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TRICARE for Life and TRICARE Plus

TRICARE for Life and TRICARE Plus. Presented by: Wendy Pritt TRIWEST Healthcare Alliance, Inc. TRICARE Regional Contractors. DEERS. Medicare status Current Uniformed services ID card DEERS automatically notifies beneficiaries within 90 days of 65 th birthday about changing benefits

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TRICARE for Life and TRICARE Plus

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  1. TRICARE for Life and TRICARE Plus Presented by: Wendy Pritt TRIWEST Healthcare Alliance, Inc.

  2. TRICARE Regional Contractors

  3. DEERS • Medicare status • Current Uniformed services ID card • DEERS automatically notifies beneficiaries within 90 days of 65th birthday about changing benefits • How many of you have received this notification?

  4. TRICARE for Life • National Defense Authorization Act for FY 2001 • Extended TRICARE eligibility • Combines TRICARE Standard with Medicare Parts A & B • Second payer to Medicare

  5. TRICARE For Life Eligibility • All TRICARE beneficiaries entitled to Medicare, regardless of age or residence • May receive Space A Military Treatment Facility (MTF) care • Some beneficiaries may enroll in the Military Treatment Facilities “TRICARE Plus” program.

  6. Medicare Eligibility • Health insurance not a benefit like TRICARE • Ages 65 and older • Under 65 with certain disabilities • Any age with end-stage renal disease or amyotrophic sclerosis (ALS); most commonly known as Lou Gehring’s disease

  7. Medicare Overview • Medicare Part A • Hospital Insurance • Medicare Part B • Medical Insurance • Medicare Part C • Medicare + Choice Plan • Medicare Part D • Medicare Prescription Drug Plan

  8. Shows your eligibility for Parts A & B and the effective dates of coverage. Medicare Card • No TRICARE For Life card • Just show this Medicare card along with your uniformed services ID card Call 1-800-MEDICARE or visit www.medicare.gov if you need a new card.

  9. Medicare Part B Enrollment • Federal law mandates enrollment to remain TRICARE eligible • Medical entitled Active Duty Service Members (ADSM)/Active Duty Family Members (ADFM) are not required to enroll until retirement • These beneficiaries retain TRICARE eligibility • Active Duty Service Members (ADSM)/Active Duty Family Members (ADFM) must have Part B enrollment in effect on retirement date to avoid break in TRICARE coverage

  10. TRICARE For Life Costs • Medicare Part A • No fee if beneficiary paid Medicare taxes while working • Medicare Part B • Monthly premium required for Medicare, no enrollment fee for TRICARE at that point • 2010 Medicare Part B Premium • Based on income • May change each year

  11. 2010 Medicare Part B Premiums

  12. Medicare TRICARE Medicare + TRICARE Standard = TFL Medicare Parts A and B along with TRICARE Standard as the second payer gives beneficiaries TRICARE For Life coverage

  13. 1st Payer: Medicare 2nd Payer: OHI or Medicare supplement 3rd Payer: TRICARE 1st Payer: Employer-sponsored plan 2nd Payer: Medicare 3rd Payer: TRICARE Coordinating TRICARE For Life with Other Health Insurance (OHI) Order of payment depends on whether or not you have employer-sponsored health insurance. Other Health Insurance (not based on current employment) With Employer-Sponsored Health Insurance (based on current employment) TRICARE For Life will always pay last.

  14. TRICARE For Life—How it Works • You visit your Medicare provider • Your provider files a claim with Medicare • Medicare pays its portion and sends the remaining amount to TRICARE • TRICARE pays remaining amount to your provider • You get an explanation of benefits from Medicare and TRICARE Contact Wisconsin Physicians Service-TFL 1-866-773-0404  www.tricare4u.com

  15. TRICARE For Life—What You Pay

  16. Medicare Advantage Plans • Health Plan options that are a part of: • HMOs • PPOs • Fee-for-service • Medicare Special Needs program • Covered services and copayments are reimbursed by TRICARE

  17. Medicare Prescription Drug Benefit – Medicare Part D • Covers brand name and generic drugs at participating pharmacies • Enrollment window – every year between Nov 15 – Dec 31 • TRICARE Pharmacy Program (may be better option for beneficiaries)

  18. Pharmacy Options and Costs *Non-formulary drugs are available at the formulary cost if medical necessity is established. Visit www.tricare.osd.mil/pharmacy for information.

  19. TRICARE for Life (TFL) Overseas • No Medicare coverage overseas • TRICARE is primary payer • Except for U.S. overseas territories • No location restrictions • TRICARE Standard is a global benefit • Beneficiaries file their own claims • Submit claim (DD form 2642) to WPS • No Medicare summary required

  20. TRICARE For Life Claims Processing • Wisconsin Physician Services (WPS) • TRICARE4u.com • Explanation of Benefits (EOB)

  21. TRICARE for Life (TFL) Explanation of Benefit (EOB) • Detailed summary of claims for all medical care processed that month

  22. TRICARE Plus • Primary care enrollment option • Available to beneficiaries not enrolled in TRICARE Prime or other HMO-like program • Offered at some MTFs* • Limited by MTF capacity • Not transferable from one MTF to another * Check with your local MTF for program availability and details.

  23. Additional Information • TRICARE For Life (TFL) -www.tricare.mil/tfl • Defense Manpower Data Center (DMDC) Support Office - (800) 538-9552 • ID Cards - www.dmdc.osd.mil/rsl/ • Social Security Administration (SSA) - www.ssa.gov • TRICARE Fact Sheets - www.tricare.mil/factsheets/index.cfm • Centers for Medicare and Medicaid Services - www.medicare.gov

  24. Questions?

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