An Important Message about TRICARE and Medicare

[CAS3]

An Important Message about TRICARE and Medicare


Recently, the House and Senate passed the "Medicare Prescription Drug, Improvement, and Modernization Act of 2003." The President is expected to sign the bill into law shortly. This bill is extensive and complex, and it makes dramatic changes to Medicare. It is important for uniformed services beneficiaries to understand the effect these changes may have on them in the near future and in the years to come.

A preliminary assessment of some of the bill's provisions is presented below. As additional provisions of interest to uniformed services beneficiaries are identified, and as more information becomes available, we will update this site. We intend to work closely with beneficiary representatives to ensure that important information gets the widest possible distribution. In the meantime, if beneficiaries have questions about their TRICARE benefits, they should contact their local TRICARE Service Center for assistance.

Medicare Prescription Drug Benefits

For most Americans, the most significant aspect of the new bill is that it introduces an outpatient prescription drug benefit. This does not affect uniformed services beneficiaries?their TRICARE pharmacy benefits will continue as a separate program.

Beneficiaries who desire to participate in the Medicare outpatient prescription plan should enroll when first eligible. If a beneficiary does not enroll when first eligible, and subsequently desires to do so, an annual late penalty would normally be assessed. However, TRICARE pharmacy benefits are considered a creditable prescription plan under the bill, and as such, uniformed services beneficiaries who do not enroll in the Medicare prescription drug benefit when first eligible do not have to pay an annual penalty if they subsequently enroll because they involuntarily lost their eligibility under TRICARE. Individuals could involuntarily lose their TRICARE eligibility when a dependent widow or widower remarries a person who is not a uniformed services member or retiree, or when a dependent and member or retired member divorce, and the dependent spouse does not qualify under the law as an eligible former spouse for TRICARE benefits.

The TRICARE pharmacy benefit provides excellent coverage and wide availability of services through military facilities, retail pharmacies, and mail order. Thus, it is likely that the vast majority of uniformed services beneficiaries will not find it advantageous to enroll in the new Medicare pharmacy benefit. TRICARE and Medicare will need to establish procedures for coordination of benefits for beneficiaries who do decide to sign up for the Medicare benefit.

Part B Premiums

The bill makes three very important changes relating to enrollment in Medicare Part B, the Supplementary Medical Insurance Program. The first two changes affect persons not enrolled, or paying surcharges because they enrolled after they were initially eligible for Part B:

First, uniformed services beneficiaries who would be eligible for TRICARE For Life, but are not enrolled in Medicare Part B, may enroll without penalty during a special enrollment period through December 31, 2004. The special enrollment period will be announced via Medicare on the TRICARE Web site (www.tricare.osd.mil) and publicized widely.

Second, uniformed services beneficiaries who enrolled in Medicare Part B in 2001, 2002, 2003, or 2004 and are subject to a premium surcharge for late enrollment in Part B can get those surcharges eliminated by demonstrating that they are covered under TRICARE. The elimination of surcharges is effective January 1, 2004, but the Department of Health and Human Services will need to work out procedures to be followed. Procedures will be announced via Medicare on the TRICARE Web site (www.tricare.osd.mil) and publicized widely.

The third change made by the bill affects all seniors, not just uniformed services beneficiaries. The Part B premium will be tied to income, beginning in 2007. Individuals with incomes above $80,000 will pay more, and couples with incomes above $160,000 will pay more.

Medicare Advantage Program

The bill introduces several enhancements to the current Medicare+Choice program that are expected to increase the availability of private plans offering benefits to Medicare beneficiaries. TRICARE For Life beneficiaries can enroll in Medicare+Choice plans (and TRICARE will reimburse their copayments). More details about Medicare+Choice plans are available on the Medicare Web site: http://www.medicare.gov/Choices. Most people eligible for Medicare use traditional fee-for-service Medicare.

The bill includes provisions for a pilot program beginning in 2010 (the Comparative Cost Adjustment program) that could result in increased Part B premiums for persons in traditional fee-for-service Medicare, if sicker patients gravitate to private plans in the test sites.

Provider Reimbursement Provisions

The bill includes numerous provisions relating to reimbursement of hospitals, physicians, and other service providers. Significantly, physicians will receive a 1.5 percent payment increase in 2004 for 2005, rather than the reduction that was anticipated.

