TRICARE FOR LIFE (TFL)

(TRICARE News Release)

            As TRICARE for Life begins 1 October, about 1.5 million uniformed services retirees, their family members and survivors, age 65 and older, will receive expanded medical coverage through the Department of Defense (DOD) health care program.  TRICARE for Life will be second payer to Medicare for services and supplies that are benefits under both programs and the provider does not have to file a TRICARE claim.

            Combined with the TRICARE Senior Pharmacy Program that was implemented last April, TRICARE for Life will cover most medical costs not covered by Medicare. There are some health care services that are benefits under either Medicare or TRICARE, but not both.  For example, Medicare covers some chiropractic services, whereas TRICARE does not.  Conversely TRICARE covers retail pharmacy prescriptions and Medicare does not.  In these circumstances, the beneficiary will remain responsible for the applicable Medicare or TRICARE cost share and deductible. For those TRICARE for Life users who have other health insurance, such as an employer-sponsored health plan, TRICARE will pay after the other health insurance and Medicare.

            “The DOD worked with Medicare to integrate our payment systems, so that the TRICARE payment is done so seamlessly that the individual is hardly aware of it,” said J. Jarrett Clinton, M.D., the DOD’s Acting Assistant Secretary of Defense for Health Affairs. Most Medicare-eligible beneficiaries of the uniformed services will on longer need an individual Medigap policy, he added.

            No TRICARE for Life beneficiary card is necessary to receive care, and no enrollment is required.  However, to be eligible for the expanded TRICARE coverage, uniformed services retirees, eligible family members and survivors, age 65 and older, need to be registered in the Defense Enrollment Eligibility Reporting System (DEERS).  They also must have Medicare Part A, and be enrolled in Part B.

            Anyone with questions about TRICARE for Life should call TRICARE’s toll-free number, 1-888-363-5433.

            Details about the TRICARE for Life Program were recently mailed regionally by TRICARE managed care support contractors to eligible beneficiaries using addresses from DEERS.  Additional information and updates about TRICARE for Life are posted on the TRICARE Web Site at http://www.tricare.osd.mil//ndaa.

TRICARE INFO

            The most comprehensive and up-to-date TRICARE information is available on the TRICARE Web at www.tricare.osc.mil//ndaa.  For those beneficiaries whose questions cannot be answered by the TRICARE Web site, there are new TRICARE toll-free telephone numbers to TRICARE representatives with answers to the following programs:  (1) TRICARE For Life, (2) TRICARE Senior Pharmacy Program and (3) TRICARE Prime Remote for active duty personnel and their family members.  When beneficiaries reach a TRICARE Information Center Rep, they are not disconnected until they have their questions answered, or until they have been connected to another person who can help them.  There are no telephone recordings or directories to sort through.  These numbers are:

            SENIOR PHARMACY PROGRAM  – 1-877-363-6337
            TRICARE FOR LIFE PROGRAM – 1-888-363-5433
            TRICARE PRIME REMOTE - 1-888-363-2273

 TRICARE information is available 24 hours a day on their web site.  Hours of phone operations are:  Monday through Friday – 7:00 am to 11:00 pm, Saturday – 9:00 am to 8:00 pm, and Sunday 10:00 am – 5:30 pm.  All times are Eastern Time.

(Info provided by TRICARE management activity.)

TRICARE SENIOR PHARMACY PROGRAM

            According to Army Colonel William Davies, director DOD Pharmacy Program, the TRICARE Senior Pharmacy Program is a great success.  The response from beneficiaries 65 and older has been overwhelmingly positive.  Among the few difficulties encountered by users were denied claims resulting from erroneous social security numbers (beneficiary’s instead of the sponsor’s) and incorrect info in the claims processor’s database about the beneficiary having other health insurance. In these situations, the DOD’s toll free TRICARE Pharmacy Help Line – 1-877-363-6337 proved to be invaluable.  From 1 April to 28 April, 450,000 prescriptions were processed.  The TRICARE retail networks processed 317,000 and the National Mail Order Pharmacy processed 133,000.

            The Military Treatment Facility (MTF) remains the best value for all users of the TRICARE Pharmacy Program.  Beneficiaries can eliminate out of pocket costs if they have their prescriptions filled at an MTF.