Tricare For Life: Stacking Insurance For Maximum Coverage

If you have other health insurance in addition to TRICARE, such as Medicare or an employer-sponsored health insurance, you can use TRICARE For Life as long as you have both Medicare Parts A and B. TRICARE pays last, after Medicare and your other health insurance. This means that your other health insurance processes your claim first, after which you or your doctor files your claim with TRICARE.

Medicare and Tricare for Life

Medicare is a health insurance program for people under 65 with certain disabilities, end-stage renal disease, or Lou Gehrig's disease. Managed by the Centers for Medicare and Medicaid Services, eligible individuals have the option of using Original Medicare or enrolling in a Medicare Advantage plan.

TRICARE For Life (TFL) is Medicare-wraparound coverage for those who are TRICARE-eligible and have Medicare Part A and B, regardless of age or place of residence. Coverage is only for those with Medicare and who are TRICARE-eligible; it does not extend to family members. TFL coverage is automatic if you have Medicare Part A and B, with no enrollment or enrollment fees. Coverage is available worldwide.

If you have other health insurance, such as a Medicare supplement or an employer-sponsored health plan, you can use TRICARE For Life as long as you have both Medicare Parts A and B. TRICARE pays last, after Medicare and your other health insurance.

When using Original Medicare, you may obtain health care services from any Medicare participating or non-participating provider, regardless of their specialty. Medicare Part A is hospital insurance financed by payroll deductions when you are or were working. Medicare Part B is medical insurance, which primarily covers outpatient services. You pay a premium each month, which is based on your income level. Medicare Supplement Insurance (Medigap) coverage is optional and pays your out-of-pocket costs in Original Medicare.

Medicare Advantage plans (also known as Medicare Part C) are offered by private companies that contract with Medicare. These plans provide all of your Part A and Part B services and usually Part D pharmacy coverage. You may pay a plan premium each month in addition to your Medicare Part B premium. You must obtain all your health care services from the Medicare Advantage plan's network of providers, except in emergencies. If you enroll in a Medicare Advantage plan, you may have to pay copayments at the time of service. TRICARE For Life can reimburse you for copayments paid for TRICARE services, and you may need to file your own claims.

Claim filing

If you have health insurance other than Tricare, such as Medicare or employer-sponsored health insurance, you can use Tricare For Life as long as you have both Medicare Parts A and B. In this case, Medicare and your other health insurance will pay out first, and Tricare will pay last.

It is important to keep your other health information updated and inform your Tricare contractors and doctors when you have other health insurance. If Tricare processes your claim before your other health insurance, it will be denied. If Tricare pays first and then discovers you had other insurance, it will take back any payments made and will only reprocess your claim after your other insurance pays out.

In most cases, your provider will file your medical claims for you, and you will receive an explanation of benefits detailing what Tricare paid. Sometimes, you will need to file your own claims. If you get care from a non-participating provider, send your claim form to Tricare as soon as possible after receiving care. In the US and US territories, you must file your claims within one year of service, and within three years if overseas.

There are several tips to follow when filing your claims to avoid delays or denials:

• Fill out all 12 blocks of the Patient's Request for Medical Payment (DD Form 2642)
• Include the sponsor's Social Security Number or Department of Defense Benefits Number, your home address and phone number, and any other pertinent information
• Use the correct diagnosis code provided by your provider and include that code with the description in Box 8a
• Sign the claim form—claims submitted without a signature will be denied payment
• Notify Tricare if there is a third party involved (e.g. if you were hurt in an accident and someone else may bear responsibility) by submitting a Statement of Personal Injury-Possible Third Party Liability (DD Form 2527) along with your medical claim form
• File claims with your other health insurance (OHI) first, then, when you receive payment from your OHI, you can file a claim with Tricare, including a copy of your explanation of benefits from your OHI
• Keep copies of everything you submit to the claims processor
• Use the correct claims address to avoid delays
• Submit each claim separately, as filing multiple claims together could cause confusion

Primary and secondary payers

If you have other health insurance alongside TRICARE, it is known as "other health insurance" (OHI). This can be through your employer or a private insurance program. By law, TRICARE pays after all other health insurance has paid out, except for State Victims of Crime Compensation Programs and Other Federal Government Programs identified by the Director, Defense Health Agency (e.g. Indian Health Service). This means your OHI processes your claim first, and then you or your doctor files your claim with TRICARE.

TRICARE For Life (TFL) is available to those with Medicare Part A and B who are TRICARE-eligible, regardless of age or place of residence. TFL is Medicare-wraparound coverage, meaning it supplements Medicare. If you have OHI, you can use TFL as long as you have both Medicare Parts A and B. If you have employer-sponsored insurance with your current employer, your employer files your health claims, and the OHI pays first, followed by Medicare. If your OHI is not based on your or a family member's current employment, Medicare pays first, and the OHI pays second. In this case, you must file a claim with the TFL contractor, Wisconsin Physicians Service (WPS).

