare cover the charges after they exceed the Tricare catastrophic cap of $3,000?

Think it’s fraud? Report it
Q. I am retired from the Army. I want to report Tricare for Life fraud. How can I do that?

Tricare must await Medicare appeals
Q. If Medicare denies a claim under Tricare for Life, Tricare denies it, too, even if the service is otherwise a Tricare benefit. How am I supposed to handle this?

Back to top


Staying in Tricare at 65 requires Medicare Part B

Tricare Help

Staying in Tricare at 65 requires Medicare Part B

November 13, 2006 Issue
Army Times

By James E. Hamby Jr.
Special to the Times

Q. I’ll be 65 in January, but I want to hold off enrolling in Medicare Part B. I plan to work for a few more years and I have free health insurance from my job as long as I continue to work. Medicare says I don’t have to enroll in Part B for as long as I work and have insurance through my employer.

If I use plain Tricare as a supplement to my employer’s health insurance like I do now, I won’t need Part B or Tricare for Life. I very seldom have anything more to pay after Tricare pays, and I’m sure it’s less than Part B would cost. What do you think?

A. Two rules involving Medicare Part B enrollment are sometimes confused. One is a Medicare rule; the other is a Tricare rule. Although both deal with Part B, their effects are unrelated.

• The Medicare rule concerns deadline dates for Part B enrollment and the penalty for late enrollment, when a person becomes entitled to Medicare Part A. It concerns the amount of one’s Medicare Part B premium only.

• The Tricare rule concerns the requirement for Part B enrollment when a Tricare beneficiary becomes entitled to Medicare Part A. Failure to enroll in Part B causes loss of Tricare eligibility until the beneficiary enrolls in Part B.

The rule described in your letter as part of your plan is a feature of Medicare law. It establishes times for Part B enrollment that depend on the Medicare beneficiary’s work status with an employer that provides health insurance. It also establishes the penalty amount for late enrollment according to that “work rule.”

If we omit the Medicare Part D pharmacy program that Tricare beneficiaries don’t need anyway, Medicare consists of two basic programs: Part A, hospital insurance, and Part B, medical insurance.

In general terms, Part A covers services a hospital provides, such as room and board, nursing services and use of radiology and laboratory facilities. Payment must go to the hospital.

Part B covers doctors’ and other individual providers’ services. Payment is sent to the doctor or other individual provider.

To learn the details, call Medicare at (800) 633-4227 or go to the official Medicare Web site at

Medicare Part A is free. When a person enrolls in Part A, he has a grace period for enrolling in Part B. If he misses the deadline for Part B, he will have to pay a penalty on his Part B premium for the rest of his life.

However, if the person has “creditable” health insurance — meaning coverage at least as good as Medicare — through employment, enrollment may be delayed without penalty for as long as the person continues to work for that employer.
That is a Medicare rule. It relates only to the premium penalty for late enrollment in Part B. It is unrelated to Tricare.

Here is the Tricare rule you overlooked that will keep your plan from working: The 1966 law creating what now is called Tricare contains a provision that applies to all Tricare beneficiaries except active-duty family members; it says Tricare beneficiaries who become eligible for Part A of Medicare cannot keep their Tricare eligibility unless they also enroll in Part B. And there is no grace period.

You will become entitled to Medicare Part A at age 65. You will not incur a Part B late-enrollment penalty for as long as you work for an employer that provides creditable health insurance. But you will lose all Tricare eligibility if you are not enrolled in Part B on the date your Part A coverage becomes effective.

One second into the first day of the month of your 65th birthday, your Defense Enrollment Eligibility Reporting System record will be changed automatically to report you as ineligible for Tricare. The only way to prevent it is to be enrolled in Part B at that moment.

Without Part B of Medicare, you will be ineligible for Tricare. But your Tricare eligibility will be restored automatically as soon as DEERS receives official notification you are enrolled in Part B.

When you are enrolled in both parts A and B of Medicare and eligible for Tricare, you have coverage under the program called Tricare for Life.

If you are still working at that time, your employer’s health insurance will be your primary coverage. Medicare parts A and B, not Tricare, will be your secondary health insurance. Tricare will be your last payer on claims, as required by law.

When you are no longer working, Medicare parts A and B will become your primary health care coverage.

