Q & A
Tricare, Medicare questions from woman turning 65.
Full Question Set: My husband is on active duty until 2017. He’s six years younger than me; I’ll turn 65 in November and become eligible for Medicare.
1. Will I receive a new military ID card? I noticed it expires in November on the day of my birth when I turn 65.
2. Will I receive something from Tricare to show they will be my secondary coverage?
3. If I choose to go to a civilian doctor, may I go to whom I want as long as that doctor takes Medicare? Will Tricare Prime pay for any testing or screening balance from Medicare?
4. Will Tricare Prime cover a co-pay for my provider after Medicare pays and the doctor bills Tricare?
5. Will Tricare send me an ID with the mailing addresses for my provider?
Answer: Let’s cover these in the same order :
1. You’ll need to renew your military ID card, but it will be the same type of ID card (retiree family member) as you have now.
2. No. When you visit a health care provider, you simply tell them that you are under Tricare for Life, with Medicare as the first payer and Tricare as the second payer.
3. Yes, you may see any Medicare- and Tricare-authorized provider.
3b. Tricare will be the second payer.
3c. The Tricare portion of your TFL benefit isn’t Tricare Prime; it’s Tricare Standard. The question of who pays what can be convoluted and largely depends on the specific health care service or procedure that you need.
When you see a Medicare provider, you have no out-of-pocket costs for services covered by both Medicare and TFL. Most health care services fall into this category. After Medicare pays its portion of the claim, TFL pays the remaining amount in full.
As the primary payer, Medicare approves services for payment. If Medicare does not pay because it determines the care is not medically necessary, TFL also does not pay. You may appeal Medicare’s decision and, if Medicare reconsiders and provides coverage, TFL also reconsiders coverage.
If a health care service is covered by both Medicare and TFL, but Medicare does not pay because you have used up your Medicare benefit, TFL becomes the primary payer. In this case, you are responsible for your TFL deductible and cost-shares.
If a health care service is normally covered by both Medicare and TFL, but you receive the service from a provider who has opted out of Medicare, the provider cannot bill Medicare and, therefore, Medicare will pay nothing. With an opt-out provider, TFL processes the claim as the second payer, unless you have other health insurance. TFL pays what it would have paid if Medicare processed the claim TFL usually pays 20 percent of the Tricare-allowable charge). You must cover the remainder of the billed charges.
4. Generally, yes.
5. Your military retiree family member ID is the only identification you will need.
Source: Military Times, June 14, 2015
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