Tricare For Life

Tricare For Life

Walter C. Seiler

Medicare-eligible uniformed services retirees, including Reserve component uniformed services retirees drawing military retired pay, their spouses and survivors who are age 65 and over will be entitled to expanded health-care benefits that were included in the FY01 National Defense Authorization Act (P.L. 106-398) signed by President Clinton on 30 October 2000. The new benefits include an expanded pharmacy program and coverage under TRICARE, the military health-care system. Under the law, the pharmacy benefits are effective 1 April 2001, and the other TRICARE health-care benefits are effective 1 October 2001. Funding for this important health-care entitlement for Medicare-eligible beneficiaries will begin in FY03, through the Department of Defense Medicare-eligible Retiree Health Care Fund established by the Department of Treasury.

TRICARE Senior Pharmacy Benefit

The new TRICARE Senior Pharmacy Benefit program, effective 1 April 2001, will limit out-of-pocket costs and increase access to the National Mail Order Program (NMOP) and retail pharmacies that are part of the Department of Defense network, which include many major chain drug stores. In addition, non-network retail pharmacies may be used. Beneficiaries who are 65 years and older will not pay enrollment fees or annual premiums for their TRICARE pharmacy benefits, but will pay modest co-pays when they use NMOP and retail network pharmacies. In addition, beneficiaries will also be able to use non-network pharmacies, but this option will entail a slightly higher co-pay and deductible. By law, to use the TRICARE retail and mailorder pharmacy benefits, beneficiaries age 65 and over must be eligible for Medicare Part A and be enrolled in Part B. There is an important exception: Those who turn age 65 before I April 2001 are eligible for the expanded pharmacy benefit, even if they are not enrolled in Medicare Part B. A s in the past, all Medicare-eligible uniformed services retirees will continue to be able to use military treatment facilities (MTFs) to have their prescription drugs filled at no cost on a space-available basis.

Eligible retired beneficiaries living overseas will be able to use the TRICARE pharmacy benefit at retail overseas pharmacies, but they will have to submit their pharmacy claims for reimbursement. They also will be able to utilize the NMOP, if certain requirements are met. Federal and state legal restrictions apply to the prescribing, dispensing and mailing of prescription drugs, so the NMOP can only mail to APOs and FPOs, which are part of the U.S. Postal Service. Also, NMOP can only fill prescriptions written by providers licensed to practice in the United States.

NMOP offers the largest discount to DoD beneficiaries. It is convenient for filling prescriptions for chronic conditions such as high blood pressure or diabetes. The retail network pharmacy program can be used for shortterm, immediate-use medications. Lists of TRICARE network pharmacies will be available from regional TRICARE contractors. Beneficiaries who use non-network pharmacies will have to meet an annual deductible, incur higher co-pay, pay the entire bill up front, and then file a claim for appropriate reimbursement. For more information, call the TRICARE Senior Pharmacy Benefit Helpline at 1-877-363-6337.

TRICARE for Life Health-Care Benefit

Effective 1 October 2001, Medicare-eligible uniformed services retirees, their family members and survivors age 65 and older must be eligible for Medicare Part A and be enrolled in Medicare Part B to become eligible for all other TRICARE benefits.

If the medical care received is a benefit of both Medicare and TRICARE, Medicare will pay the allowable amount for the care. TRICARE will pay the amount that is the Medicare cost-share, as well as any Medicare deductible. Most, but not all, medical services are a benefit under both Medicare and TRICARE.

If the medical care received is a benefit of Medicare, but not a benefit of TRICARE, Medicare will pay its normal amount and the beneficiary will be responsible only for the Medicare deductible and cost share. An example of this type of care is certain types of chiropractic care that is covered by Medicare.

If the medical care received is a benefit of TRICARE, but not a benefit of Medicare, Medicare pays nothing. TRICARE will pay the amount it pays for the same service received by a retiree under the age of 65. In this case, the beneficiary must pay the applicable TRICARE cost-share and deductibles. An example of this type of coverage is the prescription drug benefit.

TRICARE-for-Life will also be available to Medicare-eligible military beneficiaries living overseas, provided they are enrolled in Medicare Part B. TRICARE Standard rules will apply.

DoD has not as yet issued guidelines about continuing or expanding the currently popular TRICARE Senior Prime (Medicare Subvention) program or extending TRICARE Prime to beneficiaries as they reach age 65.

Eligible beneficiaries should not immediately cancel their current Medicare supplemental insurance (Medigap) coverage.DoD is working with the Health Care Financing Administration (the organization that administers the Medicare benefit) to provide the most accurate information on the appropriateness of continued enrollment in Medigap insurance policies.

What to Do Now

According to TRICARE Management Activity officials, eligible beneficiaries should do two things now to ensure their future eligibility for TRICARE-for-Life benefits. First, they should update their Defense Enrollment Eligibility Reporting System (DEERS) record with their correct address and any changes in family status such as marriage, divorce, birth or adoption. Home addresses are important because the address on file with DEERS is used to send out information on health benefits. In addition, health benefits could be denied if DEERS is not updated to reflect family changes, such as a new spouse or child. Addresses can be updated on the Military Health System/ TRICARE Web site at Retirees may also update their DEERS address by:

* Visiting the nearest military personnel office that has an ID card facility.

* Visiting their local military treatment facility.

* Calling the Defense Manpower Data Center Support Office (DSO) telephone center at 1-800-538-9552.

* Mailing the address change to DSO, Attn: COA, 400 Gigling Rd., Seaside, CA 93955-6771.

* Faxing the address change to DSO, Attn: COA, at 1-831-655-8317.

Sending an e-mail message to Messages sent should be in lower case only and include the sponsor’s name, Social Security number and telephone number, name(s) of family members affected by the address change, and the start date for the change.

Second, eligible beneficiaries should consider enrolling in Medicare Part B if they have not already done so. If they are not sure they are enrolled, they can check the back of their Medicare card for this information. A premium surcharge may be imposed on beneficiaries who did not enroll in Part B when they were eligible at age 65. For enrollment and surcharge information, contact the Social Security Administration (SSA). The general enrollment period for enrollment in Medicare Part B is held 1 January through 31 March of each year, and Part B coverage starts 1 July of that year. For details on enrollment in Part B, beneficiaries may call the SSA toll-free number, 1-800-772-1213, or visit any Social Security office. They can also find information on the Medicare Web site at

COPYRIGHT 2001 Reserve Officers Association of the United States

COPYRIGHT 2004 Gale Group