James E. Hamby Jr. may be reached by writing to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or by sending e-mail to In e-mail, please include the word Tricare in the subject line and do not attach files. If using regular mail, please include an e-mail address if possible to prompt a faster response.


Below listed TRICARE Fact Sheets are available online at (last update included in parens)

If you would like to receive TRICARE fact sheet updates via E-Mail, you may subscribe



o "Early" TRICARE Benefit for Some Activated National Guard and Reserve Members and
Family Members (06/07/2006)

o Certificate of Creditable Coverage (02/03/2004)

o Chiropractic Care Program (07/19/2004)

o College Students and TRICARE (08/26/2004)

o Defense Enrollment Eligibility Reporting System (DEERS) (10/26/2005)

o ECHO Home Health Care (EHHC) (09/28/2005)

o Extended Care Health Option (ECHO) (08/18/2005)

o Generic Drugs (06/15/2006)

o Health Insurance Portability and Accountability Act and TRICARE (12/09/2004)

o Identity Theft Victims: First Steps to Safeguard Your Information (08/15/2006)

o New TRICARE Retail Pharmacy (TRRx) Program Begins (06/02/2004)

o Newborn, Adoptees and Pre-Adoptees: DEERS Registration and Prime Enrollment

o Next Generation of TRICARE Contracts (08/01/2002)

o Patient Safety and TRICARE (02/27/2004)

o Skilled Nursing Facility and Long-Term Care (10/05/2006)

o Supplemental Insurance (11/16/2005)

o The Women, Infants and Children (WIC) Overseas Program (10/05/2006)

o Transitional Assistance Management Program (01/06/2005)

o TRICARE Appeals (11/02/2004)

o TRICARE Catastrophic Cap (09/18/2006)

o TRICARE Dental Program (01/30/2006)

o TRICARE Dental Program Survivor Benefit (07/27/2005)

o TRICARE Eligibility (06/08/2006)

o TRICARE For Life and Medicare (10/20/2005)

o TRICARE for Medal of Honor Recipients and Eligible Family Members (05/17/2005)

o TRICARE Global Remote Overseas & Puerto Rico Prime Benefit (05/07/2004)

o TRICARE Mail Order Pharmacy (09/05/2006)

o TRICARE Maternity Care Options (04/20/2005)

o TRICARE Online (03/28/2006)

o TRICARE Overseas Program (TOP) Standard (06/19/2006)

o TRICARE Pharmacy Program (10/24/2005)

o TRICARE Plus (09/14/2006)

o TRICARE Prime and Non-Medical Attendant Travel Entitlements (05/05/2005)

o TRICARE Prime Point-of-Service Option (09/20/2006)

o TRICARE Prime Portability (09/20/2006)

o TRICARE Prime Remote (03/21/2003)

o TRICARE Providers (09/22/2004)

o TRICARE Regional Contractors For the United States (09/18/2006)

o TRICARE Reserve Family Demonstration Project (11/16/2005)

o TRICARE Reserve Select (TRS) Tier 1 Coverage for Selected Reserve Members

o TRICARE Reserve Select (TRS) Tier 2 Coverage for Selected Reserve Members

o TRICARE Reserve Select (TRS) Tier 3 Coverage for Selected Reserve Members

o TRICARE Retiree Dental Program (07/26/2005)

o TRICARE Standard (01/24/2006)

o TRICARE Survivor Benefits for Active Duty Family Members (08/09/2005)

o TRICARE Vision Benefits (06/07/2006)

o TRICARE: The Basics (06/11/2003)

o TRICARE´s Notice of Privacy Practices (04/11/2003)

o Uniformed Services Family Health Plan (09/12/2006)

o Unremarried Former Spouses (URFS) Information (12/02/2004)

o Using the TRICARE Dental Program Overseas (03/08/2005)

o What Happens to My Benefit When I Retire (08/25/2006)

o Where Should Your Outpatient Medical Records Be Stored? (01/12/2004)



Tricare information now housed under one Internet roof

American Forces Press Service
Tricare beneficiaries will get a surprise the next time they visit Tricare Online. The Web site has a new name, a new look and a new home. It's now part of, the official Web site for all Tricare information.