If you are an active-duty service member, TRICARE is your primary payer, and there is no coordination of benefits with other insurance carriers. If you have OHI, you need approval from Health Net Federal Service, LLC (HNFS) for all services. All other beneficiaries with OHI (excluding Medicare) only require prior authorization for applied behaviour analysis services. The OHI must be used before TRICARE and is always the primary payer.

Medicare is often the primary payer, meaning it pays first, and another insurance plan pays some of what's left. A secondary payer covers the remaining costs, such as coinsurance or copayments. When you are enrolled in Medicare, you can still use other insurance plans to lower your costs and access more services. Medicare will usually be the primary payer, and your other health insurance plan will be the secondary payer, covering any remaining costs.

If you have TRICARE and Medicare, the primary and secondary payer for services can change depending on the services you receive and where you receive them. TRICARE will pay for services received from a Veterans Administration (VA) hospital, and Medicare will pay for services from a non-VA hospital. Medicare will be the primary payer for Medicare-covered services, and TRICARE will pay the coinsurance amount. TRICARE is the primary payer for services not covered by Medicare.

Enrollment

TRICARE is a health program for uniformed service members and their families, national guard and reserve members, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS). To be eligible for TRICARE For Life (TFL), you must be TRICARE-eligible and have Medicare Part A and B, regardless of age or place of residence. Coverage is only for those with Medicare and who are TRICARE-eligible, and it does not extend to family members.

You don't need to enroll in TRICARE For Life separately; coverage is automatic if you have Medicare Part A and B and are registered in the DEERS. However, you must pay Medicare Part B premiums, and Medicare Part A is paid from payroll taxes while you are working. Your Part B premium is based on your income.

If you have other health insurance in addition to TRICARE, such as a Medicare supplement or an employer-sponsored health plan, you can still use TRICARE For Life. In this case, TRICARE pays last, after Medicare and your other health insurance. It's important to keep your other health information updated and inform your TRICARE contractors and doctors when you have other health insurance. If your other insurance is through your current employer, they will file your health claims, and Medicare will pay second. For other types of insurance, Medicare pays first, and you must file a claim with the TFL contractor within one year of the date of care.

If you are an active duty service member, you can use other health insurance under certain circumstances and when in compliance with DoD and Service regulations. However, TRICARE won't be the second payer, and there will be no coordination of benefits with your other health insurance and TRICARE. You are responsible for all costs, and your other health insurance may have exclusions for military duty status. It is important to disclose your military status to your other health insurance to avoid claim denials or recoupments.

Overseas coverage

If you are relocating overseas, you may be wondering how your healthcare coverage will work in your new location. Tricare offers a range of plans to ensure that military families living abroad have access to healthcare services. Here is an overview of the overseas coverage provided by Tricare:

Tricare Select Overseas:

Tricare Select Overseas is available to active duty family members living overseas with their sponsors, who have relocated with service-sponsored or funded orders. It is also open to retired service members and their families, survivors, and some former spouses. This plan is similar to the Tricare Select program offered within the US, including cost-shares and deductibles.

Tricare Prime Overseas:

Tricare Prime Overseas serves active duty members, activated reserve and guard members, and their command-sponsored dependents. It is similar to the Tricare Prime program within the US, including cost-shares and deductibles. Enrollment in this plan is not automatic, and family members must enroll before receiving care.

Tricare Prime Remote Overseas:

Tricare Prime Remote Overseas is a Tricare Prime option offered in designated remote overseas locations for active-duty service members and their families. The program is similar to Tricare Prime Overseas, but you will primarily receive care from foreign providers selected and inspected by a Tricare contractor.

Tricare For Life:

Tricare For Life is Medicare wraparound coverage for Tricare beneficiaries with Medicare Part A and Part B, regardless of age or place of residence. While Medicare does not provide coverage outside the US and its territories, Tricare For Life serves as the primary payer for healthcare received in all other overseas locations. This means that you will be responsible for paying Tricare's annual deductible and cost shares.

It is important to note that you must have Medicare Part B to remain eligible for Tricare even if you live overseas, as Medicare does not provide coverage in these locations. With Tricare For Life, you can generally seek care from any overseas civilian provider without a referral, although certain services require prior authorization.

Tricare Reserve Select:

The Tricare Reserve Select (TRS) program is a premium-based insurance plan available worldwide to qualified members of the Selected Reserve and their families. To be eligible, members of the Selected Reserve (or their families) must not be on active duty orders and must not be covered under specific programs like the Transitional Assistance Management Program.

Tricare Retired Reserve:

The Tricare Retired Reserve program is a health insurance plan for retired Reservists, Guard members, and their families. It is a premium-based insurance policy with deductibles and coverage limits. Retirees remain eligible for the program until they turn 60, after which they can enrol in other premium-free Tricare programs.

In conclusion, Tricare offers comprehensive healthcare coverage for military families living overseas through a range of plans tailored to different situations and eligibility criteria. These plans ensure that military personnel and their dependents can access the necessary healthcare services while residing in or travelling to foreign countries.

Frequently asked questions