On October 1, military Medicare-eligible beneficiaries will become eligible for TRICARE For Life, under which TRICARE will provide second-payer coverage to Medicare. Unfortunately, such major and expensive benefit changes are frequently accompanied by rumors and misinformation, often spread by well-intentioned but worried people. While one can never fully protect against Murphy's Law, everything we see indicates TFL will be implemented and funded as planned on October 1. So it's time to put the kibosh on those exasperating TFL myths.
Myth #1: "TFL is not a permanent program and Congress is looking at cutbacks because of its high cost."
Reality: TFL is set in permanent law, in the same way as Social Security, Medicare, and military retired pay. As such, annual action by Congress to re-authorize TFL is not required. Public Law 106-398 established a DoD Medicare-Eligible Health Care Trust Fund, to be effective October 1, 2002. The Fund will be resourced with annual mandatory contributions from the Department of Defense and the U.S. Treasury. Congress certainly has the power to change any program, including Social Security, Medicare, military retired pay, or TFL, but that would take another law change. There has been no discussion in Congress of any TFL cutback. Congress and the Defense Department are committed to bringing TFL on line, on time, as promised.
Myth #2: "TFL has not been funded for FY 2002 so the program can't begin on October 1, 2001."
Reality: It's technically true that Congress has not yet passed the FY 2002 Defense Appropriations Act, but this is merely a formality as far as TFL is concerned. First-year TFL funding of $3.9 billion was included in the President's Budget and in the FY2002 Budget Resolution, which set Congress's spending agenda. Therefore, funds are already earmarked for inclusion in the FY 2002 Defense Appropriations Bill when Congress takes it up next month. If this defense-spending bill is not passed by October 1st, Congress will approve a Continuing Resolution (CR) to sustain funding for previously authorized initiatives. TROA has confirmed with the House and Senate Appropriations Committees and the Defense Department's General Counsel that, since TFL authority is already on the law books, it will still be implemented and funded on Oct 1 under the terms of the CR, even if no Defense Appropriations Act has been enacted by that date.
Myth #3: "My doctors will not accept me as a TFL patient because they don't participate in TRICARE."
Reality: Under TFL, all Medicare-approved providers are automatically "TRICARE-approved providers." If Medicare pays the doctor, TRICARE will too automatically. There is no requirement for the doctor to formally participate in TRICARE. In the worst case, a skeptical doctor may ask you to pay the Medicare copayment up front until he can be sure TFL will pay on time. Next month's TROA magazine will be accompanied by two copies of TROA's new TRICARE For Life Handbook for Providers. TROA designed this 8-page handbook specifically to show doctors how TFL will work, and persuade them that they won't need to require such upfront copayments.
Myth #4: "Doctors who treat TFL patients will have to file a secondary TFL claim for the supplemental coverage that my Medigap insurance now pays."
Reality: For the vast majority of cases, all the doctor has to do is file the claim with Medicare, with no extra paperwork for TFL. Most providers already bill Medicare. Medicare will process the primary claim and send the Medicare payment directly to the provider. The paid Medicare claim will be automatically forwarded to TRICARE, which will generate a TRICARE copayment directly to the provider. You will get an Explanation of Benefits (EOB) statement from both Medicare and TRICARE showing that both programs have paid their share of the bill and that you owe nothing. (Note: This automatic payment system will be in place for beneficiaries age 65 and over as of Oct 1, but won't be available until sometime next year for disabled Medicare-eligibles under 65. In the interim, a separate paper claim to TRICARE will still be necessary for the under-65 Medicare-eligibles.)
Myth #5: "Before I can get any benefits under TFL, I must have a new Uniformed Services Identification Card that shows eligibility for health care."
Reality: A new ID card is not required. Eligibility for TFL is based on your having correct information in DEERS, the Defense Enrollment Eligibility Reporting System. Even if the back of the Military ID Card indicates, "No civilian medical care is authorized" (after a stated date), TFL benefits will be paid so long as your DEERS information is accurate. In addition, TRICARE contractors mailed out a letter in late July and early August to all uniformed services beneficiaries 65 and older with a wallet-size "Information Card" that can be shown to a provider. The card states the provider should "file claims (for reimbursement) in the usual manner to Medicare." It also shows that the patient has no copay or deductible for TRICARE and Medicare-covered benefits and provides contact numbers for TFL information.
Myth #6: "Because I am enrolled in a Medicare HMO or have other health insurance (OHI) coverage, TFL will not benefit me."
Reality: We believe you won't need other health insurance under TFL, but if you decide to keep it anyway, you will not get all the benefits of your premium-free TFL coverage. That's because TFL will be third-payer after Medicare and your other insurance. TROA recommends that all TFL eligibles should review their situation to assess whether it still makes sense to pay premiums for coverage that TFL provides at no cost. But even if you retain a Medicare HMO, Medigap insurance or a former employer's plan after October 1, TFL may still be of some value. If you pay copays under your other plan, you can file a TRICARE claim and be reimbursed for those costs. Also, if your plan has limited coverage, you can file a TRICARE claim for the out-of-pocket expenses, but you must enclose proof that your other plan's benefits have been exhausted. In order to submit a claim, the receipt or explanation of benefits form from your other insurer must show the patient's name, date of care, and type of service. If you are in a Medicare HMO, you should indicate that the receipt is from a Medicare Plus Choice HMO and is for your cost-share. The receipt and a claim form may then be submitted to TRICARE for adjudication. For more information, call the DOD Customer Call Center at 888-DoD-LIFE (888-363-5433).
Myth #7: "For retirees who travel or live outside the United States (its possessions or territories), Medicare will not pay. Thus, TFL offers no benefits overseas."
Reality: While Medicare doesn't provide benefits outside the United States, TRICARE does. If you are a TFL beneficiary (enrolled in Medicare Part B) and become ill while traveling or residing outside the United States, TFL will be the first payer for TRICARE-covered benefits. In this case, you'll be responsible for paying the TRICARE copayments and deductibles, up to the catastrophic cap of $3,000 per family per year plus any excess charges. You also will be responsible for paying any billed charges above what TRICARE allows. For more information, call DoD's TFL Call Center toll-free at 1-888-363-5433.
Myth #8: "TRICARE For Life will pay for long-term nursing care services, so I won't need long-term care insurance."
Reality: TFL does not cover long-term custodial care. Medicare and TRICARE cover certain "medically-necessary" skilled nursing care either in a Skilled Nursing Facility (SNF) or at home. Such services are very different from long-term care services. SNF care may be needed following a period of hospitalization for rehabilitation or for stabilization of a condition. Long-term care, also called "custodial or personal care", is for people who require permanent assistance in activities of daily living, such as eating, bathing, dressing and physical movement. Beneficiaries are solely responsible for paying for custodial services. Beneficiaries desiring such coverage may want to purchase long-term care insurance, but they will have to meet certain "medical underwriting conditions" as determined by an insurance carrier.
©2001 The Retired Officers Association (TROA). Used with permission.
page last modified on: 5/7/2013