Military Health, Tricare programs - Army Times

Tricare Help: Can I still go with an HMO?

Q. When I turn 65, what options do I have other thaen Medicare Part B? How can I continue to use Tricare Prime? Are there any HMOs I can use instead of Medicare Part B?

A. Federal law requires all retirees and retiree family members to be enrolled in Medicare Part B on the effective date of their Medicare coverage, or they will immediately lose all Tricare eligibility, including the pharmacy benefit.

Retirees and family members with Medicare are not eligible for Tricare Prime; they immediately switch to Tricare Standard on the date their Medicare coverage becomes effective. A retiree or family member with Medicare parts A and B and Tricare Standard then becomes a member of Tricare for Life.

If you prefer to receive medical care through an HMO, contact Medicare and ask about its Medicare Advantage plans. You will still be required to enroll in Part B, however.

If you enroll in a Medicare Advantage plan, call Tricare for instructions for filing Tricare claims for your out-of-pocket expenses under that plan.

Q. I have Tricare for Life, and I live part of each year in Mexico, where Medicare won’t pay. If I can find a Mexican doctor who will accept my Medicare insurance, can I file Medicare claims to cover part of the cost?

A. It isn’t an issue of finding a foreign doctor who will accept Medicare. The issue is that Medicare cannot pay for medical care received outside the U.S.

Under Tricare for Life, you have two full-coverage, stand-alone policies: Medicare and Tricare Standard. As the Tricare Standard portion of Tricare for Life provides coverage worldwide, you can file Tricare claims for foreign medical care, but those claims will be processed as if you did not have the additional Medicare coverage. You will pay the same deductible and cost shares as you did before you got Tricare for Life.

Q. Several other wives have been telling me that they know about women who got a breast enlargement or a nose job done at a military hospital. Is that true? If so, which military hospitals do those operations?

A. While some military hospitals perform such surgeries as resources allow, Tricare does not cover surgeries like breast implants and nose jobs. Tricare covers only reconstructive surgery that is necessary due to injury or illness, such as the restoration of a body part after an accident, or reconstructive surgery after a mastectomy.

You can find more information, including specific covered procedures, by visiting www.tricare.mil/mybenefit/home/Medical/IsItCovered.jsp and selecting “Reconstructive Surgery” on the drop-down menu.

It started with a rumor that a hospital, somewhere, had reservists who were plastic surgeons on its staff. Presumably, they performed those surgeries to “keep in practice” during their brief active duty tours.

It’s sort of like the e-mail story that says, “Quick, forward this to everybody you know — Congress is going to abolish Tricare!”

Everybody with a little time on his meter has heard where rumors get started, and it’s not in the orderly room.

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Write to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or tricarehelp@atpco.com. In e-mail, include the word “Tricare” in the subject line.