Medicare Part B Deductible

The bill increases the Medicare Part B deductible to $110 in 2005 and indexes it to inflation for subsequent years. This should have minimal impact on uniformed services beneficiaries, since the Medicare deductible is payable by TRICARE.

[Doc Crow]

For those who use TRICARE for Life (TFL) please be sure that you are signed up for MEDICARE Part "B" other wise you will be ineligible for TFL unless you have a Notice of Dis-Allowance from SSI. You or your spouse then become eligible for TRICARE Standard and could be eligible for Prime if you are in what is called a Catchment area this is an area that is approx a 40 mile radius around the base. Some place's like Las Cruces, NM are considered extended catchment areas they are more then 40 miles away but the governement has expanded the area due to large numbers of elegible beneficiaries in those areas.There are going to be some areas where there are no base's that will allow TRICARE Prime one is Minneapolis/St Paul, MN the other is Des Moines, Iowa. This is being done due to the large number of eligible beneficiaries in those areas. As soon as I find the other areas I will let everyone know these. For our Active Duty Marines and Sailors if you are stationed in a Remote Area please be sure to get yourselves and family memebers if you have them signed up for TRICARE Prime Remote for Active Duty (TPRAD) and TRICARE Prime Remote for Active Duty Family Members (TPRADFM). This is vital to save you what could be a large amount of Money. If you fail to sign up for this program and have a family you could be responsible for 20 % of all allowed charges. That is after you meet the annual deductible for your rank which is any where from $50 to $300. With an office visit this is not a big deal but for a hospital admission it could get costly rather rapidly and destroy you financially so please be sure to stay on top of these things. Again if you have any question pleas contact me on this board or my e-mail at USMCDOC57@aol.com. Please be sure to mark it TRICARE Question or Issue so that it will catch my eye and not be deleted as SPAM.

[usmcmg@earthlin]

I am 100% disable and it is all service conected now I am I entited to tricare for life,?


M Gunns

[Doc Crow]

Your can actually be covered under both TRICARE and the VA. If you have lets say a cold the flu or something that is not related to the service connected disabilities you can use TFL if it is something to do with the service connected issue it has to go through the VA. So lets say you fall and God Forbid break a leg you can chose to use the VA if you like since you are 100% disabled but you can also use TFL since it is not related to the service connected disability. The key is if you chose TFL you can not switch mid way through your care. You will have to stay with TFL for that entire episode of care and that could include physical or occupational therapy etc. You actually have the best of both worlds you can be treated at the VA or use TFL. If it has even the slightest resemblance to anything to do with your disability you have to go through the VA. If you have further questions send me an e-mail at my aol address and I can give you my home phone number and we can talk over the phone just be sure to mark it TRICARE Issue that way I do not delete it by accident. My address is USMCDOC57@aol.com. Hope this answers your question

[CAS3]

If you are 100% service connected, you are covered by the VA for ALL medical, whether it is SC or not. You are a priority one which means the VA takes care of all of your illnesses.
You are eligible for tricare. You will have a co pay with them and not with the VA.

[usmcmg@earthlin]

I am still in the dark some what, being 100% can I get my perscriptions filled at lest say wall greens or one that is using tfl or do I have to us the va even if my pvt. doc writes the script.
thanks for the help.



M Gunns

[Doc Crow]

The last thing I saw was the VA would now accept scripts from Private Physicians but the VA Guru would be able to answer that better then I. I do remember the VA Secretary has told VA facilities to take private scripts but I could be incorrect on the. He is correct that you will have a co-pay with TRICARE. TRICARE does have a mail order program but it is made for maintenance medications not something you need now. If the VA does not take Private Scripts and it is maintenance medications i.e. Heart Medications etc. I would recommend the mail order program since you get a 90 day supply at the same cost as 30 at a network pharmacy for one script that can be a savings of $18 each 90 days. Add that up over 3 or 4 scripts that can be a big savings.

[CAS3]

HI DOC...I AM A WOMAN!!

Regarding VA scripts. The VA will take an outside hand written script one time only. It has to be an emergent problem and the vet must be in the process of enrolling in the VA system.

[Doc Crow]

I apologize CAS3 no offense intended