Military Health, Tricare programs - Army Times

Tricare Help: Is TFL like Medigap? Not quite

Q. I was told that under Tricare for Life, Tricare Standard serves as a Medigap policy. Medigap plans are lettered A through L. Which one is Tricare in Tricare for Life?

A. Medigap policies supplement Medicare by providing services in addition to the original Medicare plan. But that’s not the way Tricare Standard operates for Tricare for Life beneficiaries.

Under Tricare for Life, Tricare does not add covered services to your Medicare coverage. Instead, for medical services covered by both Medicare and Tricare, it pays your Medicare deductible and co-payment.

All Tricare for Life claims must be filed with Medicare first.

If there is a service on the Medicare claim that is not covered by Medicare but is covered by Tricare, Tricare will process that particular charge as if it were your only health insurance. You must pay any Tricare deductible and cost share for that medical service.

One example is an elastic stocking prescribed if your ankles swell. Medicare cannot pay for it, but Tricare can.

A claim must be filed first with Medicare. Medicare will deny payment and forward the claim to Tricare, which will pay the amount allowed less your Tricare deductible and cost share.

If there is a charge on the Medicare claim for a service that is covered by Medicare but not by Tricare, Tricare will pay nothing. You must pay any Medicare deductible and co-payment yourself. An example is chiropractic care.

For more information, call your Tricare Service Center and ask for a free TFL Handbook, or download one at www.tricare.mil/tfl (under “Downloads” at the right side of the screen).

Q. When I am 65, my federal employee plan will convert to Medicare and Tricare for Life. My wife is only 58 and can’t get Medicare yet. Will Tricare be her only insurance?

A. Your employee plan will not convert to Medicare. Medicare is a separate plan, and you must enroll in Part A and Part B at least 90 days before the month when you turn 65.

Both you and your wife will continue to be covered under your federal employees plan, and her Tricare coverage also will continue unchanged.

Your Medicare parts A and B coverage will become effective on the first day of the month of your 65th birthday. It will be in addition to your federal employees insurance.

If you are no longer working for the government, Medicare will be your primary insurance coverage: the federal employee plan will be secondary. If you are still employed, your employee plan will be primary and Medicare will be secondary.

In either case, Tricare Standard will be your third plan, and you will have to file those claims yourself.

__________________

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.