"We reorganized the Web site with our beneficiaries in mind," said Army Maj. Gen. Elder Granger, deputy director, Tricare Management Activity. "Now they can go to one site to look up benefit information, schedule an appointment or track claims. Everything's in one place, making the site easier to use." comprises five main content areas:

-- My Health (Tricare Online) -- personal health information and online appointment scheduling for Tricare Prime enrollees;
-- My Benefit -- Tricare benefit information;
-- MHS Staff -- resources for Military Health System staff members;
-- Tricare Providers -- information for Tricare network providers; and
-- Pressroom -- the latest news about Tricare and the military health system.

In the next phase of Web site improvements, beneficiaries will be able to enter their profile and receive benefit information tailored to them. Tricare expects this feature to be available in winter of 2007.

Related Sites:

TRICARE FOR LIFE = Top 10 "Need to Knows"

TRICARE for Life: Top 10 "Need-to-Knows"

More Info

Sharpen Skills at TRICARE University

TRICARE for Life: Top 10 "Need-to-Knows"

If you’re nearing retirement, transitioning health care coverage shouldn’t be a hassle. As you’re preparing to switch to TRICARE for Life (TFL), the following facts and tips will help you make a seamless transition to TRICARE for Life (TFL) coverage.

Enroll in Medicare Part B when first eligible.
TFL enrollment hinges on enrollment in Medicare Part B. You must remain enrolled in Medicare Part B (medical care) in order to maintain TRICARE eligibility.

Keep DEERS up to date.
Although Medicare provides data to DEERS, you must maintain your TRICARE eligibility by keeping DEERS up to date any time there is a life changing event, like becoming eligible for Medicare. Contact DEERS online at or call toll-free 1-800-538-9552.

Enrollment in TFL is seamless.
If you are receiving Social Security benefits, you will transition smoothly to TFL upon your 65th birthday; if you are not receiving Social Security benefits at the time of your 65th birthday, you will need to visit the nearest Social Security office and enroll in Medicare.

Medicare authorized providers are also TRICARE authorized.
You can visit any Medicare provider for care since all Medicare providers are also TRICARE authorized. Simply show your Medicare card and Uniformed Services ID card at your appointment.

Claims are paid automatically between Medicare and TFL.
As a TFL beneficiary, you will not need to submit a paper claim when you have a doctor’s visit (in most cases). The provider will submit the claim to Medicare. Medicare will then submit the claim to TRICARE once the Medicare portion is paid.

TFL is considered a second payer to Medicare.
For services covered by Medicare and TRICARE, Medicare will pay its portion of the claim and TRICARE will pay the remainder. For services that are covered by Medicare and not by TRICARE (such as chiropractic care) TRICARE will not make a payment and the beneficiary will be responsible.

Services covered by TRICARE but not Medicare (such as overseas claims) may be billed directly to Wisconsin Physicians Services (WPS) and TRICARE will pay as primary insurer. You will be responsible for any cost shares. Payments for services that are not covered by either program remain your sole responsibility.

Other health insurance (OHI) coordinates differently with TFL and Medicare.
TFL beneficiaries who have OHI need to submit their Medicare Summary Notice with a paper claim and OHI explanation of benefits (EOB) to Wisconsin Physician Services. The paper claims may be sent to:

Wisconsin Physician Services
TRICARE for Life
P.O. Box 7890
Madison, WI 53707-7890

Enrollment in Medicare Part D is not necessary.
The TRICARE pharmacy benefit is considered creditable coverage and pays equally to Medicare.

TFL beneficiaries may continue to use any of the TRICARE pharmacy programs.
You may fill prescriptions at any military treatment facility pharmacy, through the
TRICARE Mail Order Pharmacy or through any TRICARE network or non-network pharmacy.

TRICARE coverage continues for eligible family members after the death of a sponsor.
Surviving spouses remain eligible for TRICARE unless they remarry. If they remarry, they lose TRICARE eligibility and cannot regain eligibility later, even in cases of divorce or death of the new spouse. Unmarried surviving children remain eligible for TRICARE until their 21st birthday (or 23rd birthday if enrolled in college full time and if at the time of the sponsor’s death, the sponsor provided more than 50 percent of the child’s financial support.) For more information on TRICARE for Life, please visit or call Wisconsin Physicians Services toll-free at 1-866-773-0404.



Sharpen Skills at TRICARE University

Would you like to learn more about your TRICARE benefits in a convenient, interactive way? Service members and their families can take advantage of "TRICARE University," which includes three complimentary online training courses as part of its curriculum.
Learn more about TRICARE basics, TRICARE Reserve Select benefits and more.


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