Q & A
What are the rules on Tri Care for Life vs. Medicare?
Full question: My fiancé, an Army retiree, recently turned 65 and went to the Social Security office to sign up for Medicare. He was told he did not need Part B because he was eligible for Tricare for Life. I have a lot of questions:
1. Is a retiree over 65 required to also carry Medicare Parts A and B to remain eligible for Tricare for Life?
2. Must a veteran over age 65 have TFL to be cared for at a Veterans Affairs clinic or hospital?
3. If my fiancé does get Part B, can he still go to VA for care?
4. If he does get Part B, will VA refer him to a local hospital if no local VA hospital does the surgery?
5. Since he is still working, will his Part B premiums be based on his total yearly income or his military retirement pay?
6. Since he was told that he did not need Part B, can he still apply for it later?
Why does government health care have to be so confusing?
Answer: The answers actually begin with a tidbit mentioned in Question No. 5.
When your fiancé was told that he didn’t need Medicare Part B, that was not because he’s eligible for Tricare for Life; rather, it was because he is still working and presumably has, or is eligible for, employer-sponsored health coverage. As such, he may delay enrollment in Part B past age 65 without incurring the Part B “late enrollment” penalty later when he stops working for good. During this period, he remains eligible for Tricare, but cannot use Tricare until he enrolls in Part B. Read more…
Source: Navy Times - 9/18/2014
This posting is presented for informational purposes only and does not represent legal or financial guidance. Any opinions or interpretations presented are either those of the original author or, in the case of articles authored by the AMAC Foundation, are the opinions of AMAC Foundation staff, originally trained and accredited by the National Social Security Association (NSSA) and certified via the AMAC Foundation. Any links included in the article are valid on the posted date; socialsecurityreport.org cannot guarantee the duration of the links’ validity. NSSA and the AMAC Foundation and its staff are not affiliated with or endorsed by the Social Security Administration or any other governmental entity. To submit a question, visit our website (https://amacfoundation.org/services/) or email us at ssadvisor@amacfoundation.org. Because we are a non-profit organization, there is no charge for these services.
I was hospitalized on August 15th for kidney failure and soon after that the doctor ordered a blood test for me because I had surgery and I got a very resistant UTI to antibiotics. Medicare determined through their wisdom that the blood test was inappropriate so medicare did not cover the bill and tricare for life followed suit. How can this be in any common sense of the word? Medicare turned me down for no good reason and so did tricare. Wow, I needed a blood test so what?
George,
I suggest you consider filing a claim appeal to both TriCare and Medicare.
Here is a link which explains how to file an appeal with TriCare:
www.tricare.mil/ContactUs/FileComplaint/MedicalNecessity#:~:text=To%20Request%20a%20Reconsideration%20Decision,copy%20of%20the%20appeal%20decision
And here is a link which explains how to file an appeal of Medicare’s decision to not cover the blood test your doctor ordered:
www.medicare.gov/claims-appeals/how-do-i-file-an-appeal
Medicare and TriCare have specific rules for what they will cover and what they won’t, and “medical necessity” is usually a key item. However, appealing a claim denial will result in a reconsideration of the claim. Note, however, that the appeal must be filed in a timely manner (usually within 60 days of the claim denial).
Russell Gloor
National Social Security Advisor
The AMAC Foundation