There were significant changes in TRICARE in 2001.
In April of 2001 the TRICARE Senior Pharmacy Program began.
In October of 2001 TRICARE Senior became TRICARE for Life. This is an enrollment program open to retired military and their spouses who are age 65 or older if they are eligible for Medicare Part A and they pay into Medicare Part B.
For retirees under the age of 65 TRICARE can be selected at 3 levels:
Prime
Extra
Standard
NOTE: There are other TRICARE programs, such as TRICARE Plus. Check the website for more in-depth information on these plans and where they are available.
You need to check with the TRICARE representative for the details and costs of each plan. New in 2006 was a TRICARE Standard Newsletter. It is published once a year and will go automatically to those enrolled in TRICARE Standard.
TRICARE for Life
This form of TRICARE appears to be comparable to MEDICARE gap insurance. TRICARE is a second payer and the individual must pay the remaining expenses.
Cost: Medicare Part B premiums will go to DOD and you are not able to enroll in other HMOs. As of 2005 you must be enrolled in MEDICARE part B to participate in TRICARE for Life.
Eligibility: Uniformed Service retirees and family members, age 65 or older enrolled in MEDICARE Part B. (See Annex 6 for update on MEDICARE Part B and MEDICARE Part D)
Service:
For services payable by TRICARE and MEDICARE, TRICARE will be the second payer.
For service payable by TRICARE but not MEDICARE, TRICARE will pay and you pay annual deductible and cost share
For services payable by MEDICARE but not TRICARE, MEDICARE pays as usual, and TRICARE pays nothing.
For services not payable by MEDICARE or TRICARE, you are responsible for the cost.
NOTE: In 2003 a new Medicare Prescription Drug bill was passed. TRICARE for Life has some effect on this new coverage.
TRICARE Pharmacy
One of the big improvements in TRICARE is the new pharmacy services these include prescriptions filled at the following:
Military Treatment Facilities no cost
National Mail Order Pharmacy $3 for generic 90 day supply
$9 for brand name 90 day supply
$22 for a 90 day supply of certain high cost drugs.
Civilian Retail Network Same cost as Mail Order
Civilian Retail Non-Network $9 or 20% of the cost for 30 day supply
In 2005 TRICARE went to a three tier pharmacy system. Certain non-formulary medications were provided at a $22 copay. The number of medications in this category has steadily increased.
Note: In late 2006 Congress rejected increasing TRICARE pharmacy rates for 2007, but DoD already has authority to raise the non-formulary rate to $30.
MEDICARE considers TRICARE as a recognized provider of prescription medications. This means that if a veteran decides to enroll in a private plan in the future (MEDICARE Part D) there is no penalty.
TRICARE has a dental plan, but costs vary with section of the country that you live in. You need to check the details with a TRICARE Dental representative.
A spouse can be enrolled in TRICARE for Life and the retired veteran not enrolled in TRICARE for Life. A veteran is free to use both TRICARE and the VA for healthcare. However, they may be asked to receive their primary care at one location to ensure continuity of care.
TRICARE for Life excluded enrollment in other HMOs. A person needs to carefully look at the pros and cons of this system. TRICARE has guidelines on what it will and will not pay for.
The following are key TRICARE phone numbers (and links if you are reading electronically):
Eligibility (DEERS) 1-800-538-9552
TRICARE Prime Remote 1-888-363-2273
Mail-Order Pharmacy 1-866-363-8667
Retiree Dental Plan 1-888-838-8737
TRICARE Dental Program 1-800-866-8499
TRICARE For Life 1-866-773-0404
Senior Pharm. Program 1-877-363-6337
TRICARE is now in 3 regions each has its own phone number:
West Region: TriWest, 1-888-874-9378, http://www.tricare.osd.mil/west
North Region: HealthNet, 1-877-874 2273, http://www.tricare.osd.mil/north
South Region: Humana Military, 1-800-444-5445, http://www.tricare.osd.mil/south
The link for the main page: http://www.tricare.osd.mil/
In 2004 TRICARE for Life changed its claims processing to one source:
Wisconsin Physicians Service (WPS)
Beneficiaries may call WPS TFL at:
(866) 773-0404 or
TDD (866) 773-0405
For more information go to:
http://www.tricare.osd.mil/faqs/default.aspx; under "Word Search" type in "TRICARE For Life" or under the "Advanced Search" use the drop down menu, and choose category "TRICARE For Life/Dual eligible", subcategory "All" and then hit "GO".
Beneficiaries may also access TRICARE For Life information on the TRICARE Web site at www.tricare.osd.mil/tfl and on the WPS Web site at www.tricare4u.com
TRICARE For Life 1-866-773-0404
TRICARE Website: www.tricare.osd.mil
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Final Note On TRICARE
DEERS = Defense Enrollment Eligibility Reporting System
TRICARE may refuse to pay claims if the individual has not kept their DEERS information up to date.
To update your DEERS information:
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