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Tricare Help: Will Tricare cover patient's other co-pay?

Jan. 19, 2012 - 03:33PM   |   Last Updated: Jan. 19, 2012 - 03:33PM  |  
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Q. If Tricare is secondary to a commercial insurance, will Tricare pay the primary insurance's co-payment? Our medical practice treated the child of a parent who gave Health Alliance insurance as a primary carrier and Tricare "Active Duty Family Member" as the secondary insurance. The parent refused to pay the primary insurance co-pay and stated Tricare will pay the co-pay when Tricare is billed.

A. By federal law, Tricare is always last payer to all other health insurance. In most cases, Tricare will pay whatever the patient's other coverage did not pay for covered services, up to, but not more than, the amount of the Tricare allowance. Usually, that will include payment of the patient's co-payment and deductible.

Here's how to file the Tricare claim and be paid directly:

• Complete and sign a proper claim form, accepting assignment of benefits.

• Attach a copy of the same bills as were submitted to the other plan.

• Attach a copy of the other plan's explanation of benefits.

• Send to the proper Tricare claims processing contractor.

For mailing instructions or help with the claim, http://www.tricare.mil/claims">click here.

Information specifically for providers — or those who want to become one — can be found by http://www.tricare.mil/providers">clicking here.

Q. I will turn 65 in February and am in the process of enrolling in Medicare Parts A and B. Besides Tricare for Life, do I need to buy other insurance, such as Medicare Part C? My husband is a military retiree.

A. Once they become eligible for free Medicare Part A and are also enrolled in Medicare Part B, Tricare for Life beneficiaries also retain their eligibility for Tricare Standard. As second payer to Medicare, TFL acts as a free Medicare supplement. TFL beneficiaries, therefore, are covered by two full-service, stand-alone health insurance plans.

Part C, the Medicare Advantage plans, are add-ons to the original Medicare plan that are designed for civilians who do not have your free Medicare supplement. With Tricare Standard, you do not need the Part C add-ons.

You also should not enroll in the Medicare Pharmacy Program, called Part D, because you, like all Tricare beneficiaries, are automatically eligible for the free Tricare Pharmacy Program. Plus, enrollment in Part D will prevent your use of Tricare Mail Order Pharmacy plan, where the big savings come in. If you use the mail order plan, you can get a 90-day supply of drugs for the same price that you would pay locally for a 30-day supply.

Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@militarytimes.com?subject=Tricare%20Help:%20Will%20Tricare%20cover%20patients%20other%20co-pay?">click here to send an email. In email, include the word "Tricare" in the subject line and do not attach files. Get Tricare advice anytime http://www.militarytimes.com/tricarehelp">on our blog